산전진단된 배벽갈림증의 임상적 분석
The clinical outcomes on fetal gastroschisis
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목적: 태아 배벽갈림증의 주산기 경과 및 태아 치료와 산후 결과를 분석하고자 한다. 연구 방법: 1997년 3월부터 2007년 4월까지 배벽갈림증으로 진단된 35예에 대해 의무기록을 이용하여 후향적으로 분석하였다. 결과: 28명에 대해 추적관찰이 가능하였고 이 중 17명은 생존 출생하였다. 22명의 태아에서 염색체검사를 시행하였으며 모두 정상 소견이었다. 12명 (34.2%)에서 동반기형이 발견되었다. 이 중 8명은 양막대증후군 (22.9%), 6명은 척추측만 (17.1%)이었고, 구개열, 태아수종, 뇌수종, 무뇌증은 각각 1명 (2.9%)이었다. 태아 치료를 위해 4명이 양수주입술과 양수교환술을 동시에 시행 받았다. 4명 (23.5%)이 제왕절개술로 분만되었다. 신생아들은 모두 출생 직후 외과적 치료를 받았다. 8명 (47.1%)에서 수술 후 합병증을 보였다. 3명은 사망하여 전반적인 생존율은 82.4%이었다. 영아의 평균 재원기간은 36일 (2~210일)이었다. 결론: 산전진단된 배벽갈림증은 외과적 치료의 예후가 좋고 전반적인 생존율도 높았다. 이러한 결과는 기존의 연구와 일치하고 있으며, 배벽갈림증으로 산전 진단 받은 산모를 상담하는데 도움을 줄 수 있을 것으로 기대된다.
Abstract
Objective: The aim of this study is to analyze the perinatal courses, fetal treatment and postnatal outcomes of fetal gastroschisis. Methods: A retrospective review of the medical records of 35 cases with a prenatal diagnosis of gastroschisis was conducted between March 1997 and April 2007. Results: Twenty-eight fetuses were followed up and 17 fetuses of them were born alive. Chromosomal study was performed in 22 fetuses and no abnormality was detected in them. Associated anomalies except for gastrointestinal anomalies were found in 12 (34.2%) cases: amniotic band syndrome (n=8), scoliosis (n=6), cleft lip (n=1), hydrops (n=1), hydrocephalus (n=1), acrania (n=1). In 4 fetuses, amnioinfusion and amnioexchange were performed simultaneously for treatment. Four cases (23.5%) were delivered by cesarean section. All neonates received corrected operation immediately after birth and 8 (47.1%) of them had postoperative complications. Three of them were died and the overall survival rate was 82.4%. The average length of hospital stays for the survivors was 36 days (2~210days). Conclusion: Fetal gastroschisis diagnosed prenatally has a good prognosis and high survival rates. The result of this study was not different from that of preexisting studies and will be a useful guide in counseling parents with a prenatal diagnosis of gastroschisis.
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