8例寄生胎的诊治经验

Diagnosis and treatment experience of 8 cases of fetus in fetu

目的:探讨寄生胎(FIF)的临床表现、诊断、治疗及预后等各方面特点,提高对FIF的认知。方法:病例总结。回顾性分析2008年12月至2022年6月就诊于首都医科大学附属北京儿童医院,行外科手术治疗且术后病理证实为FIF的8例患儿临床资料。结果:8例患儿日龄93.0(24.3,226.8)d,其中男4例,女4例;产前超声检查发现腹部包块4例,出生后发现体表包块并逐渐增大2例,因发热、腹痛等症状就诊2例;5例(87.5%)患儿术前完善血液甲胎蛋白(AFP)检查,AFP水平为766.6(262.2,30186.5)μg/L,8例患儿术前均行超声或CT检查,了解FIF具体位置及周围组织毗邻关系,其中位于腹膜后6例(75.0%),背部1例(12.5%),会阴部1例(12.5%);患儿合并卵圆孔未闭2例(25.0%),脐茸1例(12.5%),畸胎瘤1例(12.5%),内脏转位1例(12.5%),脊柱脊髓畸形1例(12.5%),泌尿系统畸形1例(12.5%);患儿均行限期或急诊手术治疗,手术日龄(120.8±104.2)d,术时体重6.6(4.3,7.4)kg,术中完整切除FIF,术后恢复良好,均存活,住院时间为12.0(10.0,29.0)d;随访7例,随访时间为(76.6±60.5)个月,随访中发现患儿的AFP随时间推移较术前下降,患儿均未见复发征象。结论:FIF为罕见的先天性发育异常,随着医学的不断发展,产前诊断的检出率随之提高,目前治疗方案主要以外科手术为主,长期预后一般良好。

Objective To explore the clinical manifestation,diagnosis,treatment and prognosis of fetus in fetu(FIF)and improve the cognition of FIF.Methods Case summary.This retrospective analysis involved 8 patients who underwent surgery and were pathologically confirmed FIF in Beijing Children′s Hospital,Capital Medical University,from December 2008 to June 2022.Results The age of 8 children was 93.0(24.3,226.8)days,including 4 males and 4 females.Prenatal ultrasonography revealed abdominal masses in 4 patients.Two patients were found to have body surface masses that gradually enlarged after birth.Two patients went to the hospital due to fever and abdominal pain.Five patients(87.5%)had blood alpha-fetoprotein(AFP)tests before surgery,and the AFP level was 766.6(262.2,30186.5)μg/L.All 8 children underwent ultrasonography or CT before surgery to identify the specific location of FIF and its surrounding tissues.FIF was located in the retroperitoneum of 6 patients(75.0%),on the back of 1 patient(12.5%),and on the perineum of 1 patient(12.5%).Two patients(25.0%)had patent foramen ovale,1 patient(12.5%)had umbilical polyp,1 patient(12.5%)had teratoma,1 patient(12.5%)had situs inversus,1 patient(12.5%)had spinal cord malformation,and 1 patient(12.5%)had urinary system malformation.All the children underwent confine or emergency operation when they were(120.8±104.2)days old and weighed 6.6(4.3,7.4)kg.FIF was completely removed during the operation.They all survived and recovered well after the operation.The length of stay was 12.0(10.0,29.0)days.Seven patients were followed up for(76.6±60.5)months.During the follow-up,the AFP level was found to decrease over time compared with that before surgery,and no signs of recurrence were found in all of them.Conclusions FIF is a rare congenital dysplasia.With the development of medical technology,the FIF detection rate has increased in prenatal examinations.Surgery is the most effective treatment,and the prognosis is good in the long run.