中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
12期
817-821
,共5页
沈淳%庄于修%顾蔚蓉%任芸芸%郑珊%董岿然%肖现民
瀋淳%莊于脩%顧蔚蓉%任蕓蕓%鄭珊%董巋然%肖現民
침순%장우수%고위용%임예예%정산%동규연%초현민
先天畸形%产前诊断%转诊和会诊%医师诊疗模式%围产期%预后
先天畸形%產前診斷%轉診和會診%醫師診療模式%圍產期%預後
선천기형%산전진단%전진화회진%의사진료모식%위산기%예후
Congenital abnormalities%Prenatal diagnosis%Referral and consultation%Physician's practice patterns%Peripartum period%Prognosis
目的：总结产前多学科会诊胎儿结构畸形的经验，探讨适于我国的多学科会诊模式。方法复旦大学附属妇产科医院和复旦大学附属儿科医院联合建立了多学科会诊中心，由产科、儿科、儿外科、超声科等科室共同参与。2003年7月31日至2013年8月1日，共对3378例孕妇进行会诊。按会诊后的处理结果分为终止妊娠、继续妊娠和围产期治疗3类。以回执单表格及电话形式进行跟踪随访，回顾性分析会诊原因、胎儿结构畸形的系统分类、发生顺位、诊断孕周、母体相关因素、处理方法及预后。结果（1）会诊原因：3378例产前多学科会诊病例中，因胎儿因素会诊者3243例，占96.00%（3243/3378）；因母体因素会诊者135例，占4.00%（135/3378）。（2）胎儿结构畸形的分类：3243例因胎儿因素会诊者中，胎儿结构畸形占80.85%（2622/3243），排列前3位的分别是神经系统畸形（23.19%，608/2622）、泌尿系统畸形（20.25%，531/2622）和心血管系统畸形（15.48%，406/2622），其次为消化系统畸形、骨骼四肢畸形及不同部位的占位性病变。共有156例多发畸形。（3）胎儿结构畸形的诊断孕周：2622例胎儿结构畸形的平均诊断孕周为（26.7±2.1）周（21.1~30.4周）。泌尿系统畸形诊断较早，为（24.0±0.7）周；消化系统畸形诊断较晚，为（28.3±2.6）周。（4）引产病例：引产935例（因胎死宫内引产92例，主动选择引产843例），占35.66%（935/2622）。多发畸形的引产率最高（75.64%，118/156），其次为腹裂和脐膨出（62.22%，28/45）、膈疝（61.54%，24/39）、唇腭裂（55.32%，26/47）和心血管系统畸形（49.51%，201/406）。神经系统、泌尿系统和消化系统畸形引产率分别为27.80%（169/608）、25.80%（137/531）和26.94%（66/245），均低于30%。腹腔占位和骶尾部畸胎瘤引产率分别为14.04%（25/178）和13.64%（3/22），均低于15%。（5）继续妊娠：共1687例，其中剖宫产1046例（61.94%），新生儿死亡117例（6.94%）。（6）围产期治疗病例：21例在妊娠期接受治疗，其中胎儿胸、腹水引流13例，采用宫内输血治疗胎儿贫血5例，采用地高辛治疗胎儿心动过速3例。10例分娩时子宫外产时处理。297例出生后立即转新生儿外科，其中259例在新生儿期行根治性手术；11例行姑息性手术；16例随访后择期手术。结论产前多学科会诊模式可对胎儿预后作出多学科的综合评估并提出处理建议，提高可治疗结构畸形的诊治率和改善预后。
目的：總結產前多學科會診胎兒結構畸形的經驗，探討適于我國的多學科會診模式。方法複旦大學附屬婦產科醫院和複旦大學附屬兒科醫院聯閤建立瞭多學科會診中心，由產科、兒科、兒外科、超聲科等科室共同參與。2003年7月31日至2013年8月1日，共對3378例孕婦進行會診。按會診後的處理結果分為終止妊娠、繼續妊娠和圍產期治療3類。以迴執單錶格及電話形式進行跟蹤隨訪，迴顧性分析會診原因、胎兒結構畸形的繫統分類、髮生順位、診斷孕週、母體相關因素、處理方法及預後。結果（1）會診原因：3378例產前多學科會診病例中，因胎兒因素會診者3243例，佔96.00%（3243/3378）；因母體因素會診者135例，佔4.00%（135/3378）。（2）胎兒結構畸形的分類：3243例因胎兒因素會診者中，胎兒結構畸形佔80.85%（2622/3243），排列前3位的分彆是神經繫統畸形（23.19%，608/2622）、泌尿繫統畸形（20.25%，531/2622）和心血管繫統畸形（15.48%，406/2622），其次為消化繫統畸形、骨骼四肢畸形及不同部位的佔位性病變。共有156例多髮畸形。（3）胎兒結構畸形的診斷孕週：2622例胎兒結構畸形的平均診斷孕週為（26.7±2.1）週（21.1~30.4週）。泌尿繫統畸形診斷較早，為（24.0±0.7）週；消化繫統畸形診斷較晚，為（28.3±2.6）週。（4）引產病例：引產935例（因胎死宮內引產92例，主動選擇引產843例），佔35.66%（935/2622）。多髮畸形的引產率最高（75.64%，118/156），其次為腹裂和臍膨齣（62.22%，28/45）、膈疝（61.54%，24/39）、脣腭裂（55.32%，26/47）和心血管繫統畸形（49.51%，201/406）。神經繫統、泌尿繫統和消化繫統畸形引產率分彆為27.80%（169/608）、25.80%（137/531）和26.94%（66/245），均低于30%。腹腔佔位和骶尾部畸胎瘤引產率分彆為14.04%（25/178）和13.64%（3/22），均低于15%。（5）繼續妊娠：共1687例，其中剖宮產1046例（61.94%），新生兒死亡117例（6.94%）。（6）圍產期治療病例：21例在妊娠期接受治療，其中胎兒胸、腹水引流13例，採用宮內輸血治療胎兒貧血5例，採用地高辛治療胎兒心動過速3例。10例分娩時子宮外產時處理。297例齣生後立即轉新生兒外科，其中259例在新生兒期行根治性手術；11例行姑息性手術；16例隨訪後擇期手術。結論產前多學科會診模式可對胎兒預後作齣多學科的綜閤評估併提齣處理建議，提高可治療結構畸形的診治率和改善預後。
목적：총결산전다학과회진태인결구기형적경험，탐토괄우아국적다학과회진모식。방법복단대학부속부산과의원화복단대학부속인과의원연합건립료다학과회진중심，유산과、인과、인외과、초성과등과실공동삼여。2003년7월31일지2013년8월1일，공대3378례잉부진행회진。안회진후적처리결과분위종지임신、계속임신화위산기치료3류。이회집단표격급전화형식진행근종수방，회고성분석회진원인、태인결구기형적계통분류、발생순위、진단잉주、모체상관인소、처리방법급예후。결과（1）회진원인：3378례산전다학과회진병례중，인태인인소회진자3243례，점96.00%（3243/3378）；인모체인소회진자135례，점4.00%（135/3378）。（2）태인결구기형적분류：3243례인태인인소회진자중，태인결구기형점80.85%（2622/3243），배렬전3위적분별시신경계통기형（23.19%，608/2622）、비뇨계통기형（20.25%，531/2622）화심혈관계통기형（15.48%，406/2622），기차위소화계통기형、골격사지기형급불동부위적점위성병변。공유156례다발기형。（3）태인결구기형적진단잉주：2622례태인결구기형적평균진단잉주위（26.7±2.1）주（21.1~30.4주）。비뇨계통기형진단교조，위（24.0±0.7）주；소화계통기형진단교만，위（28.3±2.6）주。（4）인산병례：인산935례（인태사궁내인산92례，주동선택인산843례），점35.66%（935/2622）。다발기형적인산솔최고（75.64%，118/156），기차위복렬화제팽출（62.22%，28/45）、격산（61.54%，24/39）、진악렬（55.32%，26/47）화심혈관계통기형（49.51%，201/406）。신경계통、비뇨계통화소화계통기형인산솔분별위27.80%（169/608）、25.80%（137/531）화26.94%（66/245），균저우30%。복강점위화저미부기태류인산솔분별위14.04%（25/178）화13.64%（3/22），균저우15%。（5）계속임신：공1687례，기중부궁산1046례（61.94%），신생인사망117례（6.94%）。（6）위산기치료병례：21례재임신기접수치료，기중태인흉、복수인류13례，채용궁내수혈치료태인빈혈5례，채용지고신치료태인심동과속3례。10례분면시자궁외산시처리。297례출생후립즉전신생인외과，기중259례재신생인기행근치성수술；11례행고식성수술；16례수방후택기수술。결론산전다학과회진모식가대태인예후작출다학과적종합평고병제출처리건의，제고가치료결구기형적진치솔화개선예후。
Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.
