胎儿先天性肺囊腺瘤样畸形和肺隔离症的妊娠结局病例及系统回顾分析

发布时间：2018-04-01 08:11

本文选题：胎儿肺囊腺瘤样畸形(CCAM)　切入点：肺隔离症(BPS)　出处：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨先天性肺囊腺瘤样畸形(CCAM)和肺隔离症(BPS)胎儿的妊娠结局以及类固醇激素治疗情况,为遗传咨询、优生优育提供临床建议。方法:临床回顾性分析2006年1月至2016年12月因胎儿CCAM和BPS在我院产前诊断中心就诊的17例单胎孕妇和其中接受治疗的7例孕妇,随访并分析产前诊断结果、妊娠结局、激素治疗情况及新生儿出生情况。检索PubMed、Embase、CNKI及WanFang Data数据库中关于激素治疗胎儿CCAM和BPS的文献,进行系统回顾分析。结果:就诊的17例孕妇中,2例胎儿染色体异常,其中1例9号染色体臂间倒位继续妊娠。余胎儿染色体正常的孕妇中,1例失访,2例自行引产。继续妊娠的13例孕妇中,6例CVR1.6,无合并症,足月分娩存活。7例因CVR1.6或胎儿水肿予激素治疗,结果:胎儿存活率71.43%,水肿胎儿存活率33.33%,剖宫产率20%,均足月分娩。系统评价部分,纳入8篇文章,共97个对象。经治疗后胎儿存活率、肿块减小率分别为53%~100%、62%~100%。合并水肿的胎儿,治疗后水肿好转率54%~100%,存活率46~80%。研究中,剖宫产率为18%~60%,早产发生率为9%~27%,汇总分析后,其剖宫产率28.9%,早产率18.4%。在亚组分析中,单疗程组在胎儿存活率和水肿缓解率方面与多疗程组相比,无统计学差异。结论:胎儿CCAM和BPS属解剖结构异常,建议行胎儿染色体核型分析产前诊断。对于高危的CCAM和BPS胎儿,应用激素可改善胎儿预后,且不增加剖宫产率,但早产率较总体比例升高。此外,单疗程与多疗程的疗效相比无明显差异,对单疗程无效胎儿的下步诊疗也需进一步探讨。
[Abstract]:Objective: to investigate the pregnancy outcome and steroid hormone therapy of congenital cystadenomatoid malformation (CCAM) and pulmonary sequestration (BPSS) fetus for genetic counseling. Methods: from January 2006 to December 2016, 17 single born pregnant women and 7 pregnant women receiving treatment due to fetal CCAM and BPS in our hospital were analyzed retrospectively. The results of prenatal diagnosis, pregnancy outcome, hormone therapy and newborn birth were followed up and analyzed. Literature on hormone therapy for fetal CCAM and BPS were searched in PubMedbase Data and WanFang Data database. Results: of the 17 pregnant women, 2 had fetal chromosomal abnormalities. Among them, 1 case continued pregnancy with chromosome 9 interarm inversion, 1 case with normal fetal chromosome, 1 case lost and 2 cases spontaneous induced labor, and 6 cases of CVR 1.6 in 13 cases of continuous pregnancy, no complication, no complication, no complication, no complication, no complication, no complication, no complication, no complication, no complication, no complication, no complication, and no complication. Seven cases of full-term delivery were treated with hormone because of CVR1.6 or fetal edema. Results: fetal survival rate was 71.43%, edema fetus survival rate was 33.33%, cesarean section rate 20%, term delivery. After treatment, the survival rate of the fetus and the reduction rate of the mass were 53% and 100%, respectively. The fetus with edema, the edema improvement rate after treatment was 54 ~ 100 and the survival rate was 46 ~ 80. In the study, the cesarean section rate was 180.The incidence rate of premature delivery was 92727. The cesarean section rate was 28.9 and the premature delivery rate was 18.4.In the subgroup analysis, there was no significant difference in fetal survival rate and edema relief rate between the single course group and the multi-course group. Conclusion: fetal CCAM and BPS belong to abnormal anatomical structure. Prenatal diagnosis of fetal chromosomal karyotype analysis is recommended. For high-risk CCAM and BPS fetuses, the use of hormones can improve the fetal prognosis without increasing the cesarean section rate, but the premature delivery rate is higher than the overall rate. There was no significant difference between single course of treatment and multi course of treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.5

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