胎儿骶尾部畸胎瘤宫内治疗进展  

Advancements in intrauterine treatment of fetal sacrococcygeal teratoma

作　　者：邹庆国 刘闪闪 卢丹萍 张红芸[2] 朱江 Zou Qingguo;Liu Shanshan;Lu Danping;Zhang Hongyun;Zhu Jiang(Department of Ultrasound,Huzhou Central Hospital,Huzhou Hospital,Zhejiang University School of Medicine,Huzhou 313000,China;Department of Ultrasound Women,s Hospital,Zhejiang University School of Medicine,Hangzhou 310058,China)

机构地区：[1]湖州市中心医院、浙江大学医学院附属湖州医院超声科,湖州313000 [2]浙江大学医学院附属妇产科医院超声科,杭州310058

出　　处：《中华超声影像学杂志》2025年第1期85-89,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金项目(82272004,81974470);浙江省自然科学基金重点项目(LZ22H180001)。

摘　　要：胎儿骶尾部畸胎瘤是少见疾病,但产前发现的胎儿骶尾部畸胎瘤胎儿预后不佳,死亡率为13%~50%。其死亡原因主要为胎儿水肿及高排出量性心力衰竭,部分死亡原因包括肿瘤破裂、出血、早产及难产,或恶性畸胎瘤侵蚀周围组织。当肿瘤体积较大,尤其是血供丰富或生长迅速时应考虑行宫内治疗,以阻止动静脉分流,减灭肿瘤,以期逆转胎儿心力衰竭和水肿,让胎儿安全生长到出生可存活周,在剖宫产或自然分娩后再行二次手术彻底切除肿瘤。目前,宫内治疗方案主要有5种:①超声引导下囊性畸胎瘤穿刺引流,包括单次或多次穿刺抽液,宫内持续引流,产前穿刺抽液;②超声引导下酒精硬化治疗;③开放性胎儿手术;④激光消融,包括胎儿镜引导下消融畸胎瘤滋养血管,超声引导下激光消融;⑤超声引导下射频消融。目前根据文献报道,对于含有实性成分畸胎瘤的微创治疗,后两种宫内治疗方案效果较好,逐渐成为主流方案。Fetal sacrococcygeal teratoma(SCT)is a rare condition,but the prognosis of fetuses diagnosed with SCT prenatally is generally poor,with a mortality rate of 13%to 50%.The primary causes of death include fetal hydrops and high‒output heart failure,while other causes include tumor rupture,hemorrhage,preterm labor,dystocia,or malignant teratoma invasion of surrounding tissues.For large tumors,especially those with rich blood supply or rapid growth,intrauterine treatment should be considered to prevent arteriovenous shunting,reduce tumor size,and reverse fetal heart failure and hydrops.This approach aims to allow the fetus to grow safely to a viable gestational age,after which the tumor can be completely removed by secondary surgery following cesarean delivery or natural childbirth.Currently,there are five main intrauterine treatment strategies:①Ultrasound‒guided cystic teratoma aspiration:single or multiple aspirations,intrauterine continuous drainage,or prenatal aspiration;②Ultrasound‒guided alcohol sclerotherapy;③Open fetal surgery;④Laser ablation:fetoscopic‒guided ablation of feeding vessels of the teratoma,or ultrasound‒guided laser ablation;⑤Ultrasound‒guided radiofrequency ablation(RFA).According to the literature,the latter two minimally invasive intrauterine treatment methods show better outcomes for teratomas containing solid components and are gradually becoming the mainstream treatment options.

关 键 词：超声检查 胎儿骶尾部畸胎瘤 宫内治疗 射频消融 激光消融 

分 类 号：R714.5[医药卫生—妇产科学]