Hirose Shinjiro, Sydorak Roman M, Tsao Kuojen, Cauldwell Charles B, Newman Kurt D, Mychaliska George B, Albanese Craig T, Lee Hanmin, Farmer Diana L
Department of Surgery, University of California, San Francisco, California 94143-0570, USA.
J Pediatr Surg. 2003 Mar;38(3):446-50; discussion 446-50. doi: 10.1053/jpsu.2003.50077.
BACKGROUND/PURPOSE: The management of the fetus with a large neck mass that obstructs the airway remains a clinical challenge. The authors review their experience with giant fetal cervical teratoma and discuss options for management.
A retrospective review of all patients referred since 1994 for prenatal management of a fetal neck mass was performed. Variables examined included gestational age at diagnosis and delivery, size and location of the neck mass, presence of fetal hydrops, associated anomalies, management methods, operating time, and outcome.
Seven patients were identified with a prenatal diagnosis of giant cervical teratoma. Four patients had fetal hydrops; of these, 2 died in utero of hydrops, and a third fetus underwent elective termination. The remaining hydropic and previable fetus underwent fetal surgery for resection of the mass. The 3 nonhydropic patients underwent ex utero intrapartum treatment (EXIT) procedures for airway control. Endotracheal intubation was possible in one patient, and one received a tracheostomy. In the third fetus, neither intubation nor tracheostomy were possible, and resection of the neck mass was performed on placental support. There were no deaths in the surgical group.
The management of fetal giant cervical teratoma includes a spectrum of options. For the rare previable fetus with hydrops, fetal resection may be indicated. In patients with airway obstruction, EXIT procedure provides the luxury of time to obtain airway control either by intubation, tracheostomy, or, if necessary, tumor resection on placental support.
背景/目的：处理伴有阻塞气道的巨大颈部肿块的胎儿仍然是一项临床挑战。作者回顾了他们处理巨大胎儿颈部畸胎瘤的经验，并讨论了处理方案。
对自1994年以来因胎儿颈部肿块的产前处理而转诊的所有患者进行回顾性研究。所检查的变量包括诊断和分娩时的孕周、颈部肿块的大小和位置、胎儿水肿的存在、相关畸形、处理方法、手术时间和结局。
7例患者产前诊断为巨大颈部畸胎瘤。4例有胎儿水肿；其中2例死于子宫内水肿，第3例胎儿接受了选择性终止妊娠。其余水肿且可存活的胎儿接受了胎儿手术以切除肿块。3例无水肿的患者接受了产时宫外治疗（EXIT）程序以控制气道。1例患者成功进行了气管插管，1例接受了气管造口术。第3例胎儿既无法插管也无法进行气管造口术，在胎盘支持下进行了颈部肿块切除术。手术组无死亡病例。
胎儿巨大颈部畸胎瘤的处理包括一系列选择。对于罕见的有水肿且可存活的胎儿，可能需要进行胎儿切除术。对于气道阻塞的患者，EXIT程序提供了充足的时间，可通过插管、气管造口术或必要时在胎盘支持下进行肿瘤切除术来控制气道。
