Sasaoka N, Kitamura S, Kinouchi K, Fukumitsu K, Taniguchi A, Tohda A
Department of Anesthesiology, Osaka Medical Center & Research Institute for Maternal & Child Health.
Masui. 1998 Dec;47(12):1482-5.
We report perinatal and perianesthetic management of a female infant with sacrococcygeal teratoma who underwent fetal bladder puncture and postnatal tumor resection. At 33 weeks' gestation, fetal ultrasonography revealed an intrapelvic mass, oligohydramnios and the dilatation of the bladder. At 34 weeks' gestation, bladder puncture was performed in utero to relieve urinary obstruction by the mass. And it served to reserve the renal function but caused remarkable ascites at birth due to urine leakage to the peritoneum through the puncture site. After the delivery by cesarean section, the patient underwent the tumor extirpation at 2 days of life. The operation and anesthesia proceeded uneventfully. In previous reports, several mortalities due to exsanguinating hemorrhage during surgery have been reported. In addition, sacrococcygeal teratoma is occasionally accompanied by coagulopathy and high output cardiac failure caused by arteriovenous fistulae. Therefore it is important for good patient outcomes to evaluate preoperatively the risks mentioned above.
我们报告了一名患有骶尾部畸胎瘤的女婴的围产期及围麻醉期管理情况，该女婴接受了胎儿膀胱穿刺及出生后肿瘤切除术。妊娠33周时，胎儿超声检查发现盆腔内肿块、羊水过少及膀胱扩张。妊娠34周时，在子宫内进行膀胱穿刺以缓解肿块引起的尿路梗阻。这有助于保留肾功能，但由于尿液通过穿刺部位漏入腹膜，导致出生时出现明显腹水。剖宫产分娩后，患儿出生2天时接受了肿瘤切除手术。手术和麻醉过程顺利。在以往的报告中，曾有几例手术期间因大出血死亡的病例。此外，骶尾部畸胎瘤偶尔会伴有凝血病以及动静脉瘘引起的高输出量心力衰竭。因此，术前评估上述风险对于患者获得良好预后很重要。
