胎儿腹部肿块的评估及追踪

Evaluation and tracing of prenatally diagnosed abdominal masses

目的了解胎儿腹部肿块的产前超声评估的准确性、肿块发展的特点和家属对胎儿腹部肿块的选择状况。方法复习3年来发现的胎儿腹部肿块病例的临床资料，记录肿块发现时的胎龄、位置大小、肿块特征（囊性、实性、混合性）、产前初步诊断、出生前超声随访、家属对有腹部肿块胎儿的选择、出生后诊断、治疗随访等项目。结果共发现胎儿腹部肿块59例，腹部肿块占同期全部产前发现异常病例（身体各部畸形或肿瘤）的2．2％（59／2723）。胎龄最小20周，最大39周，平均31．3周。其中37例获尸检、生后手术或影像学证实，3例与产前诊断不符，总符合率为91．9％；肿块临产前或生后缩小消失18例（18／s9，诊断明确3例，未明确15例）；家属未采纳医生意见而选择引产19例（19／59），引产未尸检及失访共21例（21／59）。实际（经手术证实）或根据影像学检查结果推测发现肿瘤40例。结论胎儿腹部肿块较易在产前超声检查中发现，产前诊断多数能与生后诊断相符合。大多数病例自然病程及预后较为良好，即能自行消退，或生后诊断明确后或当发现肿块增大时及时手术治疗。当获知胎儿存在肿瘤可能后，相当部分的家属会选择终止妊娠。

Objective To assess the accuracy of prenatal diagnosis in abdominal masses, natural development of the mass and the status of parent＇s choice for termination. Methods Clinical data of prenatally ultrasonographic diagnosed abdominal masses in recent 3 years were reviewed, including gestation age, mass size and location, mass features （cystic, mixed, solid）, prenatal diagnosis, prenatal follow-up, the parents＂ choice for termination, postnatal diagnosis and management and follow-up. Results A total of 59 fetal abdominal masses were found. They accounted for 2. 2% among the prenatally diagnosed malformation and tumors（59/2723）in same period. Of these cases, the youngest was 20 weeks and the oldest 39 weeks. Mean gestation age is 31.3 weeks. Confirmed diagnosis from autopsy, postnatal operation and image examination was gained. Only 3 cases were not match to the prenatal diagnosis. The total accordance is 91.9%. The masses presented regression before or after birth were observed in 18 cases （18/59, 3 confirmed and 15 not confirmed）. Ninteen parents（19/59）refused the physician＇s advice and chose termination. Twenty-one （21/59） were term/nation without autopsy and lost follow-up. Fifty tumors diagnosed via operation or postnatal image examination were estab- lished. Conclusions Fetal abdominal mass can be found by sonography. Most prenatal diagnosis is match to postnatal result. The natural history of fetal mass is favorable. Some parents may choose termination when they know the fetal with suspected tumor in China.