胸腔-羊膜腔分流术应用于严重胎儿原发性胸腔积液的围产儿结局分析

Perinatal outcomes of thoraco-amniotic shunting for severe primary fetal hydrothorax

目的 评估胸腔-羊膜腔分流术（TAS）在严重原发性胸腔积液（PFHT）胎儿的治疗中应用的安全性及围产儿结局.方法 回顾性分析2012年1月至2017年12月在同济大学附属第一妇婴保健院就诊的22例经TAS宫内干预的严重PFHT胎儿的围手术期管理及妊娠结局,排除因胎儿结构或染色体异常、感染及免疫性水肿等所致的继发性胸腔积液胎儿.结果 22例经TAS治疗的严重PFHT胎儿中,共放置分流管28次,一次置管成功率为100％,进行TAS的中位孕周为31.3周（第25百分位数～第75百分位数：27.6～32.2周）.TAS后7 d内胎膜早破的发生率为9％（2/22）,分流管移位或堵塞的发生率为18％（4/22）,TAS至分娩的中位间隔时间为26 d（8～46 d）.引产1例（5％,1/22）,活产21例（95％,21/22）,分娩孕周为34.4周（33.4～37.0周）;13例（62％,13/21）新生儿出生后需机械通气;4例新生儿死亡,死亡原因均为肺发育不良.围产儿的存活率为81％（17/21）,其中胸腔积液伴水肿和不伴水肿围产儿的存活率分别为10/13、7/8.结论 TAS是相对安全的宫内干预技术,可改善严重PFHT胎儿的围产结局.

Objective To evaluate the safety and perinatal outcomes of thoracoamniotic shunting in the treatment of fetuses with severe primary hydrothorax. Methods 22 cases of suspected severe primary fetal hydrothorax which underwent thoraco-amniotic shunting in Shanghai First Maternity and Infant Hospital,Fetal Medicine Unit and Prenatal Diagnosis Center from January 2012 to December 2017 were analyzed retrospectively. Hydrothorax associated with structural or chromosomal abnormalities, infections and immune fetal hydrops were excluded. Results Totally ,28 shunts were placed in 22 fetuses. The median gestational age at TAS was 31.3 weeks. Preterm membrane rupture within 7 days after the procedure occurred in 9.1％（2/22） cases. Catheter displacement occurred in 18％（4/22） cases. The interval from shunting to delivery was 26.0 days. One fetus ended in induced abortion; 21（95％,21/22） babies were born alive, and their median gestational age at delivery was 34.4 weeks. 62％（13/21）newborns required ventilator supports; 4 neonatal deaths were attributed to pulmonary hypoplasia. The overall perinatal survival rate was 81％（17/21）. The perinatal survival rate with hydrops and without hydrops were 10/13 and 7/8 respectively. Conclusion Thoraco-amniotic shunting is a safe procedure for intrauterine therapy and could improve the perinatal outcomes of severe primary fetal hydrothorax.