胎儿泌尿系统发育异常的多学科诊治模式探讨(附55例病例)

Exploration on the mode of multi-disciplinary team for fetal urinary system anomalies

目的:探讨在胎儿医学框架上构建的胎儿泌尿系统发育异常的新型管理和诊治模式。方法:在产前诊断门诊发现的胎儿泌尿系统发育异常的孕妇在胎儿医学门诊进行系统的预约登记,进一步诊断及咨询,组织由胎儿医学专家及小儿泌尿外科专家参与的胎儿医学多学科会诊,为孕妇制定胎儿在孕期、分娩期、新生儿期的一个完整的诊疗计划并实施定期随访。结果:55例产前发现胎儿泌尿系统发育异常的孕妇接受了胎儿医学会诊及多学科会诊。55例中失访5例;36例分娩,其中4例已接受手术并取得成功;14例选择引产,其中1例提交伦理委员会讨论后引产。结论:在胎儿医学框架的基础上构建的胎儿泌尿系统发育异常的多学科诊治模式,优化了孕妇的就诊流程并利于孕妇做出进一步决定,为胎儿在孕期、分娩期、新生儿期作出一个完整的诊疗计划并实施,使新生儿得到早期干预并改善预后;根据疾病预后分组,并尝试将这一分组方法用于产前的咨询;探讨了伦理委员会制度在这一管理模式中的作用。

Objective： To explore the mode of multi-disciplinary team for fetal urinary system anomalies which builds on the framework of fetal medicine. Methods：Women who dis- covered fetal urinary system anomalies in the prenatal diagnosis clinic registered in fetal medi- cine center for further diagnosis and consultation. A multidiseiplinary fetal medicine consulta- tion was provided by fetal medicine specialists and pediatric urology experts. Then develop a complete treatment plan for the fetus during pregnancy, childbirth and the neonatal period. All patients were implemented regular follow-up. Results：55 pregnancies received fetal medicine consultations and multidisciplinary consultations. 5 cases were lost to follew-up. 36 cases main- tained pregnancy, of these 4 cases underwent surgery and be successful. 14 cases decided to terminate the pregnancy, including one case submitted to the ethics committee to discuss. Con- clusion ： The mode of multi-disciplinary team for fetal urinary system anomalies which builds on the framework of fetal medicine could not only optimize the progress of health care for pregnant women but also benefit them to make decisions. The complete treatment plan for the fetus dur- ing pregnancy, childbirth and the neonatal period was made, so that children can receive early intervention and improve outcomes. Grouped according to the prognosis of the fetal urinary sys- tem anomalies and try this method for nrenatnl col,n^lin~ In ~AAitir, n ~h h elplores the role of the ethics committee system in the mode.