KK Women's and Children's Hospital, Singapore.
Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore.
BMJ Case Rep. 2023 Sep 27;16(9):e255760. doi: 10.1136/bcr-2023-255760.
Shunt migration is a rare but significant complication of thoracoamniotic shunting, an intervention widely used for fetal pleural effusion. We describe a case of a term infant noted antenatally to have fetal hydrothorax that was managed with thoracoamniotic shunting but complicated by shunt migration. We also present the current literature on risk factors, complications and management of intrathoracic shunt migration. The majority of shunt migration cases are managed conservatively with no untoward postnatal sequelae, but surgical removal of the migrated shunt has been used for associated clinical complications, if visceral damage is suspected or if postnatal thoracic surgery is indicated for other reasons. We advocate an approach of conservative management for asymptomatic infants, where possible, to avoid unnecessary surgical and anaesthetic risks to very young, often already compromised children. However, further studies are still required to determine optimal management after shunt migration has occurred to ensure the best outcome.
分流器迁移是胸腔羊膜分流术的一种罕见但严重的并发症，胸腔羊膜分流术广泛用于治疗胎儿胸腔积液。我们描述了一例足月婴儿，产前发现胎儿胸腔积液，采用胸腔羊膜分流术治疗，但出现分流器迁移的并发症。我们还介绍了目前关于胸腔内分流器迁移的风险因素、并发症和管理的文献。大多数分流器迁移病例采用保守治疗，无不良的产后后遗症，但如果怀疑内脏损伤或因其他原因需要进行产后胸科手术，则已使用手术切除迁移的分流器。我们主张对无症状婴儿采用保守治疗方法，在可能的情况下，避免对非常年幼、往往已经受损的儿童进行不必要的手术和麻醉风险。然而，仍需要进一步的研究来确定在发生分流器迁移后的最佳管理方法，以确保最佳的结果。
