射频消融术治疗胎儿隔离肺伴水肿和胸腔积液一例  

Intrafetal Radiofrequency Ablation for Fetal Pulmonary Sequestration with Edema and Pleural Effusion:A Case Report

作　　者：王秋明[1] 王睿丽[2] 武海英[1] 王莉[1] WANG Qiu-ming;WANG Rui-li;WU Hai-ying;WANG Li(Department of Obstetrics,Henan Provincial People's Hospital,Zhengzhou 450003,China;Department of Ultrasound,Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院产科,郑州450003 [2]河南省人民医院超声科,郑州450003

出　　处：《国际妇产科学杂志》2024年第4期477-480,共4页Journal of International Obstetrics and Gynecology

摘　　要：报告1例孕24+6周孕妇因四维彩色超声提示胎儿左侧胸腔55 mm×50 mm×45 mm均质高回声,瘤头比2.63,腹腔积液,全身皮肤水肿,心脏受压向右移位,提示胎儿隔离肺,经充分沟通及多学科会诊,行超声引导下胎儿隔离肺射频消融术。术后定期复查彩色超声,胎儿情况逐渐好转。术后46 d彩色超声提示瘤头比0.95,无腹腔积液及皮肤水肿。术后49 d(孕32周)胎膜早破,急诊至当地县医院,出现规律宫缩,因臀位急诊行剖宫产术,新生儿出生20 min后死亡。该病例手术效果理想,但新生儿未能存活,考虑与孕周较小、合并隔离肺、地塞米松未能用够疗程等多种因素有关。射频消融术是治疗瘤头比大、伴有腹腔积液隔离肺的有效方法,但仍需进一步研究证实其安全性,也应该加强该类患者术后的管理。A case of a pregnant woman at 24+6weeks of pregnancy was reported.Four dimensional color ultrasound showed homogeneous hyperechogenicity of 55 mm×50 mm×45 mm in the left chest cavity of the fetus,with a tumor to head ratio of 2.63,abdominal fluid accumulation,systemic skin edema,and cardiac compression and rightward displacement.The homogeneous hyperechogenicity is fetal pulmonary sequestration.After sufficient communication and multidisciplinary consultation,ultrasound guided fetal pulmonary sequestration radiofrequency ablation was performed.Regular follow-up color ultrasound was performed after surgery,and the fetal condition gradually improved.After 46 days of surgery,color ultrasound showed a tumor to head ratio of 0.95 and no abdominal fluid or skin edema.49 days after surgery(32 weeks of pregnancy),premature rupture of membranes occurred,and the patient was rushed to the local county hospital for emergency treatment.Regular uterine contractions occurred,and a cesarean section was performed due to emergency hip position.The newborn died20 minutes after birth.The surgical effect of this case was ideal,but the newborn did not survive,which may be related to various factors such as small gestational week,concomitant with fetal pulmonary sequestration,and insufficient treatment with dexamethasone.Radiofrequency ablation is an effective treatment for large tumor to head ratios and with abdominal fluid,but further research is needed to confirm its safety,and postoperative management of such patients should also be strengthened.

关 键 词：支气管肺隔离症 胎儿 超声检查 产前 射频消融术 宫内治疗 

分 类 号：R714.5[医药卫生—妇产科学]