Bond S J, Harrison M R, Schmidt K G, Silverman N H, Flake A W, Slotnick R N, Anderson R L, Warsof S L, Dyson D C
Department of Surgery, University of California, San Francisco 94143-0510.
J Pediatr Surg. 1990 Dec;25(12):1287-91. doi: 10.1016/0022-3468(90)90535-h.
Fetal sacrococcygeal teratoma (SCT) is being recognized with increasing frequency. Placentomegaly and hydrops fetalis are preterminal events, and it has been suggested that fetal death may be due to high-output cardiac failure from arteriovenous shunting through the tumor. We had a chance to examine this hypothesis when a 21-week fetus presented with a huge sacrococcygeal teratoma. There were marked placentomegaly, cardiomegaly, hyperdynamic ventricles, and a pericardial effusion. Doppler studies showed tremendous flow through the SCT with extreme enlargement of the inferior vena cava, consistent with congestive heart failure from increased flow through the tumor. Hydrops developed, and the fetus was delivered because of placental abruption. This case provides supportive evidence that the teratoma acts as a large arteriovenous shunt, causing high-output cardiac failure. We have now collected 18 more cases of sacrococcygeal teratoma diagnosed in utero. Of the total 45 cases of fetal SCT, 9 had placentomegaly and/or fetal hydrops and all 9 fetuses died in utero or shortly after birth. We conclude that the only hope for survival in these severely affected fetuses is to reduce blood flow to the tumor before birth.
胎儿骶尾部畸胎瘤（SCT）的诊断频率日益增加。胎盘肿大和胎儿水肿是临终前的表现，有人认为胎儿死亡可能是由于肿瘤动静脉分流导致高输出量心力衰竭。当一名21周大的胎儿出现巨大骶尾部畸胎瘤时，我们有机会检验这一假说。该胎儿存在明显的胎盘肿大、心脏肥大、心室活动增强和心包积液。多普勒研究显示通过骶尾部畸胎瘤的血流量极大，下腔静脉极度扩张，这与肿瘤血流量增加导致的充血性心力衰竭相符。随后出现了水肿，由于胎盘早剥，胎儿被娩出。该病例提供了支持性证据，表明畸胎瘤起到了大型动静脉分流的作用，导致高输出量心力衰竭。我们现在又收集到18例子宫内诊断出的骶尾部畸胎瘤病例。在总共45例胎儿骶尾部畸胎瘤病例中，9例有胎盘肿大和/或胎儿水肿，所有9例胎儿均在子宫内或出生后不久死亡。我们得出结论，这些严重受影响胎儿存活的唯一希望是在出生前减少流向肿瘤的血流量。
