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[胎儿水肿——一项回顾性研究]

[Hydrops fetalis--a retrospective study].

作者信息

Kaiser László, Arany Antal, Veszprémi Béla, Vizer Miklós

机构信息

Szegedi Tudományegyetem, Altalános Orvostudományi Kar Patológiai Intézet Szeged Allomás u. 2. 6724, Hungary.

出版信息

Orv Hetil. 2007 Mar 11;148(10):457-63. doi: 10.1556/OH.2007.27951.

Abstract

In a retrospective study, the authors examined the occurrence of hydrops in foetal and neonatal cases in a five-year period. During this time, the clinical and pathologic diagnosis of hydrops was established in 28 cases. In three cases, the hydrops was caused by Rh incompatibility, and in 25 cases non-immune hydrops was discovered by clinical and pathologic examination. The cause of hydrops was recognised in 25 cases and no underlying disease was discernible in three. In 12 cases, the pregnancy was spontaneously terminated. Artificial abortion was performed in four cases. In this series, four hydropic newborns died on the first week of their life. The average age in artificial abortion was 16-20 gestational week and 24 in spontaneous abortion or stillbirth. Pathologic examination revealed increased weight, oedema, ascites, and hydrothorax in all cases. In half of the cases, there was also hydropericardium. Hepatosplenomegaly, cardiomegaly, pulmonary hypoplasia, increased extramedullary hemopoiesis, and placenta oedema were seen in all the cases. Causes of the non-immune hydrops were cardiac malformation in 4 cases, chromosome anomaly in 3, cystic hygroma in 2, skeletal anomaly in 1, foeto-foetal transfusion in 3, infection in 7 and sacrococcygeal teratoma in 1 case. In two cases, the underlying disease was reported to be of maternal origin. Comparing the clinical and pathologic findings there were only three cases with absolute agreement. The underlying disease revealed by pathologic examination was regarded to be significant from respect of inheritance, therapeutic approach, and further management in 10 cases. The authors emphasise the importance of pathologic examinations in foetal hydrops and point out the significance of clinico-pathological collaboration in the decision about further management of hydropic foetuses.

摘要

在一项回顾性研究中,作者调查了五年内胎儿及新生儿水肿的发生情况。在此期间,28例患者经临床及病理诊断为水肿。其中3例水肿由Rh血型不合引起,25例经临床及病理检查发现为非免疫性水肿。25例患者水肿病因明确,3例未发现潜在疾病。12例患者妊娠自然终止,4例行人工流产。该组中有4例水肿新生儿在出生第一周死亡。人工流产时的平均孕周为16 - 20周,自然流产或死产时为24周。病理检查显示所有病例均有体重增加、水肿、腹水及胸腔积液。半数病例还伴有心包积液。所有病例均可见肝脾肿大、心脏扩大、肺发育不全、骨髓外造血增加及胎盘水肿。非免疫性水肿的病因包括:心脏畸形4例、染色体异常3例、囊状水瘤2例、骨骼异常1例、胎儿 - 胎儿输血3例、感染7例、骶尾部畸胎瘤1例。2例患者的潜在疾病据报告源于母体。比较临床及病理检查结果,仅有3例完全相符。病理检查揭示的潜在疾病在遗传、治疗方法及后续处理方面,有10例被认为具有重要意义。作者强调病理检查在胎儿水肿中的重要性,并指出临床 - 病理协作在决定水肿胎儿后续处理措施方面的意义。

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