多学科协作诊疗模式下胎儿胸腔积液临床诊疗及转归

Diagnosis and treatment of fetal hydrothorax by multidisciplinary team mode and outcomes

目的探讨多学科协作诊疗(MDT)模式下胎儿胸腔积液临床诊疗及转归。方法选取2021年6月至12月江西省妇幼保健院收治的胎儿胸腔积液病例5例,其中初产妇2例,经产妇3例,平均年龄26.4岁,所有病例临床处理方案均经MDT讨论,对其临床资料及胎儿转归进行回顾性分析。结果5例孕妇产前均接受MDT,给予个性化指导建议,平均为30+2周(分别为29周、32周、27+5周、30周、33+2周),均为双侧胸腔积液、羊水过多。病例1、病例2、病例3孕期出现胎儿水肿。病例1、病例3实施宫内干预:病例1实施产前胸膜腔穿刺术抽液术+羊水减量术;病例3实施产前右侧胸膜腔穿刺术+左侧胸膜腔-羊膜腔分流术+羊水减量术。病例1宫内干预后7 d因胎儿水肿行剖宫产术及产时子宫外处理(EXIT),病例3宫内干预后7 d自然临产阴道分娩;病例2胎儿严重水肿,完成促胎肺成熟后行剖宫产术及EXIT。病例4、病例5保守治疗,积液产后消退,分别延长妊娠天数49 d和42 d。5例患儿4例采取剖宫产术娩出,1例阴道分娩。1例因新生儿呼吸衰竭放弃治疗,其余4例新生儿治愈出院。结论MDT及适当的产前处理对改善胸腔积液患儿的预后可能有一定的作用。

Objective To explore the diagnosis and treatment of fetal hydrothorax by multidisciplinary team(MDT)mode and the outcomes.Methods Five cases of fetal pleural effusion treated at Jiangxi Maternal and Child Health Care Hospital from June to December 2021 were selected,including 2 primiparae and 3 multiparae,with an average age of 26.4.All the cases'clinical treatment schemes were discussed by the MDT.The clinical data and fetal outcomes were retrospectively analyzed.Results All the 5 cases got individualized guidance and advices by the MDT before delivery.They were 29,32,27+5,30,and 33+2 weeks pregnant respectively,with an average of 30+2 weeks.All the cases had bilateral hydrothorax and polyhydramnios.Case 1,2,and 3 had fetal hydrops.Antenatal thracocentesis and amniotic fluid reduction were performed in case 1 and right thracocentesis,left thoraco-amniotic shunting(TAS),and amniotic fluid reduction were carried out in case 3 before delivery.Because of fetal hydrops after 7 days'intervention,case 1 took cesarean section and ex utero intrapartum treatment(EXIT);case 3 vaginally delivered after 7 days'intervention;case 2 had severe fetal hydrops,and took cesarean section and EXIT after enhancing maturity of fetal lung.The fetal pleural effusion disappeared after conservative treatment in case 4 and 5,and their pregnancies were prolonged 49 and 42 day more,respectively.Among the 5 cases,4 took cesarean section,and 1 vaginally delivered.Case 1 gave up the treatment because the neonate had respiratory failure,and the other 4 cases'neonates were cured and discharged.Conclusion MDT and appropriate prenatal treatment may improve the prognosis of fetal hydrothorax.