Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Fetal Diagn Ther. 2013;34(1):19-25. doi: 10.1159/000348776. Epub 2013 Apr 12.
From a single-center retrospective cohort with fetal chylothorax, we evaluated the factors related to the decision to use shunting, poor prognostic factors, and reported shunting outcomes with a new double basket-catheter device.
A retrospective single-center study was performed in 35 cases of fetal chylothorax.
There were 35 cases of chylothorax: 23 with hydrops and 12 without hydrops. Twenty-one procedures were performed on 15 fetuses (11 with hydrops) with a single shunt in 11, two shunts in 3 and four shunts in 1. All 12 nonhydropic cases survived. In 23 hydropic cases, overall survival rates with and without thoracoamniotic shunting were 46 and 33%, respectively. The mortality rates of fetal hydropic cases with and without ascites were 93 and 11%, respectively. Fetal ascites, progression of fetal hydrops, and premature delivery at <33 weeks were significant risk factors for a poor prognosis. Progression of polyhydramnios after shunting was also associated with a poor prognosis. Obstruction of the catheter was observed in 38%. There were no direct fetal deaths associated with shunting.
Thoracoamniotic shunting should be considered for pleural effusion before development of fetal hydrops, or at least before the appearance of fetal ascites. A double-basket catheter tends to be obstructive, but may be less invasive for fetuses.
从单中心回顾性胎儿乳糜胸队列中，我们评估了与分流决策相关的因素、不良预后因素，并报告了一种新的双篮筐导管装置的分流结果。
对 35 例胎儿乳糜胸进行回顾性单中心研究。
有 35 例乳糜胸：23 例合并水肿，12 例无水肿。15 例胎儿中有 21 例（11 例合并水肿）进行了 1 次分流术，11 例为 1 次分流，3 例为 2 次分流，1 例为 4 次分流。所有 12 例非水肿病例均存活。在 23 例水肿病例中，有和无胸羊水分流的总生存率分别为 46%和 33%。有腹水和无腹水的胎儿水肿病例的死亡率分别为 93%和 11%。胎儿腹水、胎儿水肿进展和早产<33 周是预后不良的显著危险因素。分流后羊水过多的进展也与不良预后相关。导管阻塞的发生率为 38%。与分流相关的直接胎儿死亡没有。
在胎儿水肿发生之前，或至少在出现胎儿腹水之前，应考虑进行胸腔羊水分流。双篮筐导管容易阻塞，但对胎儿的侵袭性可能较小。
