改良国产新生儿输尿管支架用于宫内治疗胎儿乳糜胸的效果及预后

Effectiveness and prognosis of improved domestic neonatal ureteral stents for intrauterine treatment of fetal chylothorax

目的探讨使用改良国产新生儿输尿管支架(简称改良双J管)行胎儿胸腔-羊膜腔分流术(thoraco-amniotic shunting,TAS)治疗胎儿乳糜胸的效果和预后。方法回顾性分析2018年4月1日至2023年9月30日于南京大学医学院附属鼓楼医院使用改良双J管行TAS治疗的21例胎儿乳糜胸病例的临床资料,总结手术相关并发症及围产儿结局,通过《年龄与发育进程问卷(第三版)》(Ages and Stages Questionnaires-Third Edition,ASQ-3)评价存活患儿在沟通、粗大动作、精细动作、解决问题和个人-社会5个能区的发育情况。采用描述性统计分析。结果(1)产前诊断胎儿乳糜胸的中位孕周28.7周(27.3~30.4周),85.7%(18/21)合并胎儿水肿,90.5%(19/21)合并羊水过多,85.7%(18/21)为双侧胸腔积液。(2)首次TAS孕周中位数为30.9周(29.7~32.7周)。21例胎儿(其中10例因引流管脱落或堵塞而重复置管)共计置管49例次,TAS后7 d内引流管脱落率为24.5%(12/49例次),引流管堵塞率为16.3%(8/49例次)。首次置管后1周内胎膜早破发生率为9.5%(2/21),总体未足月胎膜早破发生率为28.6%(6/21)。首次TAS至分娩的中位间隔时间为30.0 d(19.8~40.0 d)。21例中3例放弃继续妊娠;另18例活产分娩,分娩孕周中位数为35.6周(34.1~37.1周),3例新生儿死亡。新生儿总体存活率为15/18,存活儿随访至中位年龄30个月(7~48个月),13例发育正常,2例得分低于ASQ-3界值。结论改良双J管可用于TAS治疗胎儿乳糜胸,且预后大多较好。

ObjectiveTo investigate the effectiveness and prognosis of using improved domestic neonatal ureteral stents(referred to as improved double-J stents)for thoraco-amniotic shunting(TAS)in treating fetal chylothorax.MethodsA retrospective analysis was conducted on the clinical data of 21 cases of fetal chylothorax treated with TAS using improved double-J stents at Nanjing Drum Tower Hospital,Nanjing University Medical School from April 1,2018,to September 30,2023.Surgical complications and perinatal outcomes were summarized,and the development of surviving infants in five domains(communication,gross motor,fine motor,problem-solving,and personal-social)was assessed using the Ages and Stages Questionnaires-Third Edition(ASQ-3).Descriptive statistical analysis was used.Results(1)The median gestational age at prenatal diagnosis was 28.7 weeks(27.3-30.4 weeks),with 85.7%(18/21)of cases complicated by fetal hydrops,90.5%(19/21)by polyhydramnios,and 85.7%(18/21)by bilateral pleural effusion.(2)The median gestational age at the first TAS was 30.9 weeks(29.7-32.7 weeks).Of the 21 cases,10 required repeat stent placement due to dislodgement or blockage,with a total of 49 stent placements.The dislodgement rate within 7 days was 24.5%(12/49),and the blockage rate was 16.3%(8/49).The rate of premature rupture of membranes within one week post-stent placement was 9.5%(2/21),with an overall preterm premature rupture of membranes rate of 28.6%(6/21).The median interval from the first TAS to delivery was 30.0 d(19.8-40.0 d).Of the 21 cases,three opted for selective termination of pregnancy;the remaining 18 cases resulted in live births,with a median gestational age at delivery of 35.6 weeks(34.1-37.1 weeks),and three neonatal deaths.The overall neonatal survival rate was 15/18.Surviving infants were followed up to a median age of 30 months(7-48 months),with 13 showing normal development and two scoring below the ASQ-3 threshold.ConclusionThe improved double-J stent can be used for TAS in the treatment of fetal chylothorax,with generally favorable outcomes.