산전진단된 태아의 선천성낭성샘모양기형과 기관지 폐분리증의 비교
COMPARISON OF PRENATALLY DIAGNOSED FETAL CONGENITAL CYSTIC ADENOMATOID MALFORMATION AND BRONCHOPULMONARY SEQUESTRATION
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초록
목적산전에 선천성낭성샘모양기형과 기관지폐분리증으로 진단된 증례들의 임신 결과를 비교하고 예후인자를 알아보고자 하였다. 연구방법2005년 5월부터 2010년 9월까지 성균관대학교 삼성서울병원에서 산전에 선천성낭성샘모양기형과 기관지폐분리증으로 진단된 55예를대상으로 임신부 및 신생아의 의무기록을 후향적으로 조사하여 산모의 특성, 산전초음파 소견, 분만 후 임신결과와 신생아 결과를 비교하였다. 출생 후 진단은 조직학적 검사 및 영상의학검사를 기준으로 하였다. 결과산전에 선천성낭성샘모양기형과 기관지폐분리증으로 총 55예가 진단되었고, 선천성낭성샘모양기형이 42예(76.4%), 기관지폐분리증이 13예(23.6%)였다. 종격동 이동은 선천성낭성샘모양기형 25예, 기관지폐분리증 6예에서 관찰되었다. 본원에서 분만이 이루어진 총 27예 중자궁내 태아사망 1예를 제외한 26예에서 병변이 완전 소실된 경우가 4예(15.4%)였고 모두 산전에 선천성낭성샘모양기형으로 진단되었다. 50% 이상 병변 크기의 감소가 있었던 경우는 선천성낭성샘모양기형 7예, 기관지폐분리증 3예였고, 증가한 경우는 선천성낭성샘모양기형에서만 3예, 크기의 변화가 50% 이내였던 경우는 선천성낭성샘모양기형 4예, 기관지폐분리증 5예로 나타났다. 병변의 소실이나 50%이상 크기가 감소한 경우에 영향을 미치는 예후인자를 조사한 결과 종격동 이동(P =0.019) 유무가 병변 크기와 유의한 상관관계가 있었다. 결론본 연구에서 산전과 출생 후 진단의 일치율은 63.0%였다. 산전초음파에서 종격동 이동이 없었던 경우는 선천성낭성샘모양기형 59.5%, 기관지폐분리증 46.2%였고, 이 경우 병변의 크기가 의미 있게 감소하였다.
Abstract
Objective This study is to investigate and compare the pregnancy outcomes and prognostic factors of congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS). Methods From May 2005 to September 2010, fifty-five medical records of fetuses with prenatally diagnosed CCAM (42 cases) and BPS (13 cases) were reviewed retrospectively in Samsung Medical Center (SMC). We compared the demographic characteristics,sonographic fi ndings, postnatal diagnoses and pregnancy outcomes between CCAM and BPS. The sonographic fi ndings included the locations of lesion, changes of size, existences of mediastinal shift, associated anomalies and existences of hydrops. Postnatal diagnoses were confi rmed by pathologic fi ndings and image examinations. Results A total of fi fty-fi ve cases were prenatally diagnosed as CCAM (42 cases) and BPS (13 cases). Thirty cases were followed up in SMC. Three of the thirty cases underwent termination and one case was intrauterine fetal death. Twenty-six cases were delivered alive in SMC. The masses were found out to be disappeared by prenatal sonography in four cases (15.4%) who were antenatally diagnosed as CCAM. The sizes of the mass were decreased more than 50% in CCAM seven cases and BPS three cases. The absence of mediastinal shift (P =0.019) was signifi cantly correlated with the decrease of mass size. Conclusion The concordance rate between antenatal and postnatal diagnosis was 63.0%. There was a tendency of decreasing in lesion with most of the cases. Without mediastinal shift, the mass size decreased signifi cantly. So, existence of mediastinal shift is the most important prognostic factor of CCAM and BPS.
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