胎儿大动脉转位的围生期管理及手术治疗研究  

Perinatal management and surgical treatment for transposition of the great arteries

作　　者：王正平[1] 薛梦玲 王玉慧 张泽伟[2] WANG Zhengping;XUE Mengling;WANG Yuhui(Department of Obstetrics,Women’s Hospital,School of Medicine,Zhejiang University,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院产科,杭州310006 [2]浙江大学医学院附属儿童医院心脏外科

出　　处：《浙江医学》2020年第10期989-994,I0003,共7页Zhejiang Medical Journal

摘　　要：目的增加对胎儿大动脉转位(TGA)的认识,加强各时期的管理,同时了解TGA的手术时机及预后,为围生期合理处置胎儿TGA提供临床依据。方法选取2006年至2018年在浙江大学医学院附属妇产科医院诊断为胎儿TGA的孕妇168例,收集孕妇年龄、诊断孕周、影像学检查结果、胎儿染色体检查结果、分娩方式、分娩孕周、胎儿出生体重、新生儿娩出后一般情况、处理措施、手术时机、预后等资料,对相关数据进行归纳整理和分析。结果85.2%(75/88)的TGA在孕20~26周行胎儿超声检查时发现。72.6%(122/168)合并1个或多个心脏或其他部位畸形。46例孕妇随访至胎儿娩出,分娩孕周为(37.63±2.45)周,分娩方式:顺产23例,剖宫产21例,产钳助产2例。胎儿出生体重(3082.1±674.9)g,多数在同孕周出生胎儿体重的第10到第90百分位数之间。新生儿产后会出现不同程度的低氧血症并接受相应的处理。在接受手术治疗的31例患儿中,出生距手术的时间为出生当天~1个月不等,室间隔完整型和室间隔缺损型患儿分别为7(6,10)和8(4,26)d,但两者比较差异无统计学意义(P=0.215)。在访的患儿中,22例目前恢复良好。结论TGA胎儿若未合并其他复杂心脏畸形或其他部位异常,孕妇可考虑继续妊娠。若无阴道分娩禁忌可尝试阴道分娩,且无需提前催产。胎儿娩出后的处理以及手术时机应遵循个体化原则,手术治疗大多预后良好。Objective To review the perinatal management and surgical treatment for transposition of the great arteries(TGA).Methods The clinical data of 168 pregnant women with fetus diagnosed as TGA were enrolled from 2006 to 2018 in the Department of Obstetrics,Women’s Hospital School of Medicine Zhejiang University.The gestational age of diagnosis,result of chromosome examination,the gestational age of termination of pregnancy,delivery mode,fetal condition after delivery and their management,operative timing and the prognosis were analyzed.Results In this study,85.2%(75/88)of the cases were detected by fetal ultrasound at 20-26 weeks of gestation,and most of them were advised to continue pregnancy if there were no complex malformations;72.6%(122/168)were associated with one or more malformations of heart or other organs.46 pregnant women were followed up till childbirth,the average gestational weeks of delivery:(37.63±2.45)weeks;delivery mode:50.0%(23/46)was vaginal birth,45.7%(21/46)was cesarean section and 4.3%(2/46)was forceps delivery.Average birth weight of the fetus:(3082.1±674.9)g.Various degree of hypoxemia occurred after delivery,and different treatments were given based on symptoms.Among 46 infants,31(67.4%)received surgical treatment,and the timing of surgery ranged from d 0 to 1 month postpartum,with a median of 7 days.For children with intact ventricular septum(TGA-IVS)and ventricular septum defect(TGA-VSD),the median operation timing was 7(6,10)d and 8(4,26)d respectively(P=0.215).22 survival infants were followed up,all did well after surgery.Conclusion Transposition of the great arteries can be detected by ultrasound in the second trimester.If there is no other complicated complex abnormalities,pregnancy can be continued.The treatment of TGA after delivery and the timing of operation should be individualized and the infants generally have good prognosis after surgical treatment.

关 键 词：大动脉转位 诊断 管理 手术治疗 预后 

分 类 号：R714.7[医药卫生—妇产科学]