胎儿镜激光凝固术治疗胎盘绒毛膜血管瘤3例及文献复习  

Fetoscopic laser coagulation for placental chorioangioma:a report of three cases and literature review

作　　者：徐晓楠 魏瑗[1] 张舒沁 郭晓玥[1] 王学举[1] 原鹏波[1] 赵扬玉[1] Xiaonan Xu;Yuan Wei;Shuqin Zhang;Xiaoyue Guo;Xueju Wang;Pengbo Yuan;Yangyu Zhao(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191

出　　处：《中华围产医学杂志》2023年第4期298-304,共7页Chinese Journal of Perinatal Medicine

基　　金：首都临床诊疗技术研究及转化应用项目(Z201100005520074)。

摘　　要：目的总结胎儿镜激光凝固术治疗胎盘绒毛膜血管瘤(placental chorioangioma,CA)的临床效果。方法回顾性分析北京大学第三医院2018年1月至2020年12月收治的3例胎儿镜激光凝固术治疗的巨大CA孕妇的临床资料,并检索万方数据库、中国知网和PubMed自建库至2022年9月发表的关于胎儿镜激光凝固术治疗CA的病例。总结胎儿镜激光凝固术治疗CA的特点和干预效果。采用描述性统计分析。结果文献检索共10例病例,加之本院收治的3例共13例,孕妇年龄为(30.3±6.2)岁;12例为单胎妊娠,1例为双胎妊娠(单绒毛膜双羊膜囊)。除外文献未提及相关数据的病例外,诊断CA的孕周(n=7)为(19.9±4.5)周,CA最大径(n=6)为(6.1±4.1)cm。行胎儿镜激光凝固术治疗的孕周(n=13)为(25.0±2.0)周,术时CA最大径(n=9)为(7.6±2.8)cm。治疗后,3例羊水量降至正常,1例羊水量降低但仍高于正常上限,4例CA最大径缩小,1例胎儿大脑中动脉收缩期血流峰速降至正常,2例胎儿心功能恢复正常,1例胎儿水肿缓解。本院3例孕妇治疗后CA血供均消失。13例孕妇中2例发生胎死宫内;另11例孕妇活产分娩,分娩孕周为(36.6±3.8)周,其中剖宫产5例,阴道分娩4例,2例文献未提及分娩方式;11例孕妇活产分娩的12例新生儿均存活,出生体重为(2712±1023)g。提及存活新生儿性别的5例均为女婴,其中2例为单绒毛膜双羊膜囊双胎。本院3例CA孕妇的新生儿随访至生后6个月未见异常,其余新生儿文献报道范围内(生后10 d~6个月)未见异常。结论胎儿镜激光凝固术可能有助于减小CA,缓解并发症,改善妊娠结局。Objective To evaluate the outcome of laser coagulation under fetoscope for placental chorioangioma(CA).Methods The clinical data of three pregnant women with giant CA treated by laser coagulation under fetoscope in Peking University Third Hospital from January 2018 to December 2020 were analyzed retrospectively.Relevant articles up to September 2022 were retrieved from Wanfang Database,China National Knowledge Infrastructure and PubMed,and the clinical data of all patients were retrospectively summarized.Indications and intervention effects of fetoscopic laser therapy were analyzed.Descriptive statistics was used to describe the data.Results Thirteen patients were involved in this study including 10 cases retrieved from the databases.The average age of the pregnant women was(30.3±6.2)years old.There were 12 cases of single pregnancy and one case of twin pregnancy(monochorionic diamnionic twin pregnancy).Except for cases for which data were not available in the literatures,at the diagnosis of CA,the average gestational age was(19.9±4.5)weeks(n=7)and the average maximum diameter of the mass was(6.1±4.1)cm(n=6).The patients underwent fetoscopic laser therapy at an average gestational age of(25.0±2.0)weeks(n=13)with the average maximum tumor diameter of(7.6±2.8)cm(n=9).After treatment,the amniotic fluid volume of three cases decreased to normal.In one case,the amniotic fluid volume decreased but was still above the upper limit of the normal range.Moreover,the maximum tumor diameter decreased in four cases;the peak systolic velocity of the fetal middle cerebral artery decreased to normal in one case;fetal heart function became normal in two cases and fetal edema was relieved in one case.Among the three patients treated in our hospital,the blood supply of CA disappeared after treatment.Intrauterine fetal death occurred in two cases.The other 11 patients gave birth to live babies at the gestational age of(36.6±3.8)weeks with five through cesarean section(5/11),five through vaginal delivery(4/11)and two not reporte

关 键 词：血管瘤 胎盘疾病 胎儿镜 激光凝固术 胎儿期疗法 

分 类 号：R714.5[医药卫生—妇产科学]