胎儿巨大骶尾部畸胎瘤合并心脏功能不全的产时宫外治疗（EXIT）策略：一例病例报告及文献复习
The ex-utero intrapartum treatment (EXIT) strategy for fetal giant sacrococcygeal teratoma with cardiac insufficiency: A case report and review of the literature.
作者信息
Ding Yunping, Yang Mengmeng, Lv Min, Jiang Ying, Dong Tian, Zhao Baihui, Luo Qiong
机构信息
Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
出版信息
Front Oncol. 2022 Nov 2;12:1035058. doi: 10.3389/fonc.2022.1035058. eCollection 2022.
BACKGROUND
Antenatally diagnosed sacrococcygeal teratoma has been associated with risks of perinatal complications and death, especially when the foetus has symptoms of cardiac insufficiency, hydrops or anemia ; however, the method of intervention remains controversial.
CASE
A 25-year-old pregnant woman was found to have a cystic and solid tumor in the fetal sacrococcygeal region at 16 weeks of gestation. As the tumour grew, the mother developed polyhydramnios accompanied with gestational diabetes. Fetal and tumorous hemodynamics were closely monitored by ultrasound. Abnormal cardiac function was detected at 31 weeks' gestation, and we creatively performed pre-emptive delivery through the ex-utero intrapartum treatment with debulking. The teratoma was removed with utero-placental circulation support. The operation proceeded smoothly with favourable prognosis for both mother and newborn.
CONCLUSION
The ex-utero intrapartum treatment may improve the prognosis for fetuses with heart failure when they reach viable gestation.
背景
产前诊断的骶尾部畸胎瘤与围产期并发症及死亡风险相关，尤其是当胎儿出现心脏功能不全、水肿或贫血症状时；然而，干预方法仍存在争议。
病例
一名25岁孕妇在妊娠16周时被发现胎儿骶尾部区域有一个囊实性肿瘤。随着肿瘤生长，母亲出现羊水过多并伴有妊娠期糖尿病。通过超声密切监测胎儿及肿瘤的血流动力学。妊娠31周时检测到心脏功能异常，我们创新性地通过子宫外产时处理减瘤术进行了提前分娩。在子宫 - 胎盘循环支持下切除了畸胎瘤。手术进展顺利，母亲和新生儿预后良好。
结论
子宫外产时处理可能改善心力衰竭胎儿在达到可存活孕周时的预后。
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