胸腔-羊膜腔引流术治疗胎儿胸部疾病的妊娠结局分析 [中文引用][英文引用]

目的 探讨胎儿胸腔羊膜腔分流术对胎儿胸部疾病的治疗价值。方法 本研究选择10例经超声诊断为胎儿胸部疾病接受胸腔羊膜腔分流术的病例，分为胎儿胸腔积液组（FHT，4例）、肺隔离症组（BPS，2例）、不明原因胎儿水肿伴重度胸腔积液组（水肿组，4例），对其临床资料进行回顾性分析，探讨胸腔-羊膜腔分流术对胎儿胸部疾病治疗的临床价值。结果 ①4例FHT生存率达100%，50%发生引流管移位及早产，且存在新生儿期并发症；②水肿组胎儿生存率达50%，均为早产出生，1例因染色体异常选择性终止妊娠，1例产后确诊noonan综合征新生儿死亡；③1例BPS术后流产，1例带管至足月出生，新生儿手术后肺发育不良，新生儿死亡。结论 胸腔-羊膜腔分流术可用于治疗原发性重度胸腔积液及伴重度胸腔积液不明原因胎儿水肿有良好的治疗效果，可有效改善妊娠结局，但应用于肺隔离症，其预后与肺发育程度相关。

Objective Study on the therapeutic effect of amnioinfusion in singleton pregnancy with oligohydramnios. Methods A retrospective study was conducted on 391 single pregnant women with oligohydramnios diagnosed by the Medical Genetics Center of Guangdong Maternal and Child Health Hospital from January 2015 to December 2018, excluding cases of oligohydramnios caused by chromosome abnormalities and premature rupture of membranes. amnioinfusion was performed in 45 patients, and the surgical methods, complications and pregnancy outcomes were analyzed. Results A total of 45 pregnant women with oligohydramnios underwent amnioinfusion for 50 times. The average gestational week at the time of the first amnioinfusion was 24 (18 to 34) weeks, and the average perfusion volume was 112 (40 to 250) milliliters. After the first amnioinfusion, the average gestational weeks were 6 (1 to 17) weeks and 36 (29 to 40) weeks, respectively. the average gestational weeks after the first amnioinfusion were 6 (1 to 17) weeks and 36 (29 to 40) weeks, respectively. Of the 45 cases, 27 cases were idiopathic oligohydramnios (60%). The abnormal ultrasound findings of fetus included fetal growth restriction, abnormal blood flow of umbilical artery and enhanced echo of intestine. In 45 cases of oligohydramnios, 10 cases (22.2%) were induced labor due to absence of amniotic fluid, FGR and umbilical artery blood flow, and 4 cases (6.7%) had complications such as postoperative abortion, premature rupture of membranes, fetal death and preterm delivery, respectively. 2 cases (4.4%) died of preterm birth. The overall fetal survival rate was 64.4% (29 / 45), of which the survival rate of idiopathic oligohydramnios was 40% (18 / 45). When amniotic fluid dark area ≤ 1cm, the survival rate was 8.9% (4 / 45). The survival rate of 21 patients with oligohydramnios before 28 weeks of gestation was 22.2% (10 / 45). There were 13 patients with FGR, 7 of them had FGR, before 28 weeks of gestation. The postoperative survival rate was 15.6% (7 / 45). During the follow-up after birth, 1 case of fetal intestinal obstruction underwent surgical treatment, and the growth and development is good at present. There were 5 cases of growth retardation and intellectual development, of which 3 cases were FGR. Conclusions amnioinfusion can effectively prolong the gestational weeks and is an effective method for the treatment of oligohydramnios, but the pregnancy outcome is related to the severity of fetal oligohydramnios, premature occurrence of oligohydramnios and FGR.