Hou Longlong,Xu Suting,Xia Bo,et al.Application and effect analysis of multidisciplinary treatment throughout perinatal period of fetal sacrococcygeal teratoma[J].Journal of Clinical Pediatric Surgery,2024,(12):1117-1124.[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
- Title:
- Application and effect analysis of multidisciplinary treatment throughout perinatal period of fetal sacrococcygeal teratoma
- Keywords:
- Fetus; Teratoma; Sacrococcygeal Region; Interdisciplinary Communication; Perinatal Care; Practice Patterns; Pregnancy Outcome; Treatment Outcome; Comparative Stud
- 摘要:
- 目的 总结产前诊断的胎儿骶尾部畸胎瘤(fetal sacrococcygeal teratoma,FSCT)产前产后全过程多学科诊疗模式及应用效果。方法 回顾性分析2015年1月至2024年6月期间,广州医科大学附属妇女儿童医疗中心经产前诊断并实施产前产后全过程多学科诊疗模式的FSCT患儿临床资料,产前超声评估指标包括肿瘤体积(tumor volume,TV)、肿瘤体积指数(tumor volume index,TVI)、肿瘤体积/胎儿体重(tumor volume/fetal weight,TFR)、SCT生长速率(SCT growth rate,SCTs)、心输出量(cardiac output,CCO)、胎儿水肿以及羊水过多等。根据孕期测量肿瘤长径分为高危组(长径＞10 cm)和低危组(长径≤10 cm),比较两组患儿的临床特征及最终结局。结果 共44例FSCT患儿纳入本研究,活产28例,其中27例存活(96.43%),1例死亡(3.57%);引产13例;宫内死亡3例,出生胎龄38.3(30.28~44.28)周;27例存活患儿均于新生儿期接受切除手术,手术日龄6(3,15)d,住院时间15(9,42)d,2例(7.4%)术后复发。44例产前资料完整的FSCT中,高危组11例、低危组33例,高危组首次诊断胎龄更早(19.57周比30.43周,P=0.009),瘤体最大长径(140 mm比62 mm,P=0.001)、最大TV(1 068.03 cm3比72.38 cm3,P=0.001)、首次TVI(38.9比02.67,P=0.001)、最大TVI(124.25比8.10,P=0.001)、首次TFR(0.24比0.02,P=0.001)、最大TFR(0.38比0.03,P=0.001)以及SCTs(181.04 cm3/周比15.19 cm3/周,P=0.001)均明显高于低危组,差异有统计学意义(P<0.05);高危组出现高CCO(45.45%比8.11%,P=0.007)、羊水多(36.36%比2.70%,P=0.005)以及早产(63.64%比16.67%,P=0.011)的风险明显高于低危组,差异有统计学意义(P＜0.05);高危组与低危组存活率差异无统计学意义(72.73%比57.58%,P=0.486)。产前产后全过程多学科诊疗模式运行近10年,本院FSCT的引产率及死亡率逐渐下降,存活率不断上升。结论 产前诊断FSCT并精准评估肿瘤,有助于产前咨询与产后处理;对于高危组FSCT,应尽早识别并采取精细化管理;在产前产后多学科诊疗模式管理下,FSCT患儿预后良好,产前产后多学科诊疗模式值得推广。
- Abstract:
- Objective To summarize the multidisciplinary treatment model for the whole process of prenatal 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 volume index (TVI),tumor volume/fetal weight (TFR),SCT growth rate (SCTs),cardiac output (CCO),presence 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. Results 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 diameter (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),maximal TFR (0.38 vs.0.03,P=0.001) and SCTs (181.04 vs.15.19 cm3/week,P=0.001).All were significantly higher than those in low-risk group with statistically significant differences.The high-risk group had a significantly higher proportion of high combined cardiac index (CCO) (45.45% vs.8.11%,P=0.007),polyhydramnios (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 active 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.
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备注/Memo
收稿日期:2024-10-7。
基金项目:国家自然科学基金(82370526)
通讯作者:钟微,Email:zhongwei@gwcmc.org