侧脑室羊膜腔引流治疗胎儿脑积水一例并文献复习  

Amniotic cavity drainage of lateral ventricle for fetal hydrocephalus: one case report with a literature review

作　　者：张钦 周俏苗 邱雅波 韦勇 李艳 王纯君 凌奕[2] 孙路明[3] 顾硕 Zhang Qin;Zhou Qiaomiao;Qiu Yabo;Wei Yong;Li Yan;Wang Chunjun;Ling Yi;Sun Luming;Gu Shuo(Department of Neurosurgery,Hainan Women&Children's Medical Center,Haikou 570206,China;Department of Gynecology&Obstetrics,First Affiliated Hospital,Hainan Medical College,Haikou 570102,China;Department of Fetal Medicine,Shanghai First Maternity&Infant Hospital,Shanghai 200040,China)

机构地区：[1]海南省妇女儿童医学中心神经外科,海口570206 [2]海南医学院第一附属医院妇产科,海口570102 [3]上海市第一妇婴保健院胎儿医学科,200040

出　　处：《中华小儿外科杂志》2021年第9期813-817,共5页Chinese Journal of Pediatric Surgery

基　　金：2020海南省重点研发计划项目(ZDYF2020225)。

摘　　要：目的探索胎儿脑积水的宫内微创外科治疗方法,回顾相关文献了解宫内干预的预后情况,为胎儿脑积水的产前干预提供证据支持。方法海南省妇女儿童医学中心神经外科2019年10月为一例孕26周的重度脑积水胎儿行宫内手术,在超声引导下经母亲腹壁穿刺胎儿侧脑室置入双螺旋引流管,行胎儿侧脑室羊膜腔引流。以"胎儿、脑积水、引流"为关键词检索1980年1月至2020年1月的PubMed、中国知网的数据库关于胎儿脑积水宫内干预的文献资料并行文献复习,对干预后的胎儿预后进行分析。结果本例手术顺利,术后胎儿定期行B型超声和磁共振成像随访发现,胎儿侧脑室由术前的左侧脑室宽度26 mm和右侧脑室宽度31 mm减小为术后的11.7 mm和5.5 mm,脑实质厚度由术前左侧2.4 mm和右侧2.8 mm恢复到正常厚度的14.6 mm和11.7 mm。随访过程中,全外显子组高通量测序检测报告,患儿系X-性连锁相关脑积水,家属同意并要求给予引产。文献检索到相关文献5篇359例脑积水患儿,其中导水管狭窄是胎儿脑积水的常见病因,手术并发症多见分流管移位、宫内死亡等。统计随访结果,重度智力障碍61例(16.99%),中度83例(23.12%),轻度135例(38.68%)。结论产前对胎儿脑积水进行精准产前诊断指导胎儿侧脑室羊膜腔引流非常必要,有助于提高宫内干预后胎儿生后生存质量,降低不良结局的发生,也有助于下一胎的生育指导。Objective To explore the efficacy of mini-invasive surgery for fetal hydrocephalus through intrauterine procedures and review the relevant literature to understand the prognosis and benefit of intrauterine intervention.Methods An intrauterine operation was performed for a fetus with severe hydrocephalus at a gestational age of 26 weeks.Under ultrasonic guidance and local anesthesia,a double spiral drainage tube was inserted into lateral ventricle of the fetus through maternal abdominal wall.And amniotic cavity drainage was performed for lateral ventricle of the fetus.The literatures reporting about intrauterine intervention of fetal,hydrocephalus and drainage were retrieved from the databases of PubMed and CNKI from January 1980 to January 2020.And fetal prognosis after intervention was analyzed.Results The operation procedure was successful.Regular postoperative fetal follow-ups of type B ultrasound and magnetic resonance imaging were performed.The width of fetal lateral ventricle decreased from 26 mm of left ventricle and 31 mm of right ventricle preoperatively to 11.7 mm and 5.5 mm postoperatively.Cerebral parenchymal thickness recovered from 2.4 mm at left side and 2.8 mm at right side to 14.6 mm and 11.7 mm at normal side.During follow-ups,whole exon group high-throughput sequencing revealed that the child belonged to X-linked hydrocephalus and the family agreed to a labor induction.A total of 359 cases of hydrocephalus were retrieved from 5 literatures.Aqueduct stenosis was a common cause of hydrocephalus and surgical complications included shunt displacement and intrauterine death.The follow-up results revealed severe mental retardation(n=61,16.99%),moderate mental retardation(n=83,23.12%)and mild mental retardation(n=135,38.68%).Conclusions Accurate prenatal diagnosis of fetal hydrocephalus is vital for guiding the amniotic cavity drainage of fetal lateral ventricle.It helps to improve the fetal quality-of-life after intrauterine intervention,lower the occurrence of adverse outcomes and contribute to the

关 键 词：脑积水 胎儿 引流 

分 类 号：R726.5[医药卫生—儿科]