产时子宫外处理技术治疗胎儿先天性肺囊性腺瘤样畸形的初步探讨

目的 初步探讨采用产时子宫外处理技术（EXIT）治疗胎儿先天性肺囊腺瘤样畸形的可行性.方法 2010年10月至2012年6月我们对3例胎儿先天性肺囊腺瘤样畸形采用产时子宫外处理技术切除.3例均经2次以上产前彩超诊断为先天性肺囊腺样畸形,且巨大畸形导致胎儿心脏、纵隔部分或全部移位,术前计算CVR值均大于1.6.结果 3例术后均存活,其中男1例,女2例,手术时胎龄36 ～37＋周,平均（36.86±0.79）周,体重2 700～3 000 g,平均（2 866.67±152.75）g;麻醉时间130～134 min,平均（133.67 ±3.51）min;总手术时间92～98 min,平均（94.33 ±3.21） min;手术时间33～49 min,平均（42.67±8.50） min;术中出血量2～20 mL;平均（10.67±9.02） mL.术后病理检查结果均为肺囊性腺瘤样畸形,左肺2例,右肺1例.结论 产时子宫外处理可以作为治疗高风险先天性肺囊腺样畸形的方法之一,但因手术风险大,操作较复杂,需多学科团队进行合作,需严格把握该技术的适应证,结合各方面条件,谨慎选择.

The experience of EX utero Intrapartum Treatment to treat congenital cystic adenomatoid malformation of the lung in fetal

Objetive To approach the experience of EX utero Intrapartum Treatment to treat congenital cystic adenomatoid malformation of the lung in fetal.Methods Between October 2010 and June 2012,3 fetuses with congenital cystic adenomatoid malformation of the lung to cure by EX utero Intrapartum Treatment in FoShan Women and Children＇s Hospital of NanFang medical university were analyzed retrospectively.All of 3cases underwent prenatal ultrasound diagnostic technology and confirmed those fetuses with congenital cystic adenomatoid malformation which lead to persistent cardiac and mediastinal compression.Before the operation,CCAM-volume ratio were calculated greater than 1.6.Results All of 3 cases patients were survival,of which 1 males and 2 females,gestational age at the time of surgery 36～ 37 ＋4 w,average （36.86-± 0.79） w; fetuse weight 2 700 ～ 3 000 g,average （2 866.67 ± 152.75）g; anesthesia time 130 ～ 134 min,average 133.67 ±3.51 min ; total operation time 92 ～ 98 min,average（94.33 ± 3.21） min ; fetal surgery time 33 ～ 49 min,average （42.67 ± 8.50） min; fetal operation bleeding volume 2 ～ 20 mL,average （10.67 ± 9.02） mL.Pathology：2 cases were the left lung cystic adenomatoid malformation,I case was the right lung cystic adenomatoid malformation.Conclusion The Exutero intrapartum treatment is a favorable therapeutic approach for those fetuses with congenital cystic adenomatoid malformation which lead to persistent cardiac and mediastinal compression.