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产前胸腔穿刺术：先天性乳糜胸病例报告

Antepartum Thoracocentesis: A Case Report on Congenital Chylothorax.

作者信息

Almeida Maria, Campos Marta, Soares Celia, Godinho Cristina, Brito Maria

机构信息

Obstetrics and Gynecology, Unidade Local de Saúde de Trás-os-Montes e Alto, Vila Real, PRT.

Obstetrics and Gynecology, Unidade Local de Saúde de Gaia e Espinho, Vila Nova de Gaia, PRT.

出版信息

Cureus. 2025 Aug 17;17(8):e90275. doi: 10.7759/cureus.90275. eCollection 2025 Aug.

DOI:10.7759/cureus.90275
PMID:40964572
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12439228/
Abstract

Congenital chylothorax remains a poorly understood condition, and the optimal approach to its management continues to evolve. Rapid progression of pleural effusion with mediastinal shift and/or development of hydrops fetalis are key indications for urgent fetal intervention to enable thoracic decompression and prevent fetal compromise. We report a case of isolated mild unilateral pleural effusion identified during routine midtrimester ultrasound, successfully managed through close ultrasonographic surveillance and perinatal thoracocentesis performed immediately before delivery to facilitate lung expansion and minimize cardiopulmonary compromise. Prenatal intervention in this context was associated with favorable neonatal outcomes, including improved Apgar scores, reduced ventilator dependence, and fewer complications.

摘要

先天性乳糜胸仍然是一种了解甚少的病症，其最佳治疗方法也在不断发展。胸腔积液迅速进展伴有纵隔移位和/或胎儿水肿的发生是进行紧急胎儿干预以实现胸腔减压并防止胎儿受损的关键指征。我们报告了一例在孕中期常规超声检查时发现的孤立性轻度单侧胸腔积液病例，通过密切超声监测和在分娩前立即进行围产期胸腔穿刺术成功进行了治疗，以促进肺扩张并最大程度减少心肺功能损害。在这种情况下的产前干预与良好的新生儿结局相关，包括阿氏评分提高、呼吸机依赖减少和并发症减少。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/e625a5c6a910/cureus-0017-00000090275-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/99444c53e9f2/cureus-0017-00000090275-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/d22d95e9cdad/cureus-0017-00000090275-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/8baf7395c747/cureus-0017-00000090275-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/adc7aa9eefaa/cureus-0017-00000090275-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/e625a5c6a910/cureus-0017-00000090275-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/99444c53e9f2/cureus-0017-00000090275-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/d22d95e9cdad/cureus-0017-00000090275-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/8baf7395c747/cureus-0017-00000090275-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/adc7aa9eefaa/cureus-0017-00000090275-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e3a7/12439228/e625a5c6a910/cureus-0017-00000090275-i05.jpg

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本文引用的文献

1
Congenital chylothorax: Current evidence-based prenatal and post-natal diagnosis and management.先天性乳糜胸：当前基于证据的产前和产后诊断与管理。
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Fetal intervention for congenital chylothorax is associated with improved outcomes in early life.先天性乳糜胸的胎儿干预与早期生活中更好的预后相关。
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Outcomes of fetuses with primary hydrothorax that undergo prenatal intervention (prenatal intervention for hydrothorax).
接受产前干预（针对胸腔积液的产前干预）的原发性胸腔积液胎儿的结局。
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Arch Dis Child Fetal Neonatal Ed. 2018 May;103(3):F245-F249. doi: 10.1136/archdischild-2016-311265. Epub 2017 Aug 5.
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The prognostic factors and outcomes of primary fetal hydrothorax with the effects of fetal intervention.原发性胎儿胸腔积液的预后因素、结局以及胎儿干预的效果
Prenat Diagn. 2017 Feb;37(2):184-192. doi: 10.1002/pd.4989. Epub 2017 Jan 19.
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Thoracoamniotic Shunting for Fetal Hydrothorax: Predictors of Intrauterine Course and Postnatal Outcome.胎儿胸腔积液的胸腔羊膜分流术：宫内病程及产后结局的预测因素
Fetal Diagn Ther. 2017;41(1):58-65. doi: 10.1159/000446110. Epub 2016 May 13.
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Prenatal Therapy Improves the Survival of Premature Infants with Congenital Chylothorax.产前治疗可提高先天性乳糜胸早产儿的存活率。
Pediatr Neonatol. 2016 Apr;57(2):127-32. doi: 10.1016/j.pedneo.2015.07.001. Epub 2015 Jul 30.
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Treatment of Primary Fetal Hydrothorax with OK-432 (Picibanil): Outcome in 14 Fetuses and a Review of the Literature.
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