Quintero R A, Reich H, Romero R, Johnson M P, Gonçalves L, Evans M I
Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, MI, USA.
Ultrasound Obstet Gynecol. 1996 Jul;8(1):48-52. doi: 10.1046/j.1469-0705.1996.08010048.x.
Clinically significant chorioangiomas, i.e. those greater than 4 cm in diameter, are associated with an overall fetal loss rate of approximately 40%. Maternal complications may also be present. Most patients diagnosed with chorioangiomas have been managed expectantly. A patient with a large chorioangioma was referred to our institution, with a fetus that was hydropic and showed sonographic signs of over heart failure. Fetal anemia, marked erythropoiesis and hypoalbuminemia were documented on cordocentesis. The blood supply to the mass consisted of an artery and a vein of 9 mm in diameter. The vascular supply to the tumor was ablated via operative fetoscopy by suture ligation of the arterial supply, after subchorionic dissection of the vessel. The remaining blood supply was electrocoagulated with bipolar cautery. Although the procedure was technically successful, the fetus died on the 3rd postoperative day. This case illustrates ablation of the blood supply of placental chorioangiomas as a potential management alternative for those patients with large chorioangiomas. Early identification and treatment may result in a successful outcome.
具有临床意义的绒毛膜血管瘤，即直径大于4厘米的那些，与大约40%的总体胎儿丢失率相关。也可能出现母体并发症。大多数被诊断为绒毛膜血管瘤的患者一直采取期待治疗。一名患有大绒毛膜血管瘤的患者被转诊至我们机构，其胎儿出现水肿并显示出超声心动图上的心力衰竭迹象。脐血穿刺记录显示胎儿贫血、显著的红细胞生成和低白蛋白血症。肿块的血液供应由一条直径9毫米的动脉和一条静脉组成。在对血管进行绒毛膜下剥离后，通过手术胎儿镜检查，经缝合结扎动脉供应，对肿瘤的血管供应进行了消融。剩余的血液供应用双极电凝器进行电凝。尽管该手术在技术上是成功的，但胎儿在术后第3天死亡。这个病例说明了胎盘绒毛膜血管瘤血液供应的消融作为那些患有大绒毛膜血管瘤患者的一种潜在治疗选择。早期识别和治疗可能会带来成功的结果。
