胎儿肝内静脉输血术治疗胎儿贫血的可行性及安全性评估  

Feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia

作　　者：杨颖俊 卫星 邹刚 周奋翮 孙路明 Yang Yingjun;Wei Xing;Zou Gang;Zhou Fenhe;Sun Luming(Fetal Medicine Unit and Prenatal Diagnosis Center,Shanghai First Maternity and Infant Hospital,Tongji University,Shanghai 201204,China)

机构地区：[1]同济大学附属第一妇婴保健院胎儿医学科暨产前诊断中心,上海201204

出　　处：《中华妇产科杂志》2021年第4期244-250,共7页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划(2018YFC1002900);国家自然科学基金(82071656);上海申康医院发展中心临床科技创新项目(SHDC12016117)。

摘　　要：目的探讨胎儿肝内静脉输血术在胎儿贫血宫内输血中的可行性及安全性。方法对2010年1月至2019年12月在同济大学附属第一妇婴保健院诊治及分娩的胎儿贫血患儿的临床资料进行回顾性分析,将治疗过程中单一输血途径的胎儿按输血途径的不同,分为肝内静脉输血组和脐静脉输血组,比较两组胎儿结局及操作相关并发症的发生情况。结果48例贫血胎儿共行宫内输血术97例次,其中肝内静脉输血组16例(31例次),脐静脉输血组32例(66例次)。两组孕妇的年龄、分娩史等一般情况及首次输血前胎儿水肿比例分别比较,差异均无统计学意义(P均>0.05)。肝内静脉输血组后壁或侧壁胎盘占14/16,明显高于脐静脉输血组的78%(25/32,P<0.01)。肝内静脉输血组和脐静脉输血组的活产率分别为13/16和75%(24/32),两组比较,差异无统计学意义(P>0.05)。肝内静脉输血组输血术前胎儿水肿比例显著高于脐静脉输血组[分别为55%(17/31)和24%(16/66),P<0.05]。肝内静脉输血组和脐静脉输血组的穿刺成功率均为100%。脐静脉输血组的穿刺针滑脱率(5%,3/66)、一过性胎心率异常(11%,7/66)的发生率均高于肝内静脉输血组[分别为0和3%(1/31)],但两组分别比较,差异均无统计学意义(P均>0.05)。两组均无术后24 h内胎儿丢失、术后7 d内胎膜早破、感染及紧急剖宫产术等其他操作相关并发症的发生。结论胎儿肝内静脉输血术对于治疗胎儿贫血是一种安全可行的方法,但对术者穿刺技术及胎儿体位要求相对较高,建议在有经验的胎儿治疗中心进行。Objective To investigate the feasibility and safety of fetal intravascular transfusion via the intrahepatic vein in the treatment of fetal anemia.Methods This was a retrospective analysis of all fetuses requiring intrauterine transfusion(IUT)in the Shanghai First Maternity and Infant Hospital between January 2010 and December 2019.According to the different ways of IUT,they were divided into intrahepatic venous transfusion group and umbilical venous transfusion group,fetal outcomes and the incidence of procedure-related complications between the two groups were compared.Results A total of 97 IUTs were performed on 48 fetuses.Among them,16 cases were performed in the intrahepatic vein(31 transfusions),32 cases were performed in the cord of the umbilical vein(66 transfusions).There were no significant differences between the two groups in age,labor history and the proportion of fetal hydrops before the first transfusion.In the intrahepatic venous transfusion group,the posterior placenta was 14/16,which was significantly higher than 78%(25/32)in the umbilical venous transfusion group(P<0.01).The live-birth rates of the two groups were 13/16 and 75%(24/32).There was no significant difference between the two groups(P>0.05).Before intrahepatic venous transfusion,the proportion of fetal hydrops was significantly higher than that of umbilical venous transfusion[55%(17/31)vs 24%(16/66),P<0.05].Puncture success rate of intrahepatic venous transfusion and umbilical venous transfusion were both 100%.In the umbilical venous transfasion group,the incidence of needle slippage(5%,3/66)and the abnormality of fetal heart rate(11%,7/66)were higher than those in the intrahepatic venous transfasion group[0 and 3%(1/31)],but there were no significant differences between the two groups(all P>0.05).There were no cases of fetal loss within 24 hours,premature rupture of membranes,infection within 7 days and emergency cesarean section after IUT in both groups.Conclusions Fetal intravascular transfusion via the intrahepatic vein is safe and

关 键 词：贫血 胎儿疾病 输血 子宫内 肝静脉 可行性研究 

分 类 号：R714.5[医药卫生—妇产科学]