胎儿胸腔积液的产前诊断与处理的初步研究

Prenatal diagnosis and intervention to fetal hydrothorax： five cases analysis

目的探讨胎儿胸腔积液的产前诊断及处理的临床效果。方法选取2014年12月至2015年5月中国医科大学附属盛京医院母胎医学中心收治的胎儿胸腔积液病例5例，对其临床资料进行回顾性分析。结果5例患儿的胸腔积液诊断孕周平均为37周，均经产前诊断除外胎儿先天性畸形及染色体异常和孕妇本身的疾病。5例患儿中，例1、2、4为单侧胸腔积液，例3、5为双侧胸腔积液。对例1、2、3实施产前胸膜腔穿刺术，其中例1穿刺后5d因积液再次增多行剖宫产术及产时子宫外处理（EXIT）；例2在行胸膜腔穿刺过程中，胎心率突然降至40～50次／min，立即于全身麻醉下行剖宫产术及EXIT；例3在胎儿胸膜腔穿刺后，同时行剖宫产术及EXIT。例4及例5均采取保守治疗的方法，积液分别于孕期及产后逐渐消退。5例患儿均采取剖宫产术娩出，均存活，例1、2、3患儿出生后转入新生儿科，行呼吸机辅助通气、胸膜腔闭式引流等治疗，其后，胸腔积液逐渐消退，喂养耐受，顺利出院；例4患儿娩出后无呼吸困难，喂养耐受，未住院治疗；例5采取呼吸机辅助通气及保守治疗，胸腔积液逐渐消退，喂养耐受。结论明确的产前诊断与适当的产前处理（胸膜腔穿刺术）可能对改善胸腔积液患儿的预后有一定的作用，对不同类型的胸腔积液患儿应制订相应的治疗方案，以争取最佳预后。

Objective To research the important of prenatal diagnosis and effect of intervention to fetal hydrothorax. Methods The cases of fetal hydrothorax （n=5） were obtained from the Shengjing Hospital, China Medical University between December 2014 and May 2015. All pregnancies were uncomplicated, excluded congenital organic and chromosomal abnormalities during prenatal diagnosis and with a 37 average gestational weeks. The case 1, 2, 4 were unilateral hydrothorax and the case 3, 5 were bilateral. We performed an antenatal thraeoeentesis to case 1, 2, 3. In easel, the hydrothorax increased rapidly after 5 days, and the patient underwent a cesarean section and ex utero intrapartum treatment （EXIT）; in case 2, the fetal heart rate was decreased to 40-50 bpm suddenly during thracocentesis, and we performed an emergent cesarean section and EXIT for the patient; in case 3, the patient underwent thracoeentesis and a meanwhile cesarean section and EXIT procedure. We performed a conservative management to case 4, 5, the hydrothorax resolved spontaneously during the pregnancy and after birth, both patients underwent cesarean section. Results All fetuses were survived, the neonates of case 1, 2 and 3 underwent assited mechanical ventilation, thoracic close drainage, then discharged after hydrothorax resolved and feeding tolerance; in case 4, there was no respiratory distress and hospital treatment; in case 5, the neonate underwent assited mechanical ventilation and conservative management, the hydrothorax has resolved gradually. Conclusions The prenatal diagnosis and antenatal intercention （thracocentesis） may play an important role in fetal hydrothorax treatment. In clinical, we should choose different plan according to the gestation weeks and classification of hydrothorax of the patient.