摘要目的 探讨产前诊断的胎儿纵隔肿物患儿胎儿期管理及新生儿期胸腔镜微创治疗的初期经验.方法 回顾分析2015年11月至2016年11月,应用胸腔镜手术治疗新生儿纵隔肿物6例的临床资料.本组患儿均由产前超声发现纵隔肿物,初诊孕16周～孕31周,平均25周.经个体化胎儿期管理,多学科会诊,产前诊断,除外染色体异常和其他脏器畸形.出生后术前均行CT或MRI检查,肿物直径1.7～5.7 cm,平均3.2 cm.手术日龄4～29 d,平均12.4 d.本组病例均实施胸腔镜肿物切除术,术中病理检查确诊.结果 经个体化精准胎儿期管理,患儿均顺利出生,并证实产前诊断准确.新生儿期肿物均完整切除,其中5例顺利完成胸腔镜纵隔肿物切除术,1例后纵隔未成熟畸胎瘤中转开胸.胸腔镜手术时间100～150 min,平均112 min.估计出血量1～5 ml,全胸腔镜手术无输血患儿.住院时间11～17 d.术后无并发症发生.病理报告:6例患儿中,纵隔食管源性囊肿1例,纵隔支气管源性囊肿2例,纵隔淋巴管瘤1例,前纵隔囊性成熟型畸胎瘤1例,后纵隔未成熟畸胎瘤1例.术后随访8～14个月,平均9.6个月,患儿健康生存,无复发.结论 明确的产前诊断,多学科会诊制度,个体化精准的胎儿期管理是患儿能够早期治疗的前提条件.适宜的纵隔肿物新生儿患者应用胸腔镜治疗是安全可行的.新生儿较大的实性纵隔肿物应根据术中具体情况,必要时及时中转开胸.

abstractsObjective To investigate the fetal management of prenatally diagnosed fetal mediastinal masses and the initial experience of neonatal thoracoscopic minimally invasive treatment. Methods We per-formed a retrospective study from November 2015 to November 2016 of all newborns affected by mediastinal masses and treated by thoracoscopic surgery. This group of cases were found with mediastinal masses by pre-natal ultrasound. The earliest detection of abnormal time was 16 to 31 weeks of pregnancy,with an average of 25 weeks. In the fetal period,the patients were treated with multidisciplinary consultation and individual man-agement. Prenatal examinations helped us except for chromosomal abnormalities and other organ abnormali-ties. After birth,the patients underwent CT and MRI examination. The diameter of the tumor was 1. 7 to 5. 7 cm,with an average of 3. 2 cm. The operative age was 4 to 29 days,with an average of 12. 4 days. This group of newborns were performed thoracoscopic mass resection and confirmed by intraoperative pathological exam-ination. Results After individualized precise prenatal management,all children were born successfully and confirmed that prenatal diagnosis was accurate. All mediastinal masses were completely excised in the neo-natal period. Five mediastinal masses were completely excised. One posterior mediastinum immature teratoma was converted to open thoracotomy. The mean operative duration was 112 min(100 to 150 min). There was no operative complication with a minimal amount of blood loss. With a smooth recovery,the hospital stay was 11-17 days. Pathological results included:1 esophageal duplication,2 bronchogenic cysts,1 lymphangioma, 1 cystic teratoma of anterior mediastinum,1 immature teratoma of posterior mediastinum. During a mean fol-low-up period of 8-14 months,neither complication nor recurrence occurred. Conclusion These are the pre-conditions for early treatment of neonatal patients with mediastinal masses,including definite prenatal diagno-sis,multidisciplinary consultation system and individualized and accurate fetal management. Throcoscopic ex-cision of mediastinal masses is both feasible and safe in neonates. Proper preoperative case selection may pre-vent a conversion into thoracotomy due to huge solid mass.