胎儿先天性心脏病产前诊断与生后治疗一体化模式的探讨

目的 探讨胎儿先天性心脏病产前诊断与生后治疗一体化模式.方法 2006年8月至2010 年5月共有46位孕妇在我院产前诊断出胎儿先心病并选择继续妊娠.在我院产科自然分娩或剖腹产,胎儿出生后24 h内复查心脏超声,连续监测经皮血氧饱和度,由小儿心内科、小儿心外科、新生儿科联合制定治疗和随访方案.结果 孕妇剖腹产36例,自然分娩10例;共分娩活产新生儿47例,男40例,女7例;平均胎龄(38.0±1.4)孕周,平均体重(3.00±0.44) kg;产前和生后主要心脏畸形诊断相符.10例动脉导管依赖型复杂先心病患儿新生儿期静脉滴注前列腺素E.23例接受外科手术治疗,其中15例于新生儿期手术.7例行内科介入治疗,4例经皮肺动脉瓣成形术,3例行房间隔或室间隔缺损封堵术.16例随访患儿中2例室间隔缺损自然愈合,7例房间隔缺损和5例室间隔缺损等待择期治疗,2例随访丢失.30例已治疗的患儿中21例心脏结构恢复正常,7例心脏瓣膜存在轻微改变,术后死亡2例(病死率6.7％).结论 产前诊断与生后治疗一体化模式符合先天性心脏病诊治的发展趋势,需要多科室合作,才能及早发现胎儿心脏畸形,预测胎儿出生后的变化,消除复杂先心病出生后的急危重状态,提高生后治疗的成功率.     

腹腔镜及开腹手术治疗小儿卵巢囊肿疗效比较

目的 对比观察腹腔镜及开腹手术治疗小儿卵巢囊肿疗效。方法 对比1998年1月至2001年12月39例小儿卵巢囊肿手术治疗效果及预后，其中21例行传统手术治疗，18例行腹腔镜手术。结果 行传统开腹手术的病人平均住院日为7．40—1．05d，其中2例(0．91％)因粘连性肠梗阻二次手术治疗，1例(0．49％)并发术后切口感染，行腹腔镜治疗的病人平均住院日为4．10—0．98d，随诊半年尚未发现并发症。结论 行腹腔镜卵巢囊肿切除术治疗效果优于传统术式。     

腹腔镜治疗儿童卵巢囊肿的体会

目的　探讨电视腹腔镜治疗儿童卵巢囊肿的效果及安全性。方法　回顾性分析 2 0 0 2年 4月～ 2 0 0 3年 11月 ,12例 13侧卵巢囊肿行腹腔镜下肿瘤剔除 切除术的疗效。结果　所有患儿经腹腔镜完成手术。平均手术时间 (5 8± 32 )min ,平均住院时间 3d ,无腹膜炎发生 ,全部患儿随访 4～18个月 ,未见复发。结论　腹腔镜手术治疗儿童卵巢囊肿是一种安全、有效的手术方法 ,值得推广     

胎儿先天性心脏病产前诊断与临床意义

先天性心脏病是最常见的出生缺陷之一.孕早期先天性心脏病筛查的方法主要有颈后透明层厚度测量、静脉导管血流测量以及直接进行胎儿超声心动图检查等.孕中期绝大部分的胎儿心脏病可以直接通过胎儿超声心动图检查获得诊断,除心脏解剖结构畸形外,心律失常的诊断以及心功能的评估也是重要检查内容.加强先天性心脏病的相关基因研究,也能够为产前...     

胎儿畸胎瘤的诊断与治疗

胎儿肿瘤不多见,随着产前超声检查的常规应用及超声技术水平的提高,绝大多数胎儿肿瘤可以在孕第12期末或第3期发现。畸胎瘤是最常见的胎儿肿瘤,是由包括内胚层、中胚层和外胚层3个胚层组织来源成分组成的肿瘤。超声检查肿瘤显示为含有实性、囊性或囊实性混合性肿物,通常富含血管,发生的解剖位置包括颅内、口咽、骶尾部、纵膈、腹部和性腺。     

孕妇外周血中胎儿RNA用于产前诊断的研究进展

无创性产前诊断是目前妇产科医学的研究热点之一,其方法多种多样,但都存在应用的局限性.该文综述近年来应用母血循环中发现的胎儿RNA进行某些疾病产前诊断的研究进展,表明该方法比应用母血中胎儿有核红细胞及胎儿DNA进行产前诊断有着其不可替代的优越性.随着分子遗传学研究的进展,该方法的应用前景十分广阔.     

保留卵巢手术治疗儿童卵巢囊肿蒂扭转16例报告

目的 探讨保留卵巢手术治疗儿童卵巢囊肿蒂扭转的经验.方法 回顾性分析2011年1月至2012年3月收治的儿童卵巢囊肿蒂扭转16例的临床资料.本组均行急诊开腹探查,行扭转囊肿手法复位,观察10 min,血运完全恢复、颜色改善明显或复位后10 min内组织缺血能有部分改善者,选择保留卵巢手术.结果 本组16例均成功实施保留卵巢的囊肿切除术.复位后10 min内,10例血运完全恢复;4例血运明显改善;2例复位前为黑紫色,复位后转变为浅紫色,均行保留卵巢的囊肿切除术.术后恢复顺利,无一例肺栓塞并发症发生.16例患儿术后随访3～17个月,卵巢血运恢复好.结论 儿童卵巢囊肿蒂扭转的早期诊断和及时手术非常关键,对于良性囊肿,应根据卵巢肿瘤扭转蒂复位后血运情况尽量保留患侧卵巢.     

胎儿神经外科与胎儿脑积水治疗进展

胎儿神经外科是指在宫内期对胎儿进行神经外科手术。近10年来，胎儿神经外科学领域出现了令人惊喜的进展。以前，胎儿神经外科仅仅停留在动物实验阶段，从上世纪末，人们开始尝试对各种胎儿先天性异常进行手术治疗，其中最主要的是针对胎儿脑积水的手术，本文就这些进展作一综述。     

肠闭锁产前诊断与产后诊疗21例体会

先天性肠闭锁是新生儿肠梗阻的常见原因,发病率约为1500-40000：1,男性略多于女性,过去有较高的死亡率。作者自2003年3月-2011年9月收治获产前诊断的21例先天性肠闭锁新生儿,出生后即早期手术治疗,取得了满意疗效。临床资料     

Fetal ovarian cysts: postnatal evolution and indications for surgical treatment

Fetal ovarian cysts are an increasingly common finding during routine prenatal ultrasonography (US). These lesions were occasionally diagnosed in the past, but only on the basis of a palpable abdominal mass or, rarely, because a twisted ovarian cyst caused an acute abdomen. Surgery is currently recommended for neonates after prenatal diagnosis, even in asymptomatic cases, when the cyst has a diameter larger than 5 cm or echographic findings suggest torsion or intracystic hemorrhage. In our 12 cases of suspected fetal ovarian cysts, wide variations in diameter were seen in 6 during pre- and postnatal follow-up. Two of these were not confirmed at birth; 7 were treated conservatively and excluding 1 perinatal death from multiple associated anomalies and 1 case lost to follow-up, the remaining cases showed uneventful, spontaneous regression of the cyst. Postnatal US signs suggesting necrosis secondary to torsion in a previously uncomplicated cyst and requiring surgery were seen in only 3 cases. Conservative treatment must be recommended in most prenatally diagnosed cysts; indications for surgery cannot be based only on dimensions. The incidence of complications has been overemphasized and the risk of associated malignancy is negligible in newborns, while possible size reduction and resorption can be expected in most cases. Nonoperative management may also be recommended when signs of torsion are seen before birth and spontaneous asymptomatic involution of the cystic ovary is documented in early postnatal life. Accurate clinical and US follow-up is mandatory in all cases. Surgery must be reserved for symptomatic cases or when an alteration of the cystic structure is documented by US in a previously uncomplicated cyst.     

Neonatal ovarian cysts: management and follow-up

Twenty-seven neonatal ovarian cysts were diagnosed in utero during a 13-year period; 9 were complicated and 18 were initially simple, but 8/18 showed evidence of complications in utero or soon after birth, leaving only 10 simple cysts. One simple and 4 complicated cysts were surgically excised early in the study period; 2 simple cysts were treated by needle aspiration at birth because of their large size. The remaining 20 cases were initially managed conservatively. All simple cysts and 10/13 complicated cysts regressed completely within 12 months; 3 that failed to regress were surgically excised. Nineteen patients who did not undergo a laparotomy had ultrasonographic (US) examinations from 3 months to 9 years after birth. Echography showed both ovaries in all 9 girls who had simple cysts at birth and in 2 of the 10 with complications. In the other 8 complicated cases only one ovary was detected at follow-up. Pre- or post-natal aspiration of simple cysts 4 cm or more in diameter is recommended, while conservative management seems appropriate in the absence of symptoms for simple cysts of less than 4 cm and complicated cysts of any size tending to involute after birth. Accepted: 7 July 1999     

Neonatal ovarian cysts

Twelve cases of ovarian cysts are reported. The diagnosis was made antenatally by ultrasound scan. The authors consider the ultrasonic images of these cysts and signs of in-utero torsion, the antenatal and postnatal evolution, the pathological findings at surgery, and the histological results for six children that were operated. A review of the literature enables us to describe the possible complications in the evolution of this tumor and to discuss the perinatal management of the ovarian cyst, which depends on the appearance and diameter of the cyst and on its evolution. Offprint requests to: J. Gaudin     

腹腔镜治疗新生儿卵巢囊肿

目的探讨新生儿卵巢囊肿的治疗方法。方法对腹腔镜手术治疗的13例新生儿及小婴儿卵巢囊肿进行了回顾性总结。7例年龄小于1个月,单侧12例,双侧1例,产前B超发现12例;单纯型6例,复杂型7例。结果手术证实单纯型均无并发症发生,其中5例为新生儿。复杂型中6例并发扭转,其中1例病理诊断双侧卵巢颗粒细胞瘤;另1例复杂型实为卵巢囊性畸胎瘤。所有患儿无术中和术后并发症。结论产前B超发现的卵巢囊肿,复杂型及囊肿大于5cm的单纯型应及时腹腔镜手术。     

Percutaneous drainage as the treatment of choice for neonatal ovarian cysts

Background Involution of neonatal ovarian cysts occurs usually by 12 months. Persisting cysts larger than 4 cm are prone to torsion. Two modes of therapy are advocated: surgery and percutaneous US-guided cyst aspiration.Objective To compare ovarian preservation following the use of US-guided aspiration or conventional surgery for the treatment of large asymptomatic neonatal ovarian cysts, and to suggest alternative treatment when intrauterine ovarian torsion occurs.Materials and methods The study population comprised 25 baby girls with an ovarian cyst, 5 with a simple cyst and 20 with a complex cyst. Of these 25 infants, 8 had surgery and 17 had US-guided cyst aspiration.Results In the surgical group of 8, 6 underwent oophorectomy, and in 2 the ovary was saved. In the aspirated group of 17, the ovary was saved in 10, and was lost in 5. At the time of this report one patient was still in the follow-up period, and one was lost to follow-up.Conclusion US-guided aspiration of large neonatal cysts preserves ovarian tissue in a higher percentage of patients than surgery. It is safe, effective, and repeatable. We recommend US-guided aspiration of asymptomatic large ovarian cysts for salvage or for decompression if intrauterine ovarian torsion occurs. Surgery should be reserved for patients with acute torsion, intestinal obstruction and intestinal volvulus.     

Ovarian cysts in newborns

Before the introduction of ultrasonography (US), ovarian cysts in newborns were thought to be rare. With the extended use of real-time US, prenatal detection has increased. There is still considerable controversy regarding the best treatment of these neonatal findings. A total of 27 instances in 24 consecutive newborns of antenatally-diagnosed ovarian cysts were reviewed for US data, management, and outcome to assess the ante- and postnatal evolution of the cyst and establish appropriate therapy. The cysts detected during pregnancy were studied by repeated postnatal US studies. In 10 children (2 with bilateral cysts) the cyst evolved spontaneously toward regression. Fourteen patients were operated upon; 10 had complex and 4 (in 1 bilateral) had simple cysts. Cystectomy was employed when possible to preserve the ovarian parenchyma (3 cases); in the remaining cases oophorectomy was performed. Histologically, the cysts were of follicular origin or necrosis made a diagnosis impossible. US was found to be a helpful diagnostic tool for simple ovarian cysts, but could not reliably distinguish between benign and malignant tumors if a sonographically complex lesion was present. Based on our experience, surgical management of ovarian cysts should be reserved to complex masses. Simple cysts can be monitored safely by close US follow-up; surgery is indicated if the cyst fails to regress after several months or becomes symptomatic. Accepted: 9 March 2000     

Ovarian cysts in the newborn

Due to prenatal and perinatally performed real-time sonography, ovarian cysts are more frequently detected than before, but patients are still treated mainly after development of symptoms. We report the clinical courses of seven babies with large cysts who were asymptomatic or presented with abdominal distension, incarcerated hernia, or vomiting. The cysts were unechogenic and 3–8 cm in size with torsion in five and adhesions to the gut in three cases. Histologically, the cysts were either of follicular origin or necrosis made a distinction impossible. In our opinion, every large cyst and solid mass should be removed and examined histologically to verify the diagnosis because of the threat of complications and the possibility of malignancy. Only small, echo-free cysts may be treated expectantly with close follow-up. Correspondence to: P. Hengster     

新生儿卵巢囊肿蒂扭转的诊治

目的 通过总结本院收治的8例新生儿卵巢囊肿蒂扭转的临床资料,探讨新生儿卵巢囊肿蒂扭转的诊治经验.方法 回顾性分析2001年1月～2006年6月治疗的8例新生儿卵巢囊肿,年龄为出生后2 h～30 d,出生前经B超诊断胎儿腹部囊性病变7例;因出生后发现外阴分泌物增多就诊,B超检查有腹腔内囊性占位1例.结果 开腹手术6例,腹腔镜手术2例.8例卵巢囊肿蒂扭转360°～1800°,顺时针扭转5例,逆时针扭转3例.囊肿最小2.5 cm × 3.0 cm× 2.0 cm,最大6.0 cm×9.0 cm×10.0 cm.术后病理结果显示囊性畸胎瘤1例,卵泡囊肿4例,血肿及纤维囊壁组织伴灶性钙化3例.结论 新生儿卵巢囊肿蒂扭转罕见,但是通过对具有高危因素的胎儿进行产前B超可早期发现.根据患儿具体情况采取合适的手术方式,对可疑病例可行腹腔镜检查.     

新生儿腹腔囊性肿块108例病理与临床结果

目的分析新生儿期腹腔囊性肿块患儿的病因、病理、预后及转归。方法收集2008年8月至2013年7月我院新生儿外科术前诊断腹腔囊性肿块的病例,分析其性别、入院日龄、病因、治疗效果、病理及随访,总结预后及转归。结果 108例患儿中男女比例为40∶68;入院日龄3 h至28天,平均12天;住院日8～23天,平均11.2天;105例为足月儿,3例为早产儿。产前检查发现腹腔肿块42例（36例择期剖宫产）,新生儿期发现66例（27例剖宫产分娩）。91例患儿在新生儿期完成手术,15例患儿在生后1～3个月实施手术,均痊愈出院,另2例未行手术治疗。术后病理证实：胆总管囊肿51例,卵巢囊肿25例,肠源性囊肿16例,肠系膜淋巴管瘤6例,其他8例。2例开腹胆总管囊肿根治术患儿术后因粘连性肠梗阻再次行肠粘连松解术,恢复良好,其余手术患儿均健康成长。结论新生儿腹腔囊性肿块以女性稍多见,胆总管囊肿和卵巢囊肿占大部分,肠源性囊肿和肠系膜淋巴管瘤也是常见原因。新生儿腹腔囊性肿块患儿绝大多数预后良好,转归满意。     

Large fetal ovarian cyst: prenatal diagnosis and treatment

A female infant with a large ovarian cyst is presented. This was the first case diagnosed antenatally and operated upon in a Hong Kong Chinese. A review of the literature is made and the underlying reasons for the discrepancies in incidence in various countries are discussed. Correspondence to: A. K. Y. Lam