Jiang Sydney, Yang Catherina, Bent John, Yang Christina J, Gangar Mona, Nassar Michel, Suskin Barrie, Dar Peer
Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center / Children's Hospital of Montefiore, 3400 Bainbridge Avenue 3rd Floor, Bronx, NY, 10467, USA; Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
Int J Pediatr Otorhinolaryngol. 2019 Dec;127:109642. doi: 10.1016/j.ijporl.2019.109642. Epub 2019 Aug 13.
Currently no established criteria exist to guide use of ex utero intrapartum treatment (EXIT) for fetal neck mass management. This study aims to correlate prenatal radiographic findings with incidence of ex utero intrapartum treatment and necessity of airway intervention at delivery.
We reviewed our EXIT experience between 2012 and 17. Furthermore, we performed a literature review of articles reporting incidences of fetal neck masses considered for EXIT. Articles that were included (1) discussed prenatal radiographic findings such as size, features, and evidence of compression and (2) reported extractable data on delivery outcomes and airway status.
Ten cases at our institution were reviewed. Another 137 cases across 81 studies met inclusion criteria. These studies showed aerodigestive tract compression to be significantly associated with neck masses undergoing EXIT. Additionally, there was significantly higher incidence of airway intervention in cases where polyhydramnios, anatomic compression, and solid masses were seen on prenatal diagnostic imaging, while mass location and size did not correlate with airway intervention.
With this data, we propose that any neck mass with anatomic compression on fetal imaging in the 3rd trimester should be considered for EXIT. When radiographic findings do not show compression but do display polyhydramnios or a solid neck mass (regardless of polyhydramnios), an airway surgeon should be available for perinatal airway assistance.
目前尚无既定标准来指导胎儿颈部肿块管理中子宫外产时处理（EXIT）的使用。本研究旨在将产前影像学检查结果与子宫外产时处理的发生率以及分娩时气道干预的必要性相关联。
我们回顾了2012年至2017年间我们的EXIT经验。此外，我们对报告考虑进行EXIT的胎儿颈部肿块发生率的文章进行了文献综述。纳入的文章（1）讨论了产前影像学检查结果，如大小、特征和压迫证据，（2）报告了关于分娩结局和气道状况的可提取数据。
我们机构对10例病例进行了回顾。另外81项研究中的137例病例符合纳入标准。这些研究表明，气道消化道受压与接受EXIT的颈部肿块显著相关。此外，产前诊断成像显示羊水过多、解剖学压迫和实性肿块的病例中，气道干预的发生率显著更高，而肿块位置和大小与气道干预无关。
基于这些数据，我们建议对于孕晚期胎儿影像学检查显示有解剖学压迫的任何颈部肿块，都应考虑进行EXIT。当影像学检查结果未显示压迫但显示羊水过多或实性颈部肿块（无论是否羊水过多）时，应配备气道外科医生提供围产期气道协助。
