胎儿经腹脐静脉穿刺术临床资料分析

The analysis of the cases underwent cordocentisis

目的评价胎儿经腹脐静脉穿刺术的手术指征、方法及安全性。方法回顾性分析2012年1月至2014年12月在北京大学第一医院妇产科接受胎儿脐静脉穿刺术的303例病例的手术指征、方法及安全性。结果 91.8%(278/303)的患者手术指征为明确胎儿染色体核型。其中胎儿患有明显畸形的病例中10.5%(16/153)染色体核型异常。10例手术指征为羊膜腔穿刺的染色体核型为嵌合型或有标记物,脐血穿刺术后3例染色体核型正常,7例与羊膜腔穿刺结果相符。92.4%(280/303)的孕妇穿刺一次成功。脐血穿刺术后胎儿的总流失率为1.32%(4/303),术后2周之内的流失率为0.99%(3/303),胎心过缓率为3.0%(10/303)。结论脐血穿刺术是一个较安全的产前诊断手术,其指征可为明确胎儿染色体核型。但是急需新的实验室方法来探讨胎儿畸形的遗传学改变。

Objective To value the indications,methods and safety of the cordocentisis. Method Between January2012 and December 2014,303 cordocenteses were performed in 303 women with singleton pregnancy in the Peking University First Hospital. A 22-gauge percutaneous needle was used to puncture the umbilical vein at the relatively fixed position with the ＂free-armed＂method. Result 91. 8%（278 /303） procedures were performed to identify the fetal karyotype. But only 10. 5%（16 /153） of the karyotypes of the fetuses with obvious abnormalities are abnormal.Three cases whose chromosomal karyotypes were mosaics by amniocentesis had normal karyotypes by cordocentesis.92. 4%（ 280 /303） cases just needed one puncture. The gross fetal loss rate after cordocentesis was 1. 32%（ 4 /303）,and the fetal loss rate in two weeks was 0. 99%（3 /303）,the fetal bradycardia rate was 3. 0%（10 /303）.Conclusion Cordocentesis is a relatively safe prenatal surgery. The most important indications for the procedure should be the diagnosis and treatment for fetal anemia,and the identification for the karyotypes of the fetuese with chromosomal mosaic by amniocentesis,as well as the chromosome karyotype analysis. But new laboratory methods should be performed to investigate the genetic anomalies for the fetuses with structural abnormalities.