脐膨出畸形胎儿的妊娠结局及发育随访

Pregnancy outcome of the fetus with omphalocele deformity

目的分析脐膨出畸形胎儿的妊娠结局及发育随访,为该病的临床诊治和预后提供参考。方法回顾性分析西安两家大型三甲医院产前诊断的44例胎儿脐膨出资料,按照出生时胎儿脐膨出大小分为两组,脐膨出≤5cm组21例,脐膨出>5cm组(50%~75%肝脏位于囊内)23例。收集孕妇年龄、产次、分娩方式、是否合并其他畸形、分娩时妊娠周数、新生儿出生时体重、新生儿不良结局、新生儿性别、新生儿住院时间、新生儿禁食时间、母体孕期是否有妊娠合并症、新生儿远期发育随访资料,分析两组之间的妊娠结局。结果两组孕母年龄、孕周、产次、分娩方式、孕期是否有合并症,以及新生儿是否合并其他畸形、出生时体重、新生儿性别比较,差异无统计学意义(P>0.05)。与脐膨出≤5cm组新生儿相比,脐膨出>5cm组新生儿住院时间、禁食时间较长,不良结局发生率较高,差异有统计学意义(t=3.054、0.918,χ^(2)=5.750,P<0.05)。远期随访中,两组新生儿的术后喂养困难、运动功能、认知、体重发育、身高发育、行为、二次手术率比较,差异均无统计学意义(P>0.05)。结论大部分新生儿脐膨出≤5cm预后良好。应重视胎儿健康检查,孕期应定期行超声观察胎儿脐带发育情况,对于确诊脐膨出的畸形做好有效防控措施。

Objective To analyze the pregnancy outcome of the fetus with omphalocele,so as to provide reference for clinical diagnosis,treatment and prognosis of the disease.Methods The data of 44 cases of fetal omphalocele diagnosed prenatal in two large Grade A hospitals in Xi′an were retrospectively analyzed.According to the size of the fetal omphalocele at birth,children were divided into two groups:omphalocele≤5cm group(n=21)and omphalocele>5cm group(n=23)(50%-75%of the liver was in the capsule).Data on pregnant women′s age,time of delivery,mode of delivery,whether there were other malformations,gestational weeks at delivery,birth weight of newborns,adverse neonatal outcomes,neonatal sex,neonatal hospitalization time,neonatal fasting time,whether there were pregnancy complications during pregnancy,and long-term follow-up of neonatal development were collected and analyzed.Results There was no significant difference between the two groups in age,gestational age,time of delivery,mode of delivery,complications during pregnancy,birth weight and newborn sex(P>0.05).Compared with the omphalocele≤5cm group,the hospital stay and fasting time of neonates in the omphalocele>5cm group were longer,and the incidence of adverse outcomes was higher,with statistical significance(t=3.054,0.918,χ^(2)=5.750,P<0.05).In the long-term follow-up,there were no significant differences in postoperative feeding difficulties,motor function,cognition,weight development,height development,behavior and the rate of second operation between the two groups(P>0.05).Conclusions Most newborns with omphalocele≤5cm have a good prognosis.Attention should be paid to fetal health examination,and regular ultrasound should be performed during pregnancy to observe the development of fetal umbilical cord,and effective prevention and control measures should be taken to diagnose the malformation of omphalocele.