目的:绒毛膜血管瘤是一种挑战,缺乏足够的管理指导方针,以及关于最佳侵入性胎儿治疗选择的争议;大多数临床治疗的科学证据仅限于病例报告。这项回顾性研究的目的是回顾自然产前史,产妇和胎儿并发症,以及在单个中心妊娠合并胎盘绒毛膜血管瘤的治疗方式。
方法:这项回顾性研究是在利雅得的费萨尔国王专科医院和研究中心(KFSH&RC)进行的,沙特阿拉伯。我们的研究人群包括所有具有绒毛膜血管瘤超声特征的妊娠,或组织学证实的脉络膜血管瘤,2010年1月至2019年12月。数据是从病人的医疗记录中收集的,包括超声报告和组织病理学结果。所有受试者保持匿名;病例编号用作标识符。研究者收集的数据以加密格式输入到Excel工作表中。使用MEDLINE数据库检索32篇文献进行文献综述。
结果:在2010年1月至2019年12月的10年间,发现了11例绒毛膜血管瘤。超声仍是妊娠诊断和随访的金标准。11例中有7例经超声检查,允许适当的胎儿监测和产前随访。剩下的六个病人,其中一人接受了射频消融,两名因胎盘绒毛膜血管瘤引起的胎儿贫血而接受了宫内输血,其中一个用粘合材料进行了血管栓塞,其中2人在足月前接受了保守的超声监测.
结论:超声仍是疑似绒毛膜血管瘤的产前诊断和随访的金标准。肿瘤大小和血管分布在母婴并发症的发展和胎儿干预的成功中起着重要作用。为了确定胎儿干预的优越模式,需要更多的数据和研究;然而,胎儿镜激光光凝和胶粘材料栓塞似乎是一个领先的选择,合理的胎儿存活。
OBJECTIVE: Chorioangioma represents a challenge due to the rarity of the condition, paucity of sufficient management guidelines, and controversies regarding the best invasive fetal therapy option; most of the scientific evidence for clinical treatment has been limited to case reports. The aim of this retrospective study was to review the natural antenatal history, maternal and fetal complications, and therapeutic modalities used in pregnancies complicated with placental chorioangioma at a single Center.
METHODS: This retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSH&RC) in Riyadh, Saudi Arabia. Our study population included all pregnancies with ultrasound features of chorioangioma, or histologically confirmed chorioangiomas, between January 2010 and December 2019. Data were collected from the patients\' medical records, including the ultrasound reports and histopathology results. All subjects were kept anonymous; case numbers were used as identifiers. Data collected by the investigators were entered into Excel worksheets in an encrypted format. A MEDLINE database was used to retrieve 32 articles for literature review.
RESULTS: Over a 10-year period between January 2010 and December 2019, 11 cases of chorioangioma were identified. Ultrasound remains the gold standard for diagnosis and follow-up of the pregnancy. Seven of the 11 cases were detected by ultrasound, allowing proper fetal surveillance and antenatal follow-up. Of the remaining six patients, one underwent radiofrequency ablation, two underwent intrauterine transfusion for fetal anemia due to placenta chorioangioma, one had vascular embolization with an adhesive material, and two were managed conservatively until term with ultrasound surveillance.
CONCLUSIONS: Ultrasound remains the gold standard modality for prenatal diagnosis and follow-up of pregnancies with suspected chorioangiomas. Tumor size and vascularity play a significant role in the development of maternal-fetal complications and the success of fetal interventions. To determine the superior modality of fetal intervention mandates more data and research; nevertheless, Fetoscopic Laser Photocoagulation and embolization with adhesive material seem to be a lead choice, with reasonable fetal survival.