Hidaka Nobuhiro, Murata Masaharu, Yumoto Yasuo, Hojo Satoshi, Fujita Yasuyuki, Masumoto Kouji, Taguchi Tomoaki, Tsukimori Kiyomi, Wake Norio
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Obstet Gynaecol Res. 2009 Feb;35(1):40-7. doi: 10.1111/j.1447-0756.2008.00871.x.
To identify the clinical characteristics of fetal abdominal wall defects managed at a single institution and to provide information regarding the most likely clinical course of the affected fetuses.
A retrospective review was conducted of 44 fetuses prenatally diagnosed with abdominal wall defects at Kyushu University Hospital between 1990 and 2006.
A total of 11 cases of gastroschisis and 33 cases of omphalocele were found. Preterm delivery was observed in eight of 11 fetuses (72.7%) with gastroschisis and in 14 of 27 fetuses (51.9%) with omphalocele who were not artificially aborted. Intrauterine growth restriction (IUGR) was identified in four of 11 fetuses (36.4%) with gastroschisis and in 13 of 27 fetuses (48.1%) with omphalocele who were not aborted artificially. There was a high rate of associated structural anomalies with omphalocele (26/33). Karyotypic abnormalities were observed in eight of 29 tested fetuses with omphalocele (27.6%). The prognosis for a chromosomally normal fetus with omphalocele appeared to largely depend on the associated structural abnormalities and the gestational age at delivery. Despite the frequent presence of IUGR, the outcome of neonates with gastroschisis was good.
The possibility of preterm delivery and IUGR should be considered during the management of both omphalocele and gastroschisis. For the management of omphaloceles, chromosomal abnormalities and respiratory insufficiency after birth must also be considered. Timely prenatal diagnosis and the subsequent identification of associated anomalies will improve patient care and will enable clinicians to provide appropriate counseling about the expected course.
确定在单一机构中处理的胎儿腹壁缺陷的临床特征，并提供有关受影响胎儿最可能的临床病程的信息。
对1990年至2006年期间在九州大学医院产前诊断为腹壁缺陷的44例胎儿进行回顾性研究。
共发现11例腹裂和33例脐膨出。11例腹裂胎儿中有8例（72.7%）早产，27例未人工流产的脐膨出胎儿中有14例（51.9%）早产。11例腹裂胎儿中有4例（36.4%）出现宫内生长受限（IUGR），27例未人工流产的脐膨出胎儿中有13例（48.1%）出现宫内生长受限。脐膨出合并结构异常的发生率很高（26/33）。在29例接受检测的脐膨出胎儿中有8例（27.6%）观察到染色体异常。染色体正常的脐膨出胎儿的预后似乎很大程度上取决于相关的结构异常和分娩时的孕周。尽管腹裂胎儿经常出现宫内生长受限，但新生儿的结局良好。
在处理脐膨出和腹裂时，应考虑早产和宫内生长受限的可能性。对于脐膨出的处理，还必须考虑出生后的染色体异常和呼吸功能不全。及时的产前诊断和随后相关异常的识别将改善患者护理，并使临床医生能够就预期病程提供适当的咨询。
