Takahashi H, Ohkuchi A, Kuwata T, Usui R, Takahashi S, Matsubara S
a Department of Obstetrics and Gynecology , Jichi Medical University , Tochigi , Japan.
J Obstet Gynaecol. 2016;36(3):340-4. doi: 10.3109/01443615.2015.1060203. Epub 2015 Oct 14.
To characterise congenital mesoblastic nephroma (CMN), with special emphasis on polyhydramnios and the neonatal prognosis, we summarise 31 CMN patients (30 reported patients and the present patient). CMN was detected at a median of 30 weeks' gestation, and infants were delivered at a median of 34 weeks' gestation. Of 27 patients with available data, 19 (70%) had polyhydramnios, of which 8 required amnio- drainage. Women with amnio-drainage gave birth significantly earlier (30.4 weeks' gestation) than those without polyhydramnios (36.7 weeks' gestation). Thus, CMN was frequently associated with polyhydramnios and this polyhydramnios was associated with a significant increase in the risk of preterm birth. Of 20 patients with available data, the affected-side kidney was 'compressed' in 16 and 'replaced' in 4: polyhydramnios was present in a half vs 100%, respectively, suggesting that a 'replaced' kidney may suggest a more aggressive tumour and may be associated with a poorer prognosis. Univariate analysis showed that early gestational week at diagnosis was the only feature significantly associated with poor prognosis. Thus, polyhydramnios, 'replaced' kidney and early gestational week at diagnosis, may indicate poor prognosis, to which obstetricians should pay attention.
为了描述先天性中胚层肾瘤(CMN),特别强调羊水过多和新生儿预后,我们总结了31例CMN患者(30例已报道患者和本病例患者)。CMN在妊娠中位数30周时被检测到,婴儿在妊娠中位数34周时分娩。在有可用数据的27例患者中,19例(70%)有羊水过多,其中8例需要羊水引流。接受羊水引流的女性分娩时间明显早于无羊水过多的女性(妊娠30.4周)(妊娠36.7周)。因此,CMN常与羊水过多相关,且这种羊水过多与早产风险显著增加相关。在有可用数据的20例患者中,患侧肾脏16例被“压迫”,4例被“替代”:羊水过多分别出现在50%和100%的病例中,这表明被“替代”的肾脏可能提示肿瘤更具侵袭性,且可能与预后较差相关。单因素分析显示,诊断时的孕周早期是与预后不良显著相关的唯一特征。因此,羊水过多、“替代”肾脏和诊断时的孕周早期可能提示预后不良,产科医生应予以关注。