目的 探讨巨大胎盘绒毛膜血管瘤(CA)终止妊娠时机的选择。方法 回顾性分析2003年1月至2012年12月间本院分娩的7例巨大CA孕妇，监测胎儿生长发育及肿瘤的生长情况，测量胎儿脐动脉、脐静脉、静脉导管等血流频谱参数，计算胎儿心胸面积比值及心肌做功指数，重点监测胎儿的心功能改变，适时终止妊娠，随访妊娠结局。结果 1例患者巨大CA（90mm×70mm）位于胎盘边缘，未出现胎儿心功能异常，足月分娩一活男婴，体重等生长发育正常。6例肿瘤位于脐带根部，其中2例死胎引产产后病理诊断CA，引产孕周分别为26+4周和30+4周，肿瘤大小分别为200mm×170mm和50mm×40mm；4例胎儿出现心功能异常：1例孕29周肿瘤增长迅速，1周后由175mm×104mm增至210mm×190mm，胎儿生长受限、心功能异常，遂放弃胎儿引产；1例孕37+5周合并胎儿心脏扩大合及心包积液，孕38+1周剖宫产终止妊娠，产后测量肿瘤大小为125mm×105mm，随访5年，预后好；1例孕30周诊断巨大CA，大小约87mm×82mm，孕35+1周发现胎儿心功能不全合并右心室增厚、心包腔积液，于35+2周剖宫产分娩，产后测量肿瘤大小为100mm×100mm，随访6个月以上，除了婴儿卵圆孔未闭，其生长发育基本正常；1例外地来院会诊，诊断“孕32+6周，胎儿心功能不全、胎儿水肿”，因经济原因未能及时终止妊娠，5天后出现死胎引产，产后测量肿瘤大小为130mm×100mm。结论 巨大胎盘绒毛膜血管瘤若没有位于脐带根部，一般不影响妊娠结局；若位于脐带根部，重点动态监测胎儿心功能状况，巨大CA合并胎儿心功能异常是终止妊娠的信号。
Objective To observe the time of terminating the pregnancy in giant placental chorioangioma（CA）with abnormal fetal cardiac function. Method 7 cases of CA pregnancies were enrolled. Cardiac function of fetus and Doppler patterns of the umbilical artery, umbilical vein, ductus venosus and myocardial performance index of both ventricles were assessed. Results A placental tumouration, 90mm×70mm, far away from the umbilical cord, was detected by ultrasound in her 31 gestational weeks. She has no pregnancy complications and had an a term delivery with a male baby whose weight was 3 700g. The remaining 6 cases of placenta chorioangioma were exactly located in the umbilical cord. Umbilical venous pulsation was found in 4 fetuses. Two fetuses showed increased cardiothoracic ratio and pericardial effusion，pulsation index of the ducts venous in fetus was significant higher than that of controls. The two living babies were small for gestational age infant, whose basic growth are normal except patent foramen ovule after six months of following-up. Conclusions This tumor is not generally associated to maternal fetal complications, unless the tumor size surpasses a diameter of 5 cm and/or is near the place of umbilical cord insertion. Mild cardiovascular abnormalities were found in fetus, and follow-up examination were helpful to the assessment of severity of this disease. Abnormal cardiovascular function in fetus of giant placental chorioangioma is the signal of terminating pregnancy. The prognosis will be improved on the basis of the timely termination of pregnancy.
