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目的探讨胎儿先天性肺囊性腺瘤样畸形(CCAM)的临床特点和预后。方法回顾性分析2004年2月至2009年7月在复旦大学附属妇产科医院经产前超声诊断为CCAM的35例胎儿的临床资料。超声监测CCAM病灶大小及并发症的变化。结果超声检查提示:Ⅰ型15例,Ⅱ型11例,Ⅲ型8例,Ⅰ型合并Ⅲ型1例。14例合并纵隔或心脏移位,3例合并羊水过多,3例合并颈部透明带增厚,1例合并脑积水,2例合并胎儿生长受限,1例合并胎儿腹水和水肿,1例合并羊水过多和消化道畸形。7例行羊水穿刺染色体检查,未发现异常核型。8例诊断后失访。27例随访病例中,1例伴有水肿和腹水的胎儿孕29周胎死宫内,11例孕妇终止妊娠,15例胎儿分娩。15例婴儿中,6例妊娠期间病灶消失,4例产后病灶消失,2例未消失,3例暂未随访。产后15例婴幼儿身体健康。结论胎儿水肿和腹水是胎儿预后不良的因素。如果胎儿未出现水肿、腹水,未合并其他畸形,胎儿CCAM预后良好,可继续妊娠。
Objective To investigate the clinical characteristics and prognosis of fetal congenital cystic adenomatoid malformation (CCAM). Methods The clinical data of 35 fetuses diagnosed as CCAM by prenatal ultrasound at the Obstetrics and Gynecology Hospital of Fudan University from February 2004 to July 2009 were retrospectively analyzed. Ultrasound monitoring of CCAM lesion size and complications. Results Ultrasound examination revealed 15 cases of type Ⅰ, 11 cases of type Ⅱ and 8 cases of type Ⅲ, and 1 case of type Ⅰ and Ⅲ. 14 patients had mediastinal or cardiac transposition, 3 had polyhydramnios, 3 had thickening of the cervical zona pellucida, 1 had hydrocephalus, 2 had fetal growth restriction, 1 had fetal ascites and edema, 1 Cases of polyhydramnios and gastrointestinal malformations. Seven routine amniocentesis chromosome examination, no abnormal karyotype was found. 8 cases were lost after the diagnosis. 27 cases were followed up, 1 case with edema and ascites fetal 29 weeks of fetal death in the womb, 11 cases of pregnant women termination of pregnancy, 15 cases of childbirth. In 15 infants, 6 cases disappeared during pregnancy, 4 cases disappeared after delivery, 2 cases did not disappear, and 3 cases were not yet followed up. 15 cases of postpartum healthy infants and toddlers. Conclusion Fetal edema and ascites are the factors of poor fetal prognosis. If the fetus does not appear edema, ascites, no other deformities, fetal CCAM prognosis is good, can continue to pregnancy.