Effectiveness and prognosis of improved domestic neonatal ureteral stents for intrauterine treatment of fetal chylothorax
10.3760/cma.j.cn113903-20231130-00352
- VernacularTitle:改良国产新生儿输尿管支架用于宫内治疗胎儿乳糜胸的效果及预后
- Author:
Ya WANG
1
;
Haowei XU
;
Huirong TANG
;
Chenyan DAI
;
Yuan WANG
;
Jie QIU
;
Rui CHENG
;
Mingming ZHENG
Author Information
1. 南京大学医学院附属鼓楼医院妇产医学中心，南京 210008
- Keywords:
Congenital chylothorax;
Fetal pleural effusion;
Thoraco-amniotic shunting;
Fetal intrauterine therapy
- From:
Chinese Journal of Perinatal Medicine
2024;27(10):802-808
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effectiveness and prognosis of using improved domestic neonatal ureteral stents (referred to as improved double-J stents) for thoraco-amniotic shunting (TAS) in treating fetal chylothorax.Methods:A retrospective analysis was conducted on the clinical data of 21 cases of fetal chylothorax treated with TAS using improved double-J stents at Nanjing Drum Tower Hospital, Nanjing University Medical School from April 1, 2018, to September 30, 2023. Surgical complications and perinatal outcomes were summarized, and the development of surviving infants in five domains (communication, gross motor, fine motor, problem-solving, and personal-social) was assessed using the Ages and Stages Questionnaires-Third Edition (ASQ-3). Descriptive statistical analysis was used. Results:(1) The median gestational age at prenatal diagnosis was 28.7 weeks (27.3-30.4 weeks), with 85.7% (18/21) of cases complicated by fetal hydrops, 90.5% (19/21) by polyhydramnios, and 85.7% (18/21) by bilateral pleural effusion. (2) The median gestational age at the first TAS was 30.9 weeks (29.7-32.7 weeks). Of the 21 cases, 10 required repeat stent placement due to dislodgement or blockage, with a total of 49 stent placements. The dislodgement rate within 7 days was 24.5% (12/49), and the blockage rate was 16.3% (8/49). The rate of premature rupture of membranes within one week post-stent placement was 9.5% (2/21), with an overall preterm premature rupture of membranes rate of 28.6% (6/21). The median interval from the first TAS to delivery was 30.0 d (19.8-40.0 d). Of the 21 cases, three opted for selective termination of pregnancy; the remaining 18 cases resulted in live births, with a median gestational age at delivery of 35.6 weeks (34.1-37.1 weeks), and three neonatal deaths. The overall neonatal survival rate was 15/18. Surviving infants were followed up to a median age of 30 months (7-48 months), with 13 showing normal development and two scoring below the ASQ-3 threshold.Conclusion:The improved double-J stent can be used for TAS in the treatment of fetal chylothorax, with generally favorable outcomes.
