新生儿梨状窝囊肿产前会诊序贯治疗的临床分析（附16例报告）

Prenatal diagnosis and sequential interventions of neonatal pyriform sinus cyst： a report of 16 cases

目的 探讨产前诊断、多学科会诊（MDT）及序贯治疗在降低新生儿梨状窝囊肿（PSC）围手术期并发症及改善预后中的意义.方法 广州市妇女儿童医疗中心2011年2月至2016年4月,对16例新生儿PSC患儿进行临床资料回顾性分析及随访.根据患儿产前有无接受产前诊断、多学科会诊及序贯治疗,将16例患儿分为产前诊断组（n=8）及产后诊断组（n=8）.比较两组患儿围手术期并发症、围手术期处理及预后、随访结局.结果 16例患儿均存活,无死亡病例.产前诊断组中,1例（12.5％）患儿因肿物感染肿大、压迫气道需穿刺减压;产后诊断组中,7例（87.5％）因术前有气道压迫需穿刺减压,组间比较,差异有统计学意义（P=0.003）.产前诊断组术前无患儿需气管插管辅助通气,产后诊断组有2例（25％）需气管插管辅助通气,组间比较,差异无统计学意义（P=0.1）.产前诊断组患儿术后呼吸机辅助通气时间为（11.50±13.88）h较产后诊断组（100.71±80.04）h明显缩短,组间比较,差异有统计学意义（P=0.0089）.产后诊断组总病程为（44.00±16.90）d较产前诊断组（19.63±4.41）d明显延长,组间比较,差异有统计学意义（P=0.002）.术后随访3～62个月,平均22.16个月,产前诊断组暂无复发病例,产后诊断组有1例.结论 产前诊断、多学科会诊及序贯治疗可以降低新生儿梨状窝囊肿围手术期严重并发症的发生率,有助于缩短总病程.

Objective To explore the significance of prenatal diagnosis,multidisciplinary team （MDT） consultations and sequential interventions in reducing perioperative complications and improving the prognosis of neonatal pyriform sinus cyst （PSC）.Methods A total of 16 neonatal PCS cases were retrospectively analyzed between January 2011 and April 2016.They were assigned into the groups of prenatal diagnosis （PreD,n =8） and postnatal diagnosis （ProD,n =8） depending on whether or not prenatal information was available.And MDT consultations and sequential interventions were offered.Perioperative complications,perioperative management and prognosis were compared for two groups.Results There was no mortality case.One patient （12.5%） was drained due to preoperative respiratory distress in PreD group versus 7 patients （87.5%） in ProD group.And the differences were statistically significant.None required preoperative intubation in PreD group and intubation was required for 2 patients （25%） in ProD group.The mean postoperative duration of mechanical ventilation was significantly shorter in PreD group than that in PostD group （11.50 ± 13.88 ＆ 100.71 ± 80.04 h respectively,P =0.0089）.And the mean total course was significantly longer in PostD group than that in PreD group [（44.00 ± 16.90）vs （19.63 ± 4.41） days,P =0.002].During a mean follow-up period of 22.16 （3-65） months,one case recurred in PostD group while there was no recurrence in PreD group.Conclusions Prenatal diagnosis,MDT consultations and sequential interventions may be adopted for reducing perioperative complications,shortening disease course and improving the prognosis of neonatal PSC.