Okada Tadao, Sasaki Fumiaki, Cho Kazutoshi, Honda Shouhei, Naito Satsuki, Hirokata Gentarou, Todo Satoru
Department of Pediatric Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Pediatr Int. 2008 Aug;50(4):576-80. doi: 10.1111/j.1442-200X.2008.02703.x.
The aim of the present study was to retrospectively determine the clinical factors affecting the outcome after birth in prenatally diagnosed sacrococcygeal teratomas (SCT).
Six cases of prenatal SCT were identified from January 1985 until August 2005. A retrospective review of case-notes and pathological reports was carried out. Clinical data during the perinatal period, operative findings, postoperative complications and follow up were evaluated in the patients with prenatally diagnosed SCT.
SCT presented as type I in two neonates and type III in four between 22 and 33 weeks' gestation. Fetal intervention was not performed for any fetus. Five of six were delivered by cesarean section and the other was delivered vaginally due to small tumor size. Patients were born at between 29 and 39 weeks' gestation and weighed from 1840 to 3500 g. All patients with type III SCT presented with related diseases, including bilateral hydronephrosis, neurological deficit of the communicating peroneal nerve such as paralytic talipes equines, bladder or bowel dysfunction, high-output cardiac failure, or fetal hydrops in one of a set of fraternal twins. A baby with high-output cardiac failure and fetal hydrops underwent urgent cesarean section at 29 weeks' gestation and died 8 days after birth despite intensive care due to multi-organ failure. In five cases, surgery was successful with good outcomes maintained at follow-up of between 8 months and 14 years.
Detailed ultrasound should be performed to rule out associated anomalies, and determine the presence or absence of hydrops in prenatally diagnosed SCT. Fetal hydrops, orthopedic impairment such as lower extremity weakness and swelling, and urinary incontinence are important clinical factors affecting the outcome after birth in prenatally diagnosed SCT. In particular, the present study indicated that the association of a fraternal twin and fetal hydrops makes it very difficult to treat SCT perinatally.
本研究的目的是回顾性确定影响产前诊断的骶尾部畸胎瘤（SCT）出生后结局的临床因素。
1985年1月至2005年8月期间共确定6例产前SCT病例。对病例记录和病理报告进行回顾性分析。对产前诊断为SCT的患者围产期临床资料、手术发现、术后并发症及随访情况进行评估。
6例SCT中，2例新生儿为I型，4例为III型，孕周在22至33周之间。未对任何胎儿进行胎儿干预。6例中有5例通过剖宫产分娩，另1例因肿瘤较小经阴道分娩。患者出生时孕周在29至39周之间，体重在1840至3500克之间。所有III型SCT患者均伴有相关疾病，包括双侧肾积水、腓总神经交通支神经功能缺损（如马蹄内翻足麻痹）、膀胱或肠道功能障碍、高输出量心力衰竭或同卵双胞胎之一出现胎儿水肿。1例患有高输出量心力衰竭和胎儿水肿的婴儿在孕29周时紧急剖宫产，尽管进行了重症监护，但仍在出生后8天因多器官衰竭死亡。5例手术成功，随访8个月至14年期间预后良好。
应进行详细超声检查以排除相关畸形，并确定产前诊断的SCT中是否存在水肿。胎儿水肿、骨科损伤（如下肢无力和肿胀）以及尿失禁是影响产前诊断的SCT出生后结局的重要临床因素。特别是，本研究表明同卵双胞胎与胎儿水肿的关联使得围产期治疗SCT非常困难。
