目的:分析原发性和继发性胎儿胸腔积液(FPE)的远期预后。
方法:我们调查了一所大学医院(2005-2020年)的所有FPE病例。病例分为原发性(仅有胸腔积液的病例)和继发性(有其他异常如染色体异常或胎儿心力衰竭的病例)。我们回顾了诊断时的医疗记录,为了评估执行的医疗程序,染色体检测结果,和临床结果。
结果:在18027次交付中,鉴定出17个FPE(初级FPE:8,次级FPE:9)。大多数原发性FPE是在妊娠中期被诊断出来的,而所有继发性FPE均在妊娠晚期诊断。继发性FPE通常与染色体异常有关,包括21三体。21三体所致胸腔积液预后较好,除了TAM的情况。没有21三体的继发性FPE病例是心脏起源的,新生儿预后较差。原发性FPE组短期预后较好,但长期随访确定的条件,如难治性急性脑炎,重复性部分性癫痫发作,发育迟缓和注意力缺陷多动障碍。
结论:无染色体异常或形态的胎儿胸腔积液具有良好的短期预后,但长期预后较差。因此,所有胎儿胸腔积液病例均需长期随访。
OBJECTIVE: To analyze the long-term prognosis of primary and secondary fetal pleural effusion (FPE).
METHODS: We investigated all cases of FPE in a single University hospital (2005-2020). Cases were classified as primary (cases with only pleural effusion) and secondary (cases with other abnormalities such as chromosomal abnormalities or fetal cardiac failure). We retrospectively reviewed the medical records from the time of diagnosis, to assess medical procedures performed, chromosomal test results, and clinical outcomes.
RESULTS: Among 18 027 deliveries, 17 FPEs were identified (primary FPE: 8, secondary FPE: 9). Most primary FPEs were diagnosed in the second trimester of pregnancy, while all secondary FPEs were diagnosed in the third trimester. Secondary FPE was often associated with chromosomal abnormalities, including trisomy 21. The prognosis of pleural effusion caused by trisomy 21 was relatively good, except for cases with TAM. Cases of secondary FPE without trisomy 21 were of cardiac origin, and the neonatal prognosis was poor. The short-term prognosis was better in the primary FPE group, but long-term follow-up identified conditions such as acute encephalitis with refractory, repetitive partial seizures, developmental delay and attention deficit hyperactivity disorder.
CONCLUSIONS: Fetal pleural effusion without the presence of chromosomal abnormalities or morphologies has a good short-term prognosis, but the long-term prognosis is poor. Thus, long-term follow-up is necessary for all cases of fetal pleural effusion.