Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
J Pediatr Surg. 2013 Jan;48(1):138-44. doi: 10.1016/j.jpedsurg.2012.10.067.
To identify prenatal diagnostic features that will help select fetuses with lung masses (LM) who may benefit from ex-utero intrapartum treatment (EXIT procedure) as the preferred mode of delivery.
The CCAM-volume ratio (CVR), fetal treatment, and outcomes of all fetuses with LM evaluated between 2001 and 2011 were reviewed retrospectively. Fetuses with hydrops or CVR>1.6 were classified as high risk. Indications for fetal interventions included hydrops and heart failure, and indication for EXIT-to-resection was the finding of persistent mediastinal compression (PMC) near birth.
Of 110 fetuses evaluated for LM, 78 were classified as low-risk. No fetus in this group had PMC near birth and none required perinatal treatment. Of 32 high-risk fetuses, 8 developed heart failure of which 4 survived (3 following fetal surgery). Nine high-risk fetuses with no PMC near birth were asymptomatic postnatally and treated electively. Sixteen high-risk fetuses had PMC near birth. All 9 babies with PMC treated with EXIT-to-resection did well with discharge at a median of 10 days post-operatively. All 7 fetuses treated without an EXIT developed respiratory distress following birth requiring an urgent operation; 2 died.
The EXIT-to-resection procedure is a favorable delivery approach for those fetuses with large LM and PMC near birth.
确定产前诊断特征，以帮助选择可能受益于宫外产时治疗（EXIT 手术）的胎儿，将其作为首选分娩方式。
回顾性分析了 2001 年至 2011 年间所有患有肺肿块（LM）胎儿的 CCAM-体积比（CVR）、胎儿治疗和结局。将出现水肿或 CVR>1.6 的胎儿归类为高危。胎儿干预的指征包括水肿和心力衰竭，EXIT 至切除术的指征是出生时发现持续纵隔压迫（PMC）。
在 110 例评估 LM 的胎儿中，78 例被归类为低危。该组中无胎儿在出生时出现 PMC，也无需进行围产期治疗。在 32 例高危胎儿中，有 8 例出现心力衰竭，其中 4 例存活（3 例接受胎儿手术）。9 例出生时无 PMC 的高危胎儿出生后无症状，择期治疗。16 例出生时出现 PMC 的高危胎儿。所有 9 例接受 PMC 治疗的胎儿均通过 EXIT 至切除术顺利分娩，术后中位数 10 天出院。所有 7 例未接受 EXIT 手术的胎儿在出生后均出现呼吸窘迫，需要紧急手术；其中 2 例死亡。
对于那些临近出生时 LM 较大且出现 PMC 的胎儿，EXIT 至切除术是一种有利的分娩方式。
