产前诊断骶尾部畸胎瘤新生儿的多学科诊治分析

Multidisciplinary consultation for diagnosis and treatment of neonates prenatally diagnosed sacrococcygeal teratoma

目的总结新生儿期产前诊断为骶尾部畸胎瘤(sacrococcyleal teratoma,SCT)的治疗及预后,分析多学科联合诊治在提高SCT患儿预后的作用。方法回顾性分析2015年7月至2019年7月首都儿科研究所附属儿童医院27例产前诊断为SCT患儿的临床资料,总结产前评估、手术时机、手术方式、病理诊断及术后并发症、预后情况。结果27例SCT患儿出生后尽早确诊并适时给予有效治疗。患儿均经骶尾部入路手术,平均手术日龄为生后(8.3±7.2)d,平均住院时间(14.5±7.0)d。术中无直肠损伤;术后伤口感染1例,皮下积液2例。术后随访1个月至4年,1例术后尿潴留合并泌尿系感染治愈;1例成熟性畸胎瘤术中切除不完全,术后3个月再次手术,随访至今4年未复发;1例未成熟Ⅲ级畸胎瘤术后8个月复发并广泛转移,家长放弃治疗后患儿死亡,另1例未成熟畸胎瘤Ⅲ级术后失访。其余23例无近远期并发症发生。结论对产前诊断SCT实施产前评估、产后绿色通道转运及微创技术治疗的全方位一体化多学科综合治疗模式,可以使患儿得到及时有效的诊疗。病理组织成分与患儿术后复发、恶变等预后密切相关,可评估远期治疗效果。

Objective To summarize the treatments and outcomes of neonates prenatally diagnosed sacrococcygeal teratoma(SCT)and analyze the role of multidisciplinary consultation for prenatally diagnosed SCT.Methods Twenty-seven neonates who were prenatally diagnosed as SCT and had received treatments in our hospital from July 2015 to July 2019 were retrospectively analyzed and their prenatal evaluation,operation time,surgical management,pathological diagnosis,postoperative complications and prognosis were summarized.Results Twenty-seven patients with SCT were prenatally diagnosed and got outpatient consultation in our hospital.They were diagnosed and given effective treatments after birth as early as possible.All patients underwent tumor excision through sacrococcygeal approach.The average operative age was(8.3±7.2)days.The average in-hospital time was(14.5±7.0)days.There was no rectal injury,one case of wound infection,and two cases of subcutaneous effusion.The patients were followed up for one month to four years.One case of postoperative urinary retention with urinary tract infection was cured.One case of incompletely resection of mature teratoma,received second surgery three months later and no recurrence happened up to four years until now.One case of immature grade III teratoma recurred and metastasized eight months after the surgery and the patient died after treatment abandoning.The follow-up was lost for another case of immature teratoma of gradeⅢ.No other complications occurred in the other 23 cases.Conclusions The multidisciplinary comprehensive treatment mode of prenatally diagnosed SCT,including prenatal assessment,speedy transportation and minimally invasive surgery,can give early diagnosis and effective treatments for patients.The composition of pathological tissue is closely related to the prognosis of postoperative recurrence and malignant transformation,and can evaluate the longterm effect.