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乙醇注射疗法:胎儿血管瘤宫内治疗的选择

Alcoholization: the choice of intrauterine treatment for chorioangioma.

作者信息

Wanapirak Chanane, Tongsong Theera, Sirichotiyakul Supatra, Chanprapaph Pharuhas

机构信息

Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.

出版信息

J Obstet Gynaecol Res. 2002 Apr;28(2):71-5. doi: 10.1046/j.1341-8076.2002.00016.x.

Abstract

Chorioangioma is a vascular tumor of the placenta. Most are small and asymptomatic, whereas the large tumors are clinically significant and often associated with polyhydramnios and fetal heart failure. To prevent fetal loss from these complications, many interventions have been proposed, including intrauterine transfusion in anemic cases and fetoscopic surgery to ablate the feeding vessels. The case presented herein had large chorioangiomas, 8 and 4cm in diameter, associated with polyhydramnios and early signs of hydrops fetalis, diagnosed at 27 weeks gestation. After extensive counseling, we performed alcohol ablation of the feeding vessel of the larger tumor. Signs of fetal heart failure and hydrops fetalis disappeared dramatically. The pregnancy was extended for 2 weeks, followed by premature rupture of the membranes and spontaneous labor at 32 weeks gestation and a surviving female baby, weighing 1360g, was delivered uneventfully. This preliminary experience suggests that alcoholization may be one of the best choices for this condition due to its high efficacy, simplicity, safety and very low cost. To our knowledge, this is the first report using alcoholization for the treatment of hydrops fetalis secondary to chorioangioma.

摘要

绒毛膜血管瘤是一种胎盘血管肿瘤。大多数肿瘤较小且无症状,而大的肿瘤具有临床意义,常与羊水过多和胎儿心力衰竭相关。为防止因这些并发症导致胎儿丢失,已提出许多干预措施,包括对贫血病例进行宫内输血以及通过胎儿镜手术消融供血血管。本文介绍的病例有两个大的绒毛膜血管瘤,直径分别为8厘米和4厘米,伴有羊水过多和胎儿水肿的早期迹象,在妊娠27周时确诊。经过广泛的咨询后,我们对较大肿瘤的供血血管进行了酒精消融。胎儿心力衰竭和胎儿水肿的迹象显著消失。妊娠延长了2周,随后胎膜早破,在妊娠32周时自然分娩,一名体重1360克的存活女婴顺利出生。这一初步经验表明,由于酒精消融疗效高、操作简单、安全且成本极低,可能是治疗这种情况的最佳选择之一。据我们所知,这是第一例使用酒精消融治疗绒毛膜血管瘤继发胎儿水肿的报告。

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