腹膜后寄生胎7例及文献回顾

Retroperitoneal fetus-in-fetu:a report of 7 cases with a literature review

目的对腹膜后寄生胎产前超声特征及手术方式进行分析,并回顾相关文献。方法以2016年11月至2019年11月华中科技大学同济医学院附属湖北妇幼保健院小儿外科收治的7例腹膜后寄生胎患者为研究对象,收集患者性别、年龄、产前超声特征、寄生部位、寄生胎数目、手术方式、术前术后AFP、合并症以及病理结果资料。以“寄生胎”、“胎中胎”或“fetus-in-fetu”,“parasite twin”为关键词,在中国知网、万方数据库、Pubmed检索收集自2010—2020年的文献,总结近10年文献报道的寄生胎患者临床特征。结果7例中男4例(57.14%),女3例(42.86%);产前超声检出7例(100.00%);开腹手术5例(71.43%),微创手术2例(28.57%);双寄生胎2例(28.57%);合并梅克尔憩室1例(14.29%),合并畸胎瘤1例(14.29%);术后因并发腹腔积液二次入院1例(14.29%),无一例死亡病例。文献检索共收集144例病例,其中男63例(43.75%),女69例(47.92%),未描述性别12例(8.33%);产前超声检出48例(33.33%);传统开放手术134例(93.06%),腹腔镜辅助手术2例(1.39%);双寄生胎8例(5.56%),三寄生胎2例(1.39%);引产4例(2.78%),死亡8例(5.56%)。结论产前彩超可以作为寄生胎的筛查手段,随着孕周增加可发现脊柱、长骨、脐带样血管结构等;寄生胎亦可通过微创手术治疗,较传统开放手术治疗恢复快,预后良好。

Objective To explore the prenatal ultrasonography and surgical approaches of 7 cases of retroperitoneal fetus-in-fetu(FIF)and evaluate the clinical efficacy and review the literature.Methods From November 2016 to November 2019,7 cases of retroperitoneal FIF were reviewed for collecting the relevant clinical data,including gender,age,prenatal ultrasonography,parasitic site,parasitic fetus number,surgical approaches,pre/postoperative value of alpha-fetoprotein(AFP),concurrent diseases and pathological examinations.Using such keywords as“parasitic fetus”,“fetus-in-fetu”or“parasite twin”,the authors searched the databases of CNKI,WanFang and PubMed for collecting the relevant literatures from 2010 to 2020 and summarizing the clinical data of FIF infants.Results There were 4 boys(57.14%)and 3 girls(42.86%).All cases were detected by prenatal ultrasonography(n=7,100%).Surgical approaches were open operation(n=5,71.43%)and mini-invasive surgery(n=2,28.57%).There were twin FIF(n=2,28.57%),merging Merkel s diverticulum(n=1,14.29%)and merging teratoma(n=1,14.29%).One case was readmitted for peritoneal effusion(14.29%).There was no mortality.A total of 144 cases were collected through literature retrieval,including 63 males(43.75%),69 females(47.92%)and 12 non-specified genders(8.33%).Forty-eight cases(33.33%)were detected by prenatal ultrasonography.There were traditional surgery(n=134,93.06%)and laparoscopic-assisted surgery(n=2,1.39%).Two FIF(n=8,5.56%)and three FIF(n=2,1.39%)were found.There were induced labor(n=4,2.78%)and mortality(n=8,5.56%).Conclusion Prenatal ultrasound may be employed as a screening tool for FIF.With an advancing gestational age,spinal column,long bone and umbilical cord-like vascular structure are detected.With an excellent prognosis,mini-invasive surgery for FIF has a faster recovery than traditional open surgery.