Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital and University of Toronto, Toronto, Canada; Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland.
Obstetrics Unit, Mother-Child Department, University Hospital Lausanne, Switzerland.
Best Pract Res Clin Obstet Gynaecol. 2019 Jul;58:107-120. doi: 10.1016/j.bpobgyn.2019.01.006. Epub 2019 Jan 14.
In this review article, we discuss the most common fetal tumors, their prenatal management, and outcomes. Overall, the most important outcome predictors are tumor histology, size, vascularity, and location. Very large lesions, lesions causing cardiac failure, and hydrops and lesions obstructing the fetal airway have the poorest outcome, as they may cause fetal death or complications at the time of delivery. Fetal therapy has been developed to improve outcomes for the most severe cases and can consist of transplacental therapy (sirolimus for rhabdomyomas or steroids for hemangiomas and microcystic lung lesions) or surgical intervention (shunting of cystic masses, tumor ablation, occlusion of blood flow or airway exploration, and protection). Given the rarity of fetal tumors, patients should be referred to expert centers where care can be optimized and individualized to allow the best possible outcomes.
在这篇综述文章中，我们讨论了最常见的胎儿肿瘤、它们的产前管理和结局。总体而言，最重要的结局预测因素是肿瘤组织学、大小、血管生成和位置。非常大的病变、导致心力衰竭的病变以及伴有水肿和阻塞胎儿气道的病变，结局最差，因为它们可能导致胎儿死亡或分娩时出现并发症。胎儿治疗已被开发出来，以改善最严重病例的结局，并且可以包括胎盘内治疗（雷帕霉素治疗横纹肌瘤或类固醇治疗血管瘤和微囊性肺病变）或手术干预（囊性肿块分流、肿瘤消融、血流或气道探查阻断以及保护）。鉴于胎儿肿瘤的罕见性，患者应转至专家中心，在那里可以优化治疗并使其个体化，以获得尽可能好的结局。
