新生儿骶尾部畸胎瘤的产前诊断与多学科协作模式治疗  

Prenatal diagnosis and multidisciplinary treatment of neonatal sacrococcygeal teratoma

作　　者：田松[1] 朱小春[1] 肖尚杰[1] 李艳 原丽科 葛午平[1] Tian Song;Zhu Xiaocun;Xiao Shangjie;Li Yan;Yuan Like;Ge Wuping(Department of Neonatal Surgery,Municipal Women&Children's Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院新生儿外科,广州511400

出　　处：《临床小儿外科杂志》2022年第9期844-849,共6页Journal of Clinical Pediatric Surgery

基　　金：广东省科技厅科技计划项目(2017ZC0315)。

摘　　要：目的探讨新生儿骶尾部畸胎瘤(sacrococcygeal teratoma,SCT)的产前诊断与多学科协作治疗(multidisciplinary treatment,MDT)方案。方法以2015年4月至2021年1月广东省妇幼保健院新生儿外科接受MDT模式治疗的34例新生儿骶尾部畸胎瘤患者为研究对象。本研究中MDT团队由新生儿外科医生、产前诊断科医生、超声科医生、产科医生、新生儿科医生、病理科医生组成。按照肿瘤长径大小将34例患儿分为巨大畸胎瘤组(肿瘤长径>10 cm,13例),普通畸胎瘤组(肿瘤长径≤10 cm,21例),比较两组性别、孕周、分娩方式、出生体重、住院天数、术后并发症及肿瘤性质方面的差异。结果本组34例中,33例于孕中晚期行产前超声检查,提示骶尾部肿物,经MDT团队诊断为骶尾部畸胎瘤,并讨论制定多学科协作诊治方案;另有1例于产后诊断为骶尾部畸胎瘤。34例均接受手术治疗,术后病理结果提示成熟型畸胎瘤29例(85.3%,29/34),未成熟畸胎瘤5例(14.7%,5/34)。巨大畸胎瘤组和普通畸胎瘤组患儿孕周、分娩方式、出生体重、伤口愈合情况、平均住院天数比较,差异均无统计学意义(P>0.05)。术后并发症主要为:伤口感染3例、伤口裂开5例。34例均治愈出院,随访6个月至3年,无一例复发及明显直肠功能障碍。结论孕中晚期行产前超声检查可以及时、有效地发现胎儿骶尾部畸胎瘤,MDT有利于改善SCT患儿的预后。Objective To explore the prenatal diagnosis and multidisciplinary treatment(MDT)of neonatal sacrococcygeal teratoma(SCT).Methods From April 2015 to January 2021,clinical data were retrospectively reviewed for 35 children of neonatal SCT.The MDT team consisted of neonatal surgeons,prenatal physicians,ultrasonic specialists,obstetricians,neonatologists and pathologists.According to the tumor diameter,34 children were divided into giant teratoma group(tumor diameter>10 cm,13 cases)and ordinary teratoma group(tumor diameter≤10 cm,21 cases).The differences in gender,gestational age,birth type,birth weight,length of hospital stay,postoperative complications and tumor properties were compared between the two groups.Results Thirty-three SCT cases were identified by MDT,and one case was detected after birth.All cases were timely operated.Postoperative pathology revealed mature teratoma(n=29,85.3%)and immature teratoma(n=5,14.7%).There were no significant differences in gestational age,mode of delivery,birth weight,wound healing and average length of hospital stay between the two groups(P>0.05).Wound dehiscence and infection were two major postoperative complications.The post-discharge follow-up period was 6 to 36 mpnths.There was no recurrence or obvious rectal dysfunction.Conclusion Prenatal diagnosis can timely and effectively detect SCT children.And MDT may improve the prognosis of neonatal SCT.

关 键 词：产前诊断 畸胎瘤/外科学 婴儿 新生 跨学科研究 

分 类 号：R722.1[医药卫生—儿科]