目的 分析脐膨出畸形胎儿的妊娠结局及发育随访,为该病的临床诊治和预后提供参考。方法 回顾性分析西安两家大型三甲医院产前诊断的44例胎儿脐膨出资料,按照出生时胎儿脐膨出大小分为两组,脐膨出≤5cm 组21例,脐膨出>5cm组(50%~75%肝脏位于囊内)23例。收集孕妇年龄、产次、分娩方式、是否合并其他畸形、分娩时妊娠周数、新生儿出生时体重、新生儿不良结局、新生儿性别、新生儿住院时间、新生儿禁食时间、母体孕期是否有妊娠合并症、新生儿远期发育随访资料,分析两组之间的妊娠结局。结果 两组孕母年龄、孕周、产次、分娩方式、孕期是否有合并症,以及新生儿是否合并其他畸形、出生时体重、新生儿性别比较,差异无统计学意义(P>0.05)。与脐膨出≤5cm 组新生儿相比,脐膨出>5cm组新生儿住院时间、禁食时间较长,不良结局发生率较高,差异有统计学意义(t=3.054、0.918,χ2=5.750,P<0.05)。远期随访中,两组新生儿的术后喂养困难、运动功能、认知、体重发育、身高发育、行为、二次手术率比较,差异均无统计学意义(P>0.05)。结论 大部分新生儿脐膨出≤5cm预后良好。应重视胎儿健康检查,孕期应定期行超声观察胎儿脐带发育情况,对于确诊脐膨出的畸形做好有效防控措施。
Abstract
Objective To analyze the pregnancy outcome of the fetus with omphalocele, so as to provide reference for clinical diagnosis, treatment and prognosis of the disease. Methods The data of 44 cases of fetal omphalocele diagnosed prenatal in two large Grade A hospitals in Xi′an were retrospectively analyzed. According to the size of the fetal omphalocele at birth, children were divided into two groups: omphalocele ≤5cm group (n=21) and omphalocele >5cm group(n=23) (50% - 75% of the liver was in the capsule). Data on pregnant women′s age, time of delivery, mode of delivery, whether there were other malformations, gestational weeks at delivery, birth weight of newborns, adverse neonatal outcomes, neonatal sex, neonatal hospitalization time, neonatal fasting time, whether there were pregnancy complications during pregnancy, and long-term follow-up of neonatal development were collected and analyzed. Results There was no significant difference between the two groups in age, gestational age, time of delivery, mode of delivery, complications during pregnancy, birth weight and newborn sex (P>0.05). Compared with the omphalocele ≤5cm group, the hospital stay and fasting time of neonates in the omphalocele >5cm group were longer, and the incidence of adverse outcomes was higher, with statistical significance (t=3.054,0.918,χ2=5.750,P<0.05). In the long-term follow-up, there were no significant differences in postoperative feeding difficulties, motor function, cognition, weight development, height development, behavior and the rate of second operation between the two groups (P>0.05). Conclusions Most newborns with omphalocele ≤5cm have a good prognosis. Attention should be paid to fetal health examination, and regular ultrasound should be performed during pregnancy to observe the development of fetal umbilical cord, and effective prevention and control measures should be taken to diagnose the malformation of omphalocele.
关键词
胎儿脐膨出 /
妊娠结局 /
新生儿手术所需住院时间 /
新生儿禁食时间 /
远期发育随访
Key words
fetal omphalocele /
pregnancy outcome /
length of hospital stay required for neonatal operation /
fasting time of newborn /
long-term development follow-up
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参考文献
[1] Adams AD, Stover S, Rac MW. Omphalocele—What should we tell the prospective parents?[J]. Prenatal Diagnosis, 2021,41(4):486-496.
[2] Marshall J, Salemi JL, Tanner JP, et al. Prevalence, correlates, and outcomes of omphalocele in the United States, 1995—2005[J].Obstet Gynecol, 2015,126(2):284-293.
[3] Duong HT, Hoyt AT, Carmichael SL, et al. Is maternal parity an independent risk factor for birth defects?[J].Birth Defects Res A Clin Mol Teratol,2012,94(4):230-236.
[4] Gonzalez KW, Chandler NM. Ruptured omphalocele: Diagnosis and management[J]. Semin Pediatr Surg, 2019,28(2):101-105.
[5] Kiyohara MY, Brizot ML, Liao AW, et al. Should we measure fetal omphalocele diameter for prediction of perinatal outcome?[J]. Fetal Diagn Ther,2014,35(1):44-50.
[6] Raymond SL, Downard CD, Peter SD, et al. Outcomes in omphalocele correlate with size of defect[J].Pediatr Surg,2019,54(8):1546-1550.
[7] Aktoz F, Ozyuncu O, Tanacan A, et al. Gestational outcomes of pregnancies with prenatally detected gastroschisis and omphalocele[J]. Fetal Pediatr Pathol,2019,38(4):282-289.
[8] Revels JW, Wang SS, Nasrullah A, et al. An algorithmic approach to complex fetal abdominal wall defects[J]. Am J Roentgenol,2020,214(1):218-231.
[9] Cohen-Overbeek TE, Tong WH, Hatzmann TR, et al. Omphalocele: Comparison of outcome following prenatal or postnatal diagnosis[J]. Ultrasound Obstet Gynecol,2010,36(6):687-692.
[10] Ayub SS, Taylor JA. Cardiac anomalies associated with omphalocele[J]. Semin Pediatr Surg,2019,28(2):111-114.
[11] Akinkuotu AC, Sheikh F, Olutoye OO, et al. Giant omphaloceles: surgical management and perinatal outcomes[J]. Surg Res,2015,198(2):388-392.
[12] Conner P, Vejde JH, Burgos CM. Accuracy and impact of prenatal diagnosis in infants with omphalocele[J]. Pediatr Surg Int,2018,34(6):629-633.
[13] Roux N, Jakubowicz D, Salomon L, et al. Early surgical management for giant omphalocele[J].Pediatr Surg, 2018,53(10):1908-1913.
[14] Kumar HR, Jester AL, Ladd AP. Impact of omphalocele size on associated conditions[J]. Pediatr Surg,2008,43(12):2216-2219.
[15] Baerg JE, Munoz AN. Long term complications and outcomes in omphalocele[J]. Semin Pediatr Surg,2019,28(2):118-121.
[16] Chock VY, Davis AS, Cho SH, et al. Prenatally diagnosed omphalocele:Characteristics associated with adverse neonatal outcomes[J]. Perinatol, 2019,39(8):1111-1117.
[17] Mai CT, Isenburg JL, Canfield MA, et al. National population-based estimates for major birth defects, 2010—2014[J]. Birth Defects Res,2019,111(18):1420-1435.
[18] Fawley JA, Peterson EL, Christensen MA,et al. Can omphalocele ratio predict postnatal outcomes?[J].Pediatr Surg,2016,51(1):62-66.
[19] Fogelström A, Caldeman C, Oddsberg J,et al. Omphalocele: National current birth prevalence and survival[J]. Pediatr Surg Int, 2021,37(11):1515-1520.
[20] Baerg JE, Munoz AN. Long term complications and outcomes in omphalocele[J]. Semin Pediatr Surg, 2019,28:118-121.
[21] Hijkoop A, Peters NCJ, Lechner RL, et al. Omphalocele:From diagnosis to growth and development at 2 years of age[J]. Arch Dis ChildFetal Neonatal Ed,2019,104:F18-F23.
基金
陕西省重点研发计划项目(2021SF-134);腾讯生机计划2023健康创新公益挑战项目(202407090006)
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