目的:探讨宫颈肿块患者出生时与有创气道管理相关的产前影像学特征,以及描述产后管理和结果。
方法:回顾性分析2008年1月至2019年1月52例产前诊断为颈部肿块的患者。产前成像,交货方法,管理,从病历中提取和分析结局数据.
结果:该队列中颈部肿块的产前诊断包括41例淋巴畸形(78.8%),6例畸胎瘤(11.5%),3例血管瘤(5.8%),血管内皮瘤1例(1.9%),和1个巨大的前肠重复囊肿(1.9%)。诊断成像时的平均胎龄为29周3天(范围:19w4d-37w)。总的来说,22例患者(42.3%)出生时需要侵入性气道管理,具体而言,18例(34.6%)患者需要气管插管,4例(7.7%)患者需要气管造口术.15名患者(28.8%)接受了子宫外产时治疗(EXIT),以确保气道的安全。羊水过多,气管偏移和压缩,产前成像前肿块位置与出生时侵入性气道干预的发生率显著相关,EXIT程序,新生儿住院期间进行气管造口术(p<0.025;Fisher精确检验)。Logistic回归分析表明,产前估计的质量体积增加与出生时侵入性气道管理的发生率之间存在统计学上的显着关联(p=0.02)。产后宫颈肿块管理涉及手术切除(32.7%),硬化治疗(50%),和雷帕霉素辅助治疗(17.3%)。4例(7.7%)患者在新生儿期死亡。
结论:本系列记录了在产前诊断的宫颈肿块中最大的单中心气道管理经验。胎儿影像学特征可能有助于告知合适的分娩方法,出生时的气道管理策略,和产前咨询。
OBJECTIVE: To investigate antenatally-determined imaging characteristics associated with invasive airway management at birth in patients with cervical masses, as well as to describe postnatal management and outcomes.
METHODS: A retrospective analysis of 52 patients with antenatally diagnosed neck masses was performed using single-center data from January 2008 to January 2019. Antenatal imaging, method of delivery, management, and outcomes data were abstracted from the medical record and analyzed.
RESULTS: Antenatal diagnosis of neck masses in this cohort consisted of 41 lymphatic malformations (78.8%), 6 teratomas (11.5%), 3 hemangiomas (5.8%), 1 hemangioendothelioma (1.9%), and 1 giant foregut duplication cyst (1.9%). Mean gestational age at time of diagnostic imaging was 29 weeks 3 days (range: 19w4d - 37w). Overall, 22 patients (42.3%) required invasive airway management at birth, specifically 18 patients (34.6%) required endotracheal intubation and 4 (7.7%) required tracheostomy. 15 patients (28.8%) underwent ex-utero intrapartum treatment (
EXIT) for the purposes of securing an airway. Polyhydramnios, tracheal deviation and compression, and anterior mass location on antenatal imaging were significantly associated with incidence of invasive airway intervention at birth,
EXIT procedure, and tracheostomy during the neonatal hospitalization (p < 0.025; Fisher\'s exact test). Logistic regression analysis demonstrated statistically significant association between increasing antenatally-estimated mass volume and incidence of invasive airway management at birth (p = 0.02). Post-natal cervical mass management involved surgical excision (32.7%), sclerotherapy (50%), and adjuvant therapy with rapamycin (17.3%). Demise in the neonatal period occurred in 4 (7.7%) patients.
CONCLUSIONS: This series documents the largest single-center experience of airway management in antenatally diagnosed cervical masses. Fetal imaging characteristics may help inform the appropriate method of delivery, airway management strategy at birth, and prenatal counseling.