Sakaguchi T, Suita S, Nakano H, Kukita J, Ueda K
Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan.
J Perinat Med. 1991;19(3):191-7. doi: 10.1515/jpme.1991.19.3.191.
Due to the great advancements in fetal ultrasonography, the number of prenatal diagnoses are increasing, greatly contributing to improved neonatal surgery. It is now relatively easy to detect huge fetal cystic masses, and we have experienced three cases with a huge neck tumor detected in utero, one case with teratoma and two cases with cystic hygroma. Each case was complicated by neonatal asphyxia, and the neonate needed resuscitation by means of endotracheal intubation. The infant with teratoma unfortunately died of respiratory distress due to compression of the trachea before a perinatal team could be organized. Although the remaining cases with cystic hygroma were treated by a perinatal team, one died 19 hours after birth and the other has survived with the aid of endotracheal intubation in the hospital for three years. In addition, all four cases of cystic hygroma detected antenatally in our institute, which were not delivered, also had fetal hydrops which suggested a general lymphatic derangement. Cystic hygroma detected in utero is considered to be different from that detected after birth, since the former is associated with genetic lymphatic derangement. Prenatal diagnosis enables such patients to survive the perinatal period, but may not improve the prognosis of fetal cystic hygroma so much.
由于胎儿超声检查技术的巨大进步，产前诊断的数量不断增加，这对新生儿手术的改善起到了极大的推动作用。现在检测巨大胎儿囊性肿块相对容易，我们已经遇到了3例在子宫内检测出巨大颈部肿瘤的病例，其中1例为畸胎瘤，2例为囊状水瘤。每个病例都伴有新生儿窒息，新生儿需要通过气管插管进行复苏。患有畸胎瘤的婴儿不幸在围产期团队组建之前因气管受压死于呼吸窘迫。尽管其余患有囊状水瘤的病例由围产期团队进行了治疗，但其中1例在出生后19小时死亡，另1例借助气管插管在医院存活了三年。此外，我们研究所产前检测出的4例未分娩的囊状水瘤病例也都有胎儿水肿，这提示存在全身性淋巴管紊乱。子宫内检测出的囊状水瘤被认为与出生后检测出的不同，因为前者与遗传性淋巴管紊乱有关。产前诊断能使此类患者度过围产期，但可能无法显著改善胎儿囊状水瘤的预后。
