Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.
Department of Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy.
Eur J Pediatr Surg. 2022 Dec;32(6):536-542. doi: 10.1055/s-0042-1744149. Epub 2022 Mar 14.
Prenatal ultrasound-guided laser coagulation (USLC) for complicated bronchopulmonary sequestrations has been described but a consensus on the procedure and on the following management is still lacking. We present our experience and provide a literature review.
Retrospective review of patients treated in our center. Literature review and combined analysis of perinatal data were performed.
Five cases were treated at our center, all presenting with severe hydrothorax. Four met the criteria for fetal hydrops. Four cases underwent postnatal computed tomography (CT) scan: in one case, there was no evidence of persistent bronchopulmonary sequestration. The other three underwent thoracoscopic resection, in two, a viable sequestration was found. Including our series, 57 cases have been reported, with no mortality and a success rate of 94.7%. Mean gestational age (GA) at the procedure was 28 ± 3.4 weeks and mean GA at birth and birth weight (BW) were 38.6 ± 2.3 weeks and 3,276 ± 519.8 g, respectively. In 80.6% of the cases investigated postnatally, a residual mass was found, 50% of cases who showed prenatal arterial flow cessation had a persistent sequestration postnatally, and 26.3% of cases underwent postnatal sequestrectomy. Both patients in our series had pathology examination confirming a viable bronchopulmonary sequestration.
Prenatal USLC seems to be a valid option for bronchopulmonary sequestration complicated by severe hydrothorax and/or fetal hydrops. Authors believe that this procedure should aim to reverse fetal distress and allow pregnancy continuation, and it should not be considered a definitive treatment. The currently available data do not support changes of the common postnatal management.
已描述了产前超声引导下激光凝固术（USLC）治疗复杂型支气管肺隔离症，但对于该手术程序及后续管理仍缺乏共识。我们介绍了我们的经验并进行了文献回顾。
回顾性分析在我们中心治疗的患者。进行了文献回顾和围产期数据的综合分析。
我们中心治疗了 5 例患者，均表现为严重的胸腔积液。其中 4 例符合胎儿水肿标准。4 例患者接受了产后计算机断层扫描（CT）检查：在 1 例中，没有证据表明支气管肺隔离症持续存在。其他 3 例接受了胸腔镜切除术，其中 2 例发现了有活力的隔离症。包括我们的系列，已经报道了 57 例病例，没有死亡，成功率为 94.7%。手术时的平均孕龄（GA）为 28±3.4 周，出生时的平均 GA 和出生体重（BW）分别为 38.6±2.3 周和 3276±519.8g。在 80.6%的术后研究病例中，发现了残留肿块，50%的产前动脉血流停止的病例在产后仍存在持续性隔离症，26.3%的病例接受了产后隔离切除术。我们系列中的 2 例患者均接受了病理检查，证实了有活力的支气管肺隔离症。
产前 USLC 似乎是治疗严重胸腔积液和/或胎儿水肿合并支气管肺隔离症的有效选择。作者认为，该手术应旨在缓解胎儿窘迫并允许妊娠继续，不应被视为确定性治疗。目前的数据不支持改变常见的产后管理。
