程序化管理流程应用于产前诊断梨状窝瘘病例的效果:八例分析  

Programmed management in prenatal diagnosed pyriform sinus fistula:analysis of eight cases

作　　者：曾信豪 何秋明 钟微 王哲 颜斌 关茜思 谢晓丽 余家康 Zeng Xinhao;He Qiuming;Zhong Wei;Wang Zhe;Yan Bin;Guan Xisi;Xie Xiaoli;Yu Jiakang(Department of Pediatric Surgery,the Affiliated Hospital of Southwest Medical University Sichuan Clinical Research Center for Birth Defects,Luzhou 646000,China;Department of Neonatal Surgery Intensive Care Unit,Guangzhou Women and Children's Medical Center,Guangzhou 510623,China)

机构地区：[1]西南医科大学附属医院儿外科,四川省出生缺陷临床医学研究中心,泸州646000 [2]广州市妇女儿童医疗中心新生儿外科重症监护室,510623

出　　处：《中华围产医学杂志》2021年第10期734-740,共7页Chinese Journal of Perinatal Medicine

基　　金：西南医科大学自然科学项目(2020ZRQNB005);2019年度广东省科技创新战略专项基金(学科重点实验室项目)(2019B030301004)。

摘　　要：目的总结程序化管理流程在产前诊断为梨状窝瘘(pyriform sinus fistula,PSF)患儿的应用效果。方法广州市妇女儿童医疗中心于2016年1月制定了产前诊断PSF的程序化管理流程,即产前超声检查发现胎儿颈部囊肿后进一步完善MRI检查确诊为PSF,并对气道受压程度进行评估,生后即留置胃管,禁止经口进食,完善CT/MRI及相关术前检查后限期行手术治疗。回顾性纳入2016年1月至2020年10月按该流程进行管理的8例PSF患儿。总结产前诊断、生后治疗及随访结果。采用描述性统计分析。结果(1)产前:8例患儿首次产前超声检出颈部囊肿的孕周为(27.1±4.1)周,所有囊肿均位于左侧,产前MRI提示囊肿最大径为(32.0±12.2)mm,气管推移指数为(10.9±2.8)mm。(2)生后:8例患儿中男5例,女3例;出生胎龄为(38.0±0.9)周,出生体重为(3020±459)g。1例因宫内气管推移指数为17.4 mm,行产时气管插管。患儿生后均禁止经口进食。生后行CT/MRI检查中位日龄为2.5 d(1~8 d),囊肿最大径为(40.6±6.9)mm,囊内均可见气泡影。术前感染指标不高,手术日龄为(8.6±2.3)d,术中均未见囊肿感染,均完整摘除囊肿及高位结扎瘘管,手术用时为(95.0±19.6)min,术后中位机械通气时间为5 h(3~71 h),术后住院时间(8.8±1.0)d,无一例出现声嘶等并发症。门诊结合电话随访4~58个月,未见复发病例。结论程序化管理流程能够为产前诊断PSF病例的生后诊治提供正确的指导,有助于获得满意的治疗效果。Objective To evaluate the clinical effect of applying the programmed management procedure in the prenatal diagnosis of pyriform sinus fistula(PSF).Methods This study retrospectively enrolled eight fetuses with PSF who were managed according to the programmed management procedure for prenatal diagnosis of PSF,which was established in January 2016,in Guangzhou Women's and Children's Medical Center from January 2016 to October 2020.The procedure consisted of the detection of fetal neck cysts by prenatal ultrasound followed by further confirmation by MRI,evaluation of the degree of airway compression,indwelling gastric tube after birth,no oral feeding,complement of CT/MRI,and surgical treatment within a limited time after necessary preoperative examination.The prenatal diagnosis,postnatal treatment,and follow-up were summarized using descriptive analysis.Results(1)Prenatal:The gestational age at the first detection of cervical cysts by prenatal ultrasound was(27.1±4.1)weeks and all the cysts were located on the left side.Prenatal MRI indicated that the largest cysts was(32.0±12.2)mm in diameter,and the tracheal transit index was(10.9±2.8)mm.(2)After birth:Among the eight children,five were males and three were females,with the gestational age of(38.0±0.9)weeks and birth weight of(3020±459)g.One case was intubated during labor due to a intrauterine tracheal transposition index of 17.4 mm.All infants were not allowed for oral feeding.The median age at CT/MRI examination was 2.5 d(1-8 d),which revealed that the maximum diameter of the cysts was(40.6±6.9)mm and visible air bubbles in all cysts.The infection index before operation was not high and the age at operation was(8.6±2.3)d.All cysts were completely removed and the PSFs were ligated at a higher position,with the average operative duration of(95.0±19.6)min,and the postoperative duration of mechanical ventilation and hospitalization of 5 h(3-71 h)and(8.8±1.0)d,respectively.No complications such as hoarseness were reported.During the follow-up of 4 to 58 mon

关 键 词：瘘 梨状隐窝 产前诊断 疾病管理 

分 类 号：R714.5[医药卫生—妇产科学]