胚外体腔穿刺术的初步临床研究

目的 :探讨胚外体腔液穿刺术的实施方法、短期安全性及临床应用的可行性。方法 :孕 6～ 12周要求人工流产的孕妇 6 2例 ,在人流前行胚外体腔穿刺术抽取胚外体腔液 ,对其中 30例在穿刺 2～ 14d后再行人流术 ,随访期间观察孕妇流产率 ,穿刺前及穿刺后 1,5min ,2～ 14d后的胎心率变化 ,穿刺前后CRL变化 ,穿刺前后 15min母体血清甲胎蛋白 (AFP)浓度的变化。结果 :胚外体腔穿刺的总成功率为 95 .2 %。穿刺均在 5min内完成。孕 7～ 10周者一次穿刺成功率为 90 % ,孕 6～ 7周者为 2 0 % ,孕 10～ 12周者为4 3%。胚外体腔液中含有一定量的体腔细胞。 30例孕妇在随访期间 1例胎死宫内 ,与高热和病毒感染有关。穿刺前及穿刺后 5min与 2～ 14d后胎心率无明显变化 (P >0 .0 5 )。随访结束后预测胎龄 (根据穿刺前CRL计算的胎龄 +随访天数 )与实际胎龄 (根据穿刺后CRL计算的胎龄 )差异无显著性 (P >0 .0 5 )。穿刺前后血清AFP浓度变化差异无显著性(P >0 .0 5 )。结论 :胚外体腔穿刺术操作简单易行 ,穿刺成功率高 ,穿刺的最佳时间为孕 7～ 10周 ,这是一种较为安全的产前诊断取材术 ,穿刺术后短期内对胎儿的生长无影响 ,对胎盘无损害

A clinical study on coelocentesis

Objective:To explore the techniques of coelocentesis and evaluate the feasibility of sampling coelomic fluid.Methods:Coelocentesis was performed in 62 women scheduled for at 6～12 weeks of gestation.Of 62 cases,30 women accepted elective termination of pregnancy 2～14 days after coelocentesis.During the following up period,the following values were observed (1) the rate of miscarriages,(2)fetal heart rate (FHR) before the procedure and 1,5 min and 2～14 days afterwards.(3)fetal crown rump length (CRL) before the procedure and 2～14 days afterwards.(4)maternal serum concentration of alpha fetoprotein (AFP) before coelocentesis and 15 min afterwards.Results:Coelocentesis was performed sussessfully in 95.2% of all cases in five minutes.The coelomic fluid was successfully aspirated at first attempt in 90% at 7～10 week's gestation,20% at 6～7 weeks,43% at 10～12weeks.Of 30 cases, there was only one fetal loss died of high fever and virus infection.There was no significent difference between FHR before coelocentesis compared to the values at 5 min and 2～14 days afterwards (P>0.05).There were no significent difference between maternal serum AFP concentration before the procedure compared to the value at 15 min afterwards (P>0.05).Conclusion:Coelocentesis procedure is technically simple and the optimal time for the procedure is at 7～10 week’s gestation.The procedure of coelocentesis is safe for mother and fetus,with no obvious influence on the fetal growth and is not associated with the placental haemorrhage.