Creden Samuel P, Portuondo Jorge, Cheng Lily S, Halaweish Ihab, Keswani Sundeep G, King Alice L, Lee Timothy C, Sun Raphael C
Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio.
J Surg Res. 2023 Dec;292:38-43. doi: 10.1016/j.jss.2023.07.021. Epub 2023 Aug 12.
Ex-utero intrapartum treatment has been established as an option for fetal and perinatal surgeons to deliver patients with sacrococcygeal teratomas (SCTs) which are causing significant fetal distress and possible in-utero fetal demise. However, ex-utero intrapartum treatment procedures carry significant maternal risk and morbidity. Herein, we report an alternative technique of Cesarean section to immediate resection (CSIR) for managing high-risk SCTs.
A retrospective institutional review board-approved review was performed on all SCTs evaluated at our fetal center from May 2014 to September 2020. Demographics; prenatal imaging characteristics; prenatal interventions; and postnatal surgery data including operative time, estimated blood loss, pathology, and outcomes were collected. Outcomes of interest included surveillance serum alpha-fetoprotein levels, imaging surveillance, developmental milestones, and the presence or absence of constipation or fecal incontinence.
A total of 20 patients with prenatal diagnosis of SCT were evaluated. Mothers who transferred their care to another institution after diagnosis were excluded from this study. Twelve neonates underwent standard postnatal resection. Three neonates underwent emergent CSIR for high output cardiac failure, fetal anemia, or concerns for in-utero hemorrhagic rupture. The median (interquartile range) operative time was 231.5 (113) minutes for the standard operative group versus 156 min in the CSIR group. We present three patients who underwent immediate resection after emergent Cesarean section. We report 100% survival for the three consecutive cases.
CSIR is a safe and feasible approach for managing appropriately selected high-risk SCTs with signs of hydrops, fetal distress, or fetal anemia. Despite patient prematurity, we demonstrated 100% survival of three consecutive cases. We suggest that CSIR be considered an option in the management algorithm for high-risk SCTs.
宫外产时治疗已成为胎儿和围产期外科医生为患有导致严重胎儿窘迫和可能宫内胎儿死亡的骶尾部畸胎瘤（SCT）的患者接生的一种选择。然而，宫外产时治疗程序具有重大的母体风险和发病率。在此，我们报告一种用于处理高危SCT的剖宫产即刻切除术（CSIR）替代技术。
对2014年5月至2020年9月在我们胎儿中心评估的所有SCT进行了一项经机构审查委员会批准的回顾性研究。收集了人口统计学数据、产前影像学特征、产前干预措施以及包括手术时间、估计失血量、病理和结局在内的产后手术数据。感兴趣的结局包括监测血清甲胎蛋白水平、影像学监测、发育里程碑以及便秘或大便失禁的有无。
共评估了20例产前诊断为SCT的患者。诊断后将护理转至另一机构的母亲被排除在本研究之外。12例新生儿接受了标准的产后切除术。3例新生儿因高输出量心力衰竭、胎儿贫血或担心宫内出血破裂而接受了急诊CSIR。标准手术组的中位（四分位间距）手术时间为231.5（113）分钟，而CSIR组为156分钟。我们展示了3例急诊剖宫产后即刻切除的患者。我们报告连续3例患者的生存率为100%。
CSIR是一种安全可行的方法，用于处理经适当选择的有水肿、胎儿窘迫或胎儿贫血迹象的高危SCT。尽管患者早产，但我们证明连续3例患者的生存率为100%。我们建议在高危SCT的管理算法中应考虑CSIR作为一种选择。
