三村 貴志, 長谷川 潤一, 市塚 清健, 松岡 隆, 大槻 克文, 関沢 明彦, 岡井 崇

Takashi MIMURA, Junichi HASEGAWA, Kiyotake ICHIZUKA, Ryu MATSUOKA, Katufumi OTSUKI, Akihiko SEKIZAWA, Takashi OKAI

昭和大学医学部産婦人科学教室

Department of Obstetrics and Gynecology, Showa university school of medicine

キーワード : EXIT, lymphangioma, ginat fetal neck mass

EXIT（ex utero intrapartum treatment）とは，出生直後の気道確保が困難であると予測される頸部腫瘍などの症例に対して，児娩出に際し胎児・胎盤循環を維持しながら児の一部を子宮外に露出し気道確保を行い，肺呼吸への移行を円滑，かつ安全にする方法である．症例は30歳，女性．1回経妊，0回経産．前医より頸部腫瘍を指摘され当院を受診した．経腹超音波にて胎児の頸部に9.0cm×7.7cm大のlow echoで内部に隔壁を伴うhypovascularな多嚢胞性腫瘤を認めた．下顎の輪郭は保たれ，頸部前面を覆う様な腫瘤であった．さらに，MRI検査を追加し頸部lymphangiomaが疑われた．巨大頸部腫瘍があるため，出生後の気道狭窄が懸念され，安全に児の気道確保を行うためEXITの方針とした．妊娠37週1日で帝王切開術を施行した．児娩出時にEXITを施行し気道確保後，安全に児を娩出することが出来た．児は女児で，体重3,145g，Apgar scoreは1分後4点，5分後5点で，臍帯動脈血ガスpHは7.233であった．頸部にはソフトボール大の腫瘤を認め，穿刺吸引による内容はリンパ液であり，lymphangiomaと診断された．その後の児の経過は良好である．

Giant fetal neck masses can cause airway obstructions with potentially poor fetal prognoses after delivery. The relationship between the fetal neck mass and the airway structure can be evaluated prenatally with ultrasound and magnetic resonance imaging (MRI). The ex utero intrapartum treatment (EXIT) procedure can be used to obtain a fetal airway while fetomaternal circulation is preserved. We present a case in which a giant mass in the fetal neck was diagnosed prenatally at time of ultrasound and MRI examination and a successful EXIT procedure was carried out. The 30-year-old woman (gravida 1, para 0) had been referred to this institution in her 26th week of gestation. We diagnosed the mass as a giant fetal cervical lymphangioma (9.0×7.7 cm) based on the ultrasound and MRI findings. The EXIT procedure was performed at 37 weeks of gestation, and the airway was successfully secured. The baby was female and weighed 3,145 grams. Arterial cord blood gas value was pH 7.233; PCO₂, 65.3 mm Hg; PO₂, 6.2 mm Hg; BE, minus;2 mmol/L. The baby had a giant neck mass the size of a soft ball. The tumor was pathologically diagnosed as a lymphangioma. The postpartum clinical course has been good since the EXIT procedure.