产前超声诊断胎儿腹腔实性占位的生后转归及预后  

Postnatal outcomes and prognosis of fetal intra-abdominal solid masses diagnosed by prenatal ultrasound

作　　者：杨少波[1] 黄燕炳 董岿然[1] 孙路明 熊钰 沈淳[1] Yang Shaobo;Huang Yanbing;Dong Kuiran;Sun Luming;Xiong Yu;Shen Chun(Department of Pediatric Surgery,Children's Hospital of Fudan University,National Children's Medical Center,Shanghai 201102,China;Department of Obstetrics,Obstetrics and Gynecology Hospital Affiliated to Fudan University,Shanghai 200090,China)

机构地区：[1]国家儿童医学中心(上海)复旦大学附属儿科医院外科,上海201102 [2]同济大学附属第一妇婴保健院胎儿医学科&产前诊断中心,上海201204 [3]复旦大学附属妇产科医院产科,上海200090

出　　处：《中华围产医学杂志》2022年第5期355-359,共5页Chinese Journal of Perinatal Medicine

基　　金：上海市“医苑新星”青年医学人才培养资助计划(沪卫人事[2019]72号)。

摘　　要：目的探讨产前超声诊断胎儿腹腔实性占位的生后转归及预后。方法回顾性纳入2015年3月至2021年3月在复旦大学附属儿科医院新生儿外科收治的30例产前超声诊断为胎儿腹腔实性占位病例,分析这些病例的产前超声表现、生后治疗、转归及预后情况。结果30例患儿中,男18例,女12例,首次产前超声发现腹腔实性占位中位孕周为36周(28~39周)。生后确诊为肝脏来源16例(肝血管瘤14例、肝母细胞瘤2例),腹膜后来源13例(神经母细胞瘤6例、畸胎瘤4例、肾上腺血肿1例、肾上腺皮质腺瘤1例、肾毛细血管增生症1例),胃肠道来源畸胎瘤1例。产前超声诊断腹腔实性占位起源部位的准确率为73%(22/30),其中肝脏及肝外来源诊断准确率分别为13/16和9/14;良性肿瘤占73%(22/30),恶性肿瘤(肝母细胞瘤2例和神经母细胞瘤6例)占27%(8/30)。15例良性肿瘤患儿(肝血管瘤及肾上腺血肿)生后密切随访或药物治疗,其中13例明显缩小或消退,另2例肝血管瘤稳定;14例患儿(神经母细胞瘤6例、肝母细胞瘤1例、畸胎瘤5例、肾上腺皮质腺瘤1例和肾毛细血管增生症1例)经手术治疗或术后联合化疗预后良好;1例肝母细胞瘤患儿新生儿期家属即放弃治疗后死亡。总体存活率为97%(29/30),中位随访时间24个月(4~60个月)。结论对于胎儿腹腔实性占位起源部位,产前超声具有较高准确率,生后密切随诊及时处理,转归及预后良好。Objective To investigate the clinical outcomes and prognosis of children who were prenatally diagnosed with solid space-occupying abdominal lesions by ultrasound.Methods This study retrospectively enrolled 30 children with solid space-occupying abdominal lesions that were indicated by prenatal ultrasound at Children's Hospital of Fudan University from March 2015 to March 2021.Prenatal ultrasound findings,postnatal treatment,clinical outcomes,and prognosis were analyzed.Results These subjects included 18 male and 12 female infants,with the median gestational age at the first sonographic diagnosis of 36 weeks(28 to 39 weeks).The intra-abdominal solid masses were postnatally confirmed to be located in liver,retroperitoneum,and gastrointestinal tract,which were hepatic hemangioma(n=14),hepatoblastoma(n=2),neuroblastoma(n=6),abdominal teratoma(n=4),adrenal hematoma(n=1),adrenocortical adenoma(n=1),hyperplasia of renal capillary(n=1),and gastrointestinal teratoma(n=1).The accuracy of prenatal ultrasound in detecting the location of masses was 73%(22/30)and which was 13/16 in detecting masses from liver and 9/14 in that outside the liver.Among the 30 cases,73%(22/30)were benign tumors,and 27%(8/30)were malignant tumors(hepatoblastoma in two cases and neuroblastoma in six cases).Among 15 patients with benign tumors(hepatic hemangioma and adrenal hematoma)who received close follow-up or drug therapy,tumor/lesion regression occurred in 13 cases and the other two were observed with stable hepatic hemangiomas.Fourteen patients,including six with neuroblastoma,two with hepatoblastoma,five with teratoma,one with adrenocortical adenoma,and one with hyperplasia of renal capillary,had good prognosis after primary tumor resection or combined with postoperative chemotherapy.One hepatoblastoma case died after withdrawing treatment.The overall survival rate was 97%(29/30)with a median follow-up time of 24 months(4 to 60 months).Conclusions Prenatal ultrasound has high accuracy in identifying the anatomic region of fetal solid space-o

关 键 词：腹部肿瘤 超声检查 产前 胎儿疾病 预后 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]