Zhang Haichun, Tian Junzhang, Chen Zhongping, Ma Xiaoyan, Yu Gang, Zhang Jiangyu, Jiang Guihua, Wang Limin
Southern Medical University, Guangzhou, Guangdong, China.
Pediatr Surg Int. 2014 Jan;30(1):47-53. doi: 10.1007/s00383-013-3434-1. Epub 2013 Nov 21.
To describe the prenatal findings, treatments and outcomes of fetuses with pulmonary sequestrations (PS), which were retrospectively studied.
From May 2010 to January 2013, 292 women were referred to the Guangdong Women and Children Hospital, Guangzhou because obstetric ultrasound had demonstrated fetal lung lesions. In 68 fetuses, the echogenic lung masses were pulmonary sequestrations deriving arterial blood supply from clearly identifiable systemic arteries rather than the pulmonary artery. We examined records of the 68 fetuses and measured the lesions and congenital cystic adenomatoid malformation volume ratio (CVR), provided prenatal counseling and treatment, documented the CVR, location of lesion, gestational age at diagnosis, need for fetal intervention, perinatal clinical course (including the development of hydrops, effusions, and neonatal respiratory distress), gestational age at delivery, postnatal ultrasound and CT, operation treatment, survival and pathology.
There were 68 PS in our study. All of 56 cases with CVR ≤ 1.6, survived without prenatal hydrops or postnatal respiratory symptoms. In 12 cases with CVR >1.6, 7 cases (58.3 %, 7/12) had hydrops, 10 cases (83.3 %, 10/12) survived, 2 cases (16.7 %, 2/12) of induced abortion, 8 cases (66 %, 8/12) were postnatal symptomatic. There was statistical significant difference in the incidence rate of hydrops and postnatal respiratory symptoms between the PS with CVR ≤ 1.6 and that with CVR >1.6. 66 cases postnatal survived, two cases of induced abortion. 64 cases had no prenatal treatment, two cases underwent thoracoamniotic shunt. The mean gestational age at birth was 38 weeks (range 34-40 weeks). 21 asymptomatic cases had no surgery. 45 cases (8 symptomatic and 37 asymptomatic) underwent surgical resections, 43 cases without postoperative complications, two cases of postoperative pneumothorax, no wound infection. Postoperative follow-up showed good growth in all surgery cases.
PS specific absence of hydrop was a congenital disorder with an excellent prognosis. CVR >1.6 was associated with fetal hydrops and postnatal symptoms. However, absolute CVR value cannot be used to select fetuses for fetal treatment before the development of hydrops. Surgery of PS in neonates or infants presented a good outcome.
描述经回顾性研究的肺隔离症（PS）胎儿的产前检查结果、治疗及预后情况。
2010年5月至2013年1月，292名因产科超声显示胎儿肺部病变而转诊至广州广东省妇幼保健院的孕妇。在68例胎儿中，肺内强回声肿块为肺隔离症，其动脉血供来自可明确识别的体循环动脉而非肺动脉。我们检查了这68例胎儿的记录，测量了病变及先天性囊性腺瘤样畸形体积比（CVR），提供产前咨询和治疗，记录CVR、病变位置、诊断时的孕周、是否需要胎儿干预、围产期临床过程（包括水肿、胸腔积液及新生儿呼吸窘迫的发生情况）、分娩时的孕周、产后超声及CT检查、手术治疗、生存情况及病理结果。
本研究中有68例PS。CVR≤1.6的56例均存活，无产前水肿或产后呼吸症状。CVR>1.6的12例中，7例（58.3%，7/12）出现水肿，10例（83.3%，10/12）存活，2例（16.7%，2/12）引产，8例（66%，8/1十二）产后有症状。CVR≤1.6与CVR>1.6的PS在水肿发生率及产后呼吸症状方面存在统计学显著差异。66例产后存活，2例引产。64例未接受产前治疗，2例接受胸腔羊膜腔分流术。出生时的平均孕周为38周（范围34 - 40周）。21例无症状病例未手术。45例（8例有症状，37例无症状）接受手术切除，43例无术后并发症，2例术后气胸，无伤口感染。术后随访显示所有手术病例生长良好。
PS特异性无水肿是一种预后良好的先天性疾病。CVR>1.6与胎儿水肿及产后症状相关。然而，在水肿出现前，绝对CVR值不能用于选择胎儿进行治疗。新生儿或婴儿期PS手术预后良好。
