Fetal Medicine Unit, Mount Sinai Hospital, Toronto, ON, Canada.
Ultrasound Obstet Gynecol. 2013 Oct;42(4):440-8. doi: 10.1002/uog.12515. Epub 2013 Sep 12.
To report three different antenatal therapeutic approaches for fetal lung masses associated with hydrops.
Three prospectively followed cases are described, and all 30 previously published minimally invasive cases of fetal therapy for hydropic lung masses are reviewed.
Three hydropic fetuses with large intrathoracic lung masses presented at 17, 25 and 21 weeks of gestation, respectively. An aortic feeding vessel was identified in each case and thus a bronchopulmonary sequestration (BPS) was suspected. Under ultrasound guidance, the feeding vessel was successfully occluded with interstitial laser (Case 1), radiofrequency ablation (RFA) (Case 2) and thrombogenic coil embolization (Case 3). Complete (Cases 1 and 2) or partial (Case 3) resolution of the lung mass and hydrops was observed. A healthy infant was born at term after laser therapy (Case 1), and the involved lung lobe was resected on day 2 of postnatal life. In Case 2, hydrops resolved completely following RFA, but an iatrogenic congenital diaphragmatic hernia and abdominal wall defect became apparent 4 weeks later. The neonate died from sepsis following spontaneous preterm labor at 33 weeks. In Case 3, despite technical success in complete vascular occlusion with coils, a stillbirth ensued 2 days after embolization.
The prognosis of large microcystic or echogenic fetal chest masses associated with hydrops is dismal. This has prompted attempts at treatment by open fetal surgery, with mixed results, high risk of premature labor and consequences for future pregnancies. We have demonstrated the possibility of improved outcome following ultrasound-guided laser ablation of the systemic arterial supply. Despite technical success, RFA and coil embolization led to procedure-related complications and need further evaluation.
报告 3 例与积水相关的胎儿肺肿块的产前治疗方法。
描述了 3 例前瞻性随访病例，并回顾了 30 例以前发表的胎儿治疗积水性肺肿块的微创病例。
3 例积水胎儿分别在妊娠 17、25 和 21 周时出现大的胸腔内肺肿块。在每个病例中均识别出主动脉供血血管，因此怀疑为支气管肺隔离症（BPS）。在超声引导下，成功地用间质激光（病例 1）、射频消融（RFA）（病例 2）和血栓形成线圈栓塞（病例 3）闭塞了供血血管。观察到肺肿块和积水完全（病例 1 和 2）或部分（病例 3）消退。激光治疗后（病例 1）足月分娩了一个健康的婴儿，出生后第 2 天行受累肺叶切除术。在病例 2 中，RFA 后积水完全消退，但 4 周后出现医源性先天性膈疝和腹壁缺损。新生儿在自发性早产 33 周后死于败血症。在病例 3 中，尽管线圈完全闭塞的技术成功，但栓塞后仍发生死产。
与积水相关的大微囊型或高回声胎儿胸腔肿块的预后不佳。这促使人们尝试采用开放性胎儿手术进行治疗，但结果喜忧参半，早产风险高，对未来妊娠有影响。我们已经证明，超声引导下激光消融体循环动脉供应可能会改善预后。尽管技术上成功，但 RFA 和线圈栓塞导致与程序相关的并发症，需要进一步评估。
