摘要
目的比较产前与产后诊断为新生儿骶尾部畸胎瘤(sacrococcygeal teratoma,SCT)患儿的临床表现及预后差异,分析不良临床表现影响因素,总结治疗经验。方法回顾性分析2013年8月至2019年8月于复旦大学附属儿科医院小儿外科接受手术治疗的新生儿SCT患儿的临床资料,41例SCT患儿符合标准纳入统计,其中男13例,女28例。产前诊断组21例,产后诊断组20例。比较两组新生儿SCT患儿在性别、出生方式、孕周、出生体重、甲胎蛋白水平、影像学性质、病理性质、Altman分型、入院年龄、肿瘤大小和住院时间等临床表现上的差异;分析两组间并发症的发生及术后复发、病死率的差异;利用Logistic回归分析不良临床表现相关影响因素。结果产前诊断组和产后诊断组患儿足月产比例分别为71.43%(15/21)和100%(20/20),剖宫产比例分别为85.71%(18/21)和40%(8/20),入院年龄分别为(5.67±14.18)d和(35.80±42.53)d,肿瘤大小分别为(9.46±3.19)cm和(6.90±3.18)cm,住院时间分别为(19.57±8.19)d和(15.10±6.89)d,两组间比较,差异均有统计学意义(P=0.002,P=0.032,P<0.001,P=0.006,P=0.018)。两组患儿在性别、出生体重、AFP水平、影像学性质、病理性质、Altman分型等临床表现上的差异均无统计学意义(P>0.05)。随访时间中位数24个月,死亡0例,复发1例(产前诊断组);共14例出现不良临床表现,Logistic回归分析结果提示,诊断时间与不良临床表现的发生有关(OR=0.029,95%可信区间0.001~0.747,P=0.033)。两组间术前和术后并发症发生率及术后复发率和死亡率的差异均无统计学意义(P>0.05)。结论产前和产后诊断SCT的患儿在分娩方式、孕周、入院年龄、肿瘤大小和住院时间均存在差异,且产前诊断组患儿发生不良临床表现的风险高于产后诊断组,但两者总体预后均良好。
Objective To compare the differences of clinical manifestations and prognoses of neonatal sacrococcygeal teratomas between prenatal diagnosis and postnatal diagnosis,to analyze the influencing factors of adverse clinical manifestations and to summarize the therapeutic experience.Methods Clinical data were collected for operated children with neonatal sacrococcygeal treatomas from August 2013 to August 2019.Retrospective analysis was performed for comparing the differences of gender,delivery mode,gestational age,birth weight,level of alpha fetoprotein(AFP),imaging findings,pathological features,Altman's classification,age of admission,tumor size,hospital stay,complications,recurrence and mortality between prenatal and postnatal diagnoses.The relevant factors of adverse manifestations were evaluated by Logistic analysis.Results Among them,71.43%(15/21)of prenatal diagnoses and 100%(20/20)of postnatal diagnoses were full-term births.And 85.71%(18/21)of prenatal diagnoses and 40%(8/20)of postnatal diagnoses were delivered by cesarean section.The average age of admission was(5.67±14.18)days for prenatal diagnoses and(35.80±42.53)days for postnatal diagnoses.Tumor size was(9.46±3.19)cm for prenatal diagnoses and(6.90±3.18)cm for postnatal diagnoses.And hospital stay was(19.57±8.19)days for prenatal diagnoses and(15.10±6.89)days for postnatal diagnoses.Two data sets showed a statistically significant difference(P=0.002,P=0.032,P<0.001,P=0.006,P=0.018).No significant differences existed in gender,birth weight,AFP level,imaging findings,pathological features or Altman's classification.During a median follow-up period of 24 months,there was no death and one child replaced(prenatal diagnoses).A total of 14 children had adverse clinical manifestations.The diagnostic time was correlated with poor prognosis by Logistic analysis(OR=0.029,95%CI 0.001-0.747,P=0.033).No significant differences existed in complications,recurrence or mortality(P>0.05).Conclusions Neonates with prenatally diagnosed neonatal sacrococcygeal teratomas have a higher rate of premature caesarean delivery,younger age,larger tumour and longer hospital stay.And the risk of adverse manifestations is higher in the group of prenatal diagnosis.However,two groups both have a favorable prognosis.
作者
潘晓雪
沈淳
朱海涛
何炜婧
胡明哲
Pan Xiaoxue;Shen Chun;Zhu Haitao;He Weijing;Hu Mingzhe(National Children's Medical Center of Pediatric Surgery,Affiliated Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第12期1069-1073,共5页
Chinese Journal of Pediatric Surgery
关键词
新生儿
骶尾部
畸胎瘤
产前
产后
临床表现
预后
Neonatal
Sacrococcygeal
Teratoma
Prenatal
Postnatal
Clinical manifestations
Prognosis
作者简介
通信作者:沈淳,Email:chunshen@fudan.edu.cn。
