临床小儿外科杂志2024，Vol.23Issue(12)：1117-1124,8.DOI:10.3760/cma.j.cn101785-202410006-003
胎儿骶尾部畸胎瘤的产前产后全过程多学科诊疗模式及应用研究
Application and effect analysis of multidisciplinary treatment throughout perinatal period of fetal sacro-coccygeal teratoma
摘要
Abstract
Objective To summarize the multidisciplinary treatment model for the whole process of pre-natal and postpartum period and outcomes of fetal sacrococcygeal teratoma(FSCT).Methods A retrospective study was conducted for the relevant clinical data of FSCT neonates diagnosed antenatally and managed with a perinatal multidisciplinary diagnostic and therapeutic mode from January 2015 to June 2024.Prenatal data were collected,including ultrasonic assessment parameters during pregnancy such as tumor volume(TV),tumor vol-ume index(TVI),tumor volume/fetal weight(TFR),SCT growth rate(SCTs),cardiac output(CCO),pres-ence of fetal edema and polyhydramnios.Based upon the longest diameter of tumor measured during pregnancy,they were divided into two groups of high-risk(diameter＞10 cm,n=11)and low-risk(diameter ≤10 cm,n=33).And general clinical profiles and perinatal clinical outcomes were compared between two groups.Re-sults Among 44 neonates of FSCT,there were 28 live births with a median gestational age of 38.3(30.28-44.28)week,including 10 preterm births.There were 27 survivors(96.43％)and 1 death(3.57％).Twenty-seven surviving neonates underwent complete surgical resection in neonatal period with a median operative age of 6(3-15)day and a median hospitalization stay of 15(9-42)day.Two cases(7.4％)recurred.The high-risk group had an earlier diagnosis of fetal age(19.57 vs.30.428 week,P=0.009),larger maximum tumor di-ameter(140 vs 62 mm,P=0.001),maximal TV(1068.03 vs.72.38 cm3,P=0.001),initial TVI(38.9 vs.2.67,P=0.001),maximal TVI(124.25 vs.8.10,P=0.001),initial TFR(0.24 vs.0.02,P=0.001),maxi-mal TFR(0.38 vs.0.03,P=0.001)and SCTs(181.04 vs.15.19 cm3/week,P=0.001).All were signifi-cantly higher than those in low-risk group with statistically significant differences.The high-risk group had a sig-nificantly higher proportion of high combined cardiac index(CCO)(45.45％vs.8.11％,P=0.007),polyhydr-amnios(36.36％vs.2.70％,P=0.005)and risk of preterm birth(63.64％vs.16.67％,P=0.011)than low-risk group with statistically significant differences(P＜0.05).No statistically significant inter-group difference existed in survival rate(72.73％vs.57.58％,P=0.486).The multidisciplinary treatment model for the entire process of prenatal and postpartum has been in operation for nearly 10 years,and the induction and mortality rates of FSCT have gradually decreased,while the survival rate has continued to rise.Conclusions Prenatal diagnosis and precise assessment of tumors in FSCT shall facilitate appropriate counseling during prenatal period and post-delivery management.Early identification and refined management of high-risk FSCT cases,along with ac-tive exploration of delivery and surgical timing,are essential for optimizing clinical outcomes.With standardized management of multidisciplinary treatment throughout perinatal period,the prognosis for FSCT is excellent and such a practice is worthy of wider promotion.关键词
胎儿/畸胎瘤/骶尾部/学科间信息交流/产前产后医护/诊疗模式/妊娠结局/治疗结果/对比研究Key words
Fetus/Teratoma/Sacrococcygeal Region/Interdisciplinary Communication/Perinatal Care/Practice Patterns/Pregnancy Outcome/Treatment Outcome/Comparative Stud引用本文复制引用
侯龙龙,徐素婷,夏波,吕俊健,何秋明,钟微..胎儿骶尾部畸胎瘤的产前产后全过程多学科诊疗模式及应用研究[J].临床小儿外科杂志,2024,23(12):1117-1124,8.基金项目
国家自然科学基金(82370526) National Natural Science Foundation of China(82370526) （82370526）
