Professional Documents
Culture Documents
Sindromi I Bandes Amniotike
Sindromi I Bandes Amniotike
Sindromi I Bandes Amniotike
Fig.1. Striktur amniotike cirkumferenciale n 1/3 e poshtme t parakrahut, pas trajtimit kirurgjikal pacienti pa deficite
neurovaskulare, me kontur t rregullt t ansis dhe pranueshm nga ana kozmetike
Diagnoza. Anomalit e rnda zakonisht identifikohen n fund t tremujorit t par ose t dyt t
shtatzanis me an t ekzaminimit me ultratinguj (13).
Esht e vshtir t vendoset nj diagnoze prenatale pr defektet e mesme dhe t lehta, dhe ato
vihen re vetm pas lindjes s femijs, pas ekzaminimit klinik (3).
Teknikat m t fundit t ekzaminimit me ultratinguj, tre-dimensionale dhe katr-dimensionale
rrisin ndjeshmrin dhe saktsin n vendosjen e nj diagnoze prenatale t SBA dhe n raste m
t ndrlikuara sht e domosdoshme rezonanca magnetike fetale (3,14).
Ekzaminimi i placents dhe i amnionit pas lindjes duhet t jet i deturueshm pr vlersimin dhe
diagnostikimin e t porsalindurit pasi ndr t tjera mund t tregoj dhe prezencn e bandave
amniotike (3,15,16).
Ekzaminimi fizik sht kryesor n vendosjen e diagnozs postnatale t SBA. Ekzaminime
suplementare si ai me ultratinguj, ekokardiografia, ai radiologjik; jan t rndsishme pr
vlersimin e anomalive n organe dhe pjes t ndryshme t trupit.
Diagnoza diferenciale. Duhet t bhet me defektet e tubit neural, omfaloceln, sindromn
Fanconi si dhe me keqformimet e izoluara limfatike dhe ato vaskulare.
Trajtimi. Nse sht vendosur diagnoza prenatale e SBA, fmija duhet t lind n nj qndr
terciare nn kujdesin e mjekut neonatolog, kirurgve pediatr dhe kirurgve ortoped.
Trajtimi sht kryesisht kirurgjikal dhe i prshtatur sipas rastit, varet nga natyra e SBA dhe
shkalla e deformimit.
Trajtimi kirurgjikal pr clirimin e strikturave (Fig.2,3,4) normalisht fillon rreth moshs 3 muaj.
Shpesh krkohet qasje multidisiplinare pasi rastet mund t jen t ndrlikuara (kirurg plastik,
kirurg ortoped, ortodontist, oftalmolog, neurokirurg) (1).
N rastet kur strikturat nuk jan cirkumferenciale dhe nuk shoqrohen me edem distalisht apo
deficite neurovaskulare, nuk kan nevoj pr ndrhyrje kirurgjikale. N raste t tjera krkohet
ndrhyrje kirurgjikale me etapa pr ekcizimin e bandave, Z-platik, W-plastik, plastik sipas
Sin apo procedura sipas Mutaf. Rastet me anomali kockore i nnshtrohen kirurgjis ortopedike.
Fig.1. Prcaktimi i planit t hyrjes kirurgjikale, sipr dhe posht strikturs amniotike.
Fig.3. Clirohet rreth 1.5 cm e shtress s subkutis nga fascia ne t dyja ant e strikturs amniotike
Koht e fundit ka pasur prpjekje pr trajtimin intrauterin t SBA duke realizuar incizimin
fetoskopik me lazer t bandave amniotike prpara se t shkaktohen keqformimet (17). N rastet
kur anomalit fetale jan t papajtueshme me jetn, kshillohet ndrprerja e shtatzanis (2).
Konkluzion. SBA sht anomali e rrall, megjithat duhet marr n konsiderat tek cdo i
porsalindur me anomali kongjenitale. Baza e diagnozs postnatale sht ekzaminimi fizik dhe
ekzaminime t tjera suplementare pr t prjashtuar malformacione t tjera t organeve. sht i
rndsishm t realizohet kariotipi kromozomal i fmijs pr t shmangur nj diagnoz t
gabuar. SBA krkon trajtim multidisiplinor.
BIBLIOGRAFI
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Poeuf B, Samson P, Magalon G. Amniotic band syndrome. Chir Main 2008;27(Suppl 1):S136-47.
Burk CJ, Aber C, Connelly EA. Ehlers-Danlos syndrome type IV: keloidal plaques of the lower extremities, amniotic band limb deformity,
and a new mutation. J Am Acad Dermatol 2007;56(2Suppl):S53-S54.
Merrimen JL, McNeely PD, Bendor-Samuel RL,Schmidt MH, Fraser RB. Congenital placentalcerebral adhesion: an unusual case of
amniotic band sequence. J Neurosurg 2006; 104(5 Suppl): 3525
Evans C, Marton T, Rutter S, Anumba DO, Whitby EH, Cohen MC. Cranial vault defects: the description of three cases that illustrate a
spectrum of anomalies. Pediatr Dev Pathol 2009;12(2):96-102.
Jabor MA, Cronin ED. Bilateral cleft lip and palate and limb deformities: a presentation of amniotic band sequence? J Craniofac Surg
2000;11(4):388-93.
Kutlu Dilek TU, Yazici G, Gulhan S, Polat A, Dilek B, Dilek S. Amniotic Band Syndrome Associated With Cranial Defects and Ectopia
Cordis: A Report of Two Cases. J Turkish German Gynecol Assoc 2005;308-10
Ross MG. Pathogenesis of amniotic band syndrome. American Journal of Obstetrics and Gynecology 2007; 197(2):219-20.
Brent RL. Environmental Causes of Human Congenital Malformations: The Pediatricians Role in Dealing With These Complex Clinical
Problems Caused by a Multiplicity of Environmental and Genetic Factors. Pediatrics 2004;113(4 Suppl):957-68.
Martnez-Fras ML. Epidemiological characteristics of amniotic band sequence (ABS) and body wall complex (BWC): are they two
different entities? Am J Med Genet 1997;73(2):176-9.
Cignini P, Georlandino C, Padula F, Dugo N, Cafa EV, Spata A. Epidemiology and risk factors of amniotic band syndrome, or ADAM
sequence. J Prenat Med. 2012;6(4):59-63.
Jabor MA, Cronin ED. Bilateral cleft lip and palate and limb deformities: a presentation of amniotic band sequence? J Craniofac Surg
2000;11(4):388-93.
McGuirk CK, Westgate MN, Holmes LB. Limb Deficiencies in Newborn Infants. Pediatrics 2001; 108(4)
Allen LM. Constriction Rings and Congenital Amputations of the Fingers and Toes in a Mild Case of Amniotic Band Syndrome. Journal of
Diagnostic Medical Sonography 2007;23:280-5.
Nardozza LM, Araujo Jnior E, Caetano AC, Moron AF. Prenatal Diagnosis of Amniotic band syndrome in the third trimester of pregnancy
using 3D ultrasound. J Clin imaging Sci. 2012;2:22
Ferns S, Sharma R, Narayanan P, Bhat BV. Limb Amputation Defects In Utero-A Case Report. J Anat Soc India 2001;50(2):156-8.
Bower C, Norwood F, Knowles S. Amniotic band syndrome: a population-based study in two Australian states. Paediatric and Perinatal
Epidemiology 1993;7(4):395-403
Quintero RA, Morales WJ, Phillips J, Kalter CS, Angel JL. In utero lysis of amniotic bands. Ultrasound Obstet Gynecol 1997;10(5):316-20