重度原发性胸腔积液胎儿的宫内治疗及临床结局分析

cOutcomes of severe primary fetal hydrothorax treated by prenatal intervention

目的 探讨重度原发性胸腔积液胎儿的宫内治疗及临床结局。方法 收集2014年1月至2017年12月广东省妇幼保健院收治的重度原发性胸腔积液胎儿共12例，对其宫内治疗及临床结局进行回顾性分析。结果（1）一般情况：12例胎儿的胸腔积液中位诊断孕周为30．8周（24．0-33．0周），均经产前诊断胎儿无染色体异常，母亲无妊娠合并症及并发症。12例胎儿中，3例（3／12）仅为右侧胸腔积液，余9例（9／12）为双侧胸腔积液；12例胎儿均合并胎儿水肿。（2）宫内治疗：12例胎儿中，7例（7／12）胎儿诊断后行胸腔。羊膜腔分流术；4例（4／12）行胸腔穿刺术，术后胸腔积液反复出现，均行胸腔一羊膜腔分流术；1例（1／12）胎儿行第1次胸腔穿刺术后引发早产。（3）转归及预后：12例胎儿中，2例（2／12）胸腔积液消失，6例（6／12）胸腔积液减少，1例（1／12）导管移位，1例（1／12）胸腔穿刺术后早产，1例（1／12）胎死宫内，1例（1／12）因效果欠佳家属放弃治疗后引产。10例顺利分娩的患儿中，5例（5／10）早产；男女比例为7：3；其中，6例（6／10）患儿出生后予呼吸机辅助通气，8例（8／10）出生后予胸腔闭式引流等治疗后好转；10例患儿均顺利出院。结论及时对重度原发性胸腔积液胎儿进行宫内干预，能有效改善其预后，降低其病死率；对于重度原发性胸腔积液胎儿，应首选胸腔．羊膜腔分流术治疗。

Objective To investigate the effect of intrauterine intervention on severe primary fetal hydrothorax. Methods Twelve cases with severe fetal primary hydrothorax who underwent prenatal intervention from January 2014 to December 2017 in Guangdong Women and Children Hospital were retrospectively reviewed. Results The median gestational age of prenatal diagnosis was 30.8 weeks （24.0- 33.0 weeks）. All cases were excluded congenital chromosomal abnormalities by prenatal diagnosis, and had no complications of pregnancy during prenatal diagnosis and had hydrothorax. Three cases （3/12） were right hydrothorax, the other 9 cases （9/12） were bilateral. Thoracoamniotic shunting was performed in 7 cases （7/12）. Thoracentesis was performed in 5 cases （5/12）, and the hydrothorax reappeared soon after operation in 4 cases, shunt placement was performed again. The hydrothorax was dissolved in 2 cases, released in 6 cases.Tube falling off occurred in 1 case, treatment was abandoned in 1 case and intrauterine fetal death happened in 1 case, and 1 case wasn＇t rechecked by ultrasonic due to premature birth following thoracentesis. In 10 cases who had deliveries, 5 newborns （5/10） were premature, 6 newborns （6/10） underwent assisted mechanical ventilation, 8 newborns （8/10） underwent thoracic close drainage, all of them were discharged when hydrothorax resolved. Conclusions Antenatal intervention may improve the chance of survival in severe primary fetal hydrothorax. Thoracoamniotic shunting is the first-choice for the primary severe fetal hydrothorax.