先天性畸形的产前诊断、围产期管理及随诊网络的建立与初步实践效果分析

Establishment and preliminary practice efficacy of the network in prenatal diagnosis, perinatal management and monitoring of congenital malformation

目的通过先天性畸形的产前诊断、围产期管理和随诊网络的建立，分析初步实践的效果。方法网络由“产前诊断和分娩中心”与“新生儿治疗及随诊中心”组成。两个中心随时保持业务交流与合作，以实现其网络化功能。结果网络运行模式：超声科及产科通过超声等影像学检查发现畸形，家长到新生儿外科咨询，新生儿外科与产科、超声科讨论诊断、制定分娩与诊疗计划，按计划分娩，根据病情选择：（1）配有新生儿转运设备的救护车即刻转诊；（2）救护车常规转运；（3）在分娩医院观察及出院后到新生儿外科门诊。转诊患儿进一步检查后根据病情选择急诊手术、择期手术或观察。2003年3月至2007年12月共接诊经产前超声诊断的先天性畸形患儿228例。19例妊娠中期终止妊娠；4例出生后放弃治疗；56例在新生儿期手术，其中51例治愈、5例术后放弃治疗；149例出生后未行手术，仅观察。结论对先天性畸形的产前诊断、围产期管理及随诊实施网络化管理，进一步加强小儿外科与产科、超声科的密切交流与合作，在实践中逐步建立一套适合我国现实医疗环境、较规范的运作模式，可望进一步提高我国先天性畸形的围产期管理和总体诊治水平。

Objective To summarize the establishment and preliminary practice efficacy of the network in prenatal diagnosis, perinatal management and monitor of congenital malformation. Methods The network consists two parts： one is the center of prenatal diagnosis and delivery, the other is the center of neonatal treatment and follow-up. The two centers keep in cooperation and exchange experiences to realize the function of the network. Results Parents were consulted in the clinics of neonatal surgery once malformation had been detected by ultrasonograghy. And treatment regimen was planned according to suggestions from pediatric surgeons, obstetricians and doctors of ultrasound. After delivery, the newborns will be transferred to children hospital by ambulance equipped by transfer facility specially for newborns or regular ambulance, or followed up. After evaluation, the baby would be operated on in emergency, select procedure or observed. Two hundreds and twenty eight cases of malformation diagnosed prenatally were treated in our hospitals from Mar. 2003 to Dec. 2.007. Nineteen cases were terminated in the second trimester. Four left without any management after birth. Among 56 neonates who underwent operation, 51 recovered and 5 refused further treatment. One hundred and forty nine cases received expective management during the pregnancy and followed up after delivery. Conclusions The establishment of the network in prenatal diagnosis, perinatal management and monitoring for congenital malformation is practical and matched with the current situation in the country. It may be helpful for improving the quality of perinatal management, total diagnosis and treatment of the congenital malformations in China.