胎儿骶尾部畸胎瘤的预后评估研究进展

Advances in the prognostic predication of fetal sacrococcygeal teratoma

骶尾部畸胎瘤（sacrococcygeal teratoma，SCT）是并不少见的胎儿及新生儿肿瘤，在出生活婴中发病率是1／40000-1／35000，男女比例1：3-1：4。通常认为SCT胎儿出生后经手术治疗预后良好，但据文献报道，产前诊断为SCT的胎儿死亡率却高达16％-63％。因此，SCT胎儿的预后评估指标和产前诊疗策略是当前研究的重点。本文对近年来SCT胎儿预后评估的研究进展进行了综述。肿瘤囊实性评分、TFR、STV：HV、STⅥ、肿瘤生长速度与CVPS等是SCT胎儿预后评估的有意义指标，这些指标各有利弊。在临床上，建议同时评估肿瘤囊实性比例与TFR这2个简便易行的指标，有条件的产前诊断中心也可选测STV：HV或STVI任一个指标。复查过程应监测肿瘤生长速度。CVPS可用于评估SCT胎儿心力衰竭的发生及进展，以决定干预时机。若SCT胎儿出现进展性高输出型心衰，孕28周前首先考虑胎儿手术，孕28周后可予治疗性早产。目前，SCT胎儿的预后评估尚处于探索阶段，本文所述产前策略亦并不完善，有待更多医学工作者投入研究。

Sacrococcygeal teratoma （SCT） is a common fetal and neonatal tumor in live births with an incidence of 1/40,000 to 1/35,000. And it has a male-to-female ratio of 1 ： 3 to 1 ： 4. The prognosis of SCT is generally fair after birth. However, the mortality of fetal SCT was reported at 16% to 63 % in the literature. Thus its prenatal diagnosis and prognostic indicators have become a hot focus of current researches. Here recent advances in its prognostic predication are reviewed. Various indicators such as tumor cystic proportion, tumor-fetal ratio （TFR）, solid tumor volume divided by head volume （STV： HV）,solid tumor volume index （STVI）, tumor growth and cardiovascular profile score （CVPS） are discussed. In clinical practices, tumor cystic proportion and TFR are recommended. Or either STV： HV or STVI may be used. Tumor growth should be always monitored. CVPS may be monitored be to assess the extent of fetal heart failure to determine the timing of intervention. If high output heart failure occurs, fetal surgery should be performed in the first 28 weeks of pregnancy and therapeutic delivery should be considered after 28 weeks of pregnancy. Currently the prognosis of SCT fetus is still in an exploratory stage. Due to imperfect prenatal policies, more in-depth researches are warranted.