胎儿外科相关疾病的产前诊断及干预

The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies.

目的 分析胎儿外科相关疾病的产前诊断、治疗及愈后现状,为探索产前胎儿评估及治疗准则提供临床依据.方法 对2008年12月至2010年6月广东省妇幼保健院发现的胎儿外科相关疾病病例建立档案,收集病情相关资料,分析胎儿外科相关疾病的产前诊断与出生后诊断符合率、总体生存率、各系统疾病的构成比,以及外科干预对疾病转归的影响.结果 胎儿外科相关疾病的诊断时间多在孕中、后期,产前诊断与出生后诊断的符合率为96.4%.各系统胎儿外科疾病的构成比为泌尿系统28.4%、消化系统20.7%、呼吸系统11.9%、神经系统10.3%、循环系统8.0%、骨骼运动系统7.3%、颌面部畸形2.7%、生殖系统0.8%、多发畸形及其它10.0%.17%的患外科相关疾病胎儿存在严重出生缺陷,51.4%,患有外科疾病的胎儿出生后需手术治疗,总体生存率58.7%,出生后生存率90.7%,存活患儿愈后情况良好.结论 科学的产前诊断、评估、干预既可减少不必要的引产,又有助于控制严重出生缺陷胎儿的出生,降低新生儿死亡率.完善胎儿先天性疾病的诊疗流程,已成为医学上亟待解决的问题.

Objective Review the antenatal diagnosis, therapy, and the outcome of fetal surgical anomalies, which is supposed to provide clinical evidence for the study of antenatal assessment. Methods Collect cases about fetal surgical anomalies diagnosed in our hospital between December 2009 and June 2010. Review the coincidence rate of diagnosis, total survival rate, constituent ratio of each system diseases, and the influ- ence of surgical intervention on the outcome. Results Fetal surgical anomalies usually can＇ t be discovered until mid trmuhimester of pregnancy or late trimester of pregnancy. The proportion of fetal surgical anomalies in each system is urinary system 28.4% , digestive system 20.7% , respiratory system 11.9% , nervous system 10. 3% , circulatory system 8.0% , locomotor system7.3% , maxillofacial deformity 2.7% , genital system 0. 8% , muhi-abnormity and the else 10.0%. In our study, the coincidence rate of diagnosis is 96.4%. About 17% of fetuses with surgical anomalies get severe birth defects. 51.4% of fetuses with surgical anomalies need surgery therapy after birth. Fortunately, fetuses get a high survival rate after birth and their outeomes are gratifying. Conclusions Antenatal diagnosis, assessment, and intervention are conducive to reduce unnecessary abortion, control fetuses born with severe birth defects, and reduce neonatal mortality.