胎儿镜用于羊膜带综合征宫内诊断和治疗7例临床分析及文献复习  

Fetoscopy for intrauterine diagnosis and treatment of amniotic band syndrome:a clinical analysis of 7 cases and literature review

作　　者：李娇 李根霞[1] 董理 冯帆[2] 楚书慧 杨宁 谢明坤[1] 程春花[1] 孙柳桥 Li Jiao;Li Genxia;Dong Li;Feng Fan;Chu Shuhui;Yang Ning;Xie Mingkun;Cheng Chunhua;Sun Liuqiao(Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ultrasound,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;School of Public Health,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第三附属医院产科,郑州450052 [2]郑州大学第三附属医院超声科,郑州450052 [3]郑州大学公共卫生学院,郑州450001

出　　处：《中华妇产科杂志》2024年第7期530-539,共10页Chinese Journal of Obstetrics and Gynecology

基　　金：河南省医学科技攻关计划(LHGJ20220536)。

摘　　要：目的探讨胎儿镜在羊膜带综合征(ABS)宫内诊断和治疗中的临床应用价值。方法回顾性分析2020年12月至2023年8月于郑州大学第三附属医院行宫内胎儿镜干预的7例ABS胎儿的临床资料。在中国知网、万方、PubMed数据库检索胎儿镜治疗ABS的文献,提取临床资料,总结胎儿镜手术治疗ABS的特点和干预效果。结果(1)胎儿镜干预前评估:7例ABS胎儿的诊断孕周为(19.8±4.4)周,干预孕周为(22.2±2.8)周,胎儿镜干预指征包括:脐带受累(3例),肢体羊膜带出现缩窄环(2例),指端显示不清(3例)。(2)妊娠结局:7例ABS胎儿中,4例因胎儿镜检查发现严重宫内截肢或截指选择优生引产;3例行胎儿镜羊膜带松解术,其中1例术后2周发生胎儿宫内死亡(IUFD),2例预后良好。(3)文献复习结果:纳入文献17篇(共37例ABS胎儿),加上本院实施胎儿镜手术治疗的3例,共纳入40例胎儿镜羊膜带松解术,手术指征包括肢体羊膜带伴缩窄环形成、脐带受累,手术成功率82%(33/40),33例手术成功胎儿累及的37例次肢体受累中,78%(29/37)的受累肢体保留了良好的功能。33例手术成功胎儿中,胎膜早破是最主要的并发症,发生率为48%(16/33),手术至胎膜早破的时间间隔为(6.1±5.1)周,手术至分娩的时间间隔(10.5±4.1)周,分娩孕周为(33.7±3.6)周;按手术路径使用穿刺套管(Trocar)数目,分为单Trocar组(27例)与双Trocar组(13例),成功率分别为78%(21/27)、12/13,两组比较,差异无统计学意义(χ^(2)=0.474,P=0.491);手术成功者的分娩孕周分别为(32.7±3.4)、(35.4±3.2)周,两组比较,差异有统计学意义(t=-2.185,P<0.05),两组的手术成功率、胎膜早破发生率、手术至胎膜早破时间间隔、手术至分娩时间间隔、早产率分别比较,差异均无统计学意义(P均>0.05)。结论胎儿镜可用于ABS的宫内诊断和治疗,胎儿镜羊膜带松解术可能是治疗ABS的有效方法,有助于保留肢体功能、防止宫内截肢和IUFD�Objective To summarize the clinical value of fetoscopy in the prenatal diagnosis and treatment of amniotic band syndrome(ABS).Methods A retrospective analysis was conducted on the clinical data of seven ABS fetuses who underwent prenatal fetoscopic intervention at the Third Affiliated Hospital of Zhengzhou University from December 2020 to August 2023.Literatures related to fetoscopic treatment of ABS were searched in databases including China National Knowledge Infrastructure,Wanfang Data,and PubMed.Clinical data were extracted and the characteristics and intervention effects of fetoscopic surgery in the treatment of ABS were summarized.Results(1)Preoperative evaluation:the gestational age at diagnosis for the seven ABS fetuses was(19.8±4.4)weeks,and the gestational age at fetoscopic intervention was(22.2±2.8)weeks.The indications for fetoscopic intervention included umbilical cord involvement(3 cases),limb amniotic band with circular constriction(2 cases),and unclear visualization of digits(3 cases).(2)Pregnancy outcomes:among the seven ABS fetuses,four cases underwent selective termination of pregnancy due to severe intrauterine limb amputation,and three cases underwent fetoscopic lysis of amniotic bands.Among the latter three cases,one case experienced intrauterine fetal death(IUFD)two weeks after the procedure,and two cases had good postoperative outcomes.(3)Literature review:a total of 40 cases,including 37 cases from 17 articles and three cases from our institution,were included in the analysis.The indications for fetoscopic surgery included limb amniotic band with circular constriction and involvement of the umbilical cord.The success rate of the surgery was 82%(33/40),and 78%(29/37)of the affected limbs retained good functionality.Premature rupture of membranes was the most common complication,with an incidence rate of 48%(16/33).The average interval from the surgery to membrane rupture was(6.1±5.1)weeks,and the average interval from the surgery to delivery was(10.5±4.1)weeks,with an average gestation

关 键 词：羊膜带综合征 胎儿镜检查 产前诊断 胎儿期疗法 

分 类 号：R714.5[医药卫生—妇产科学]