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中华医学超声杂志(电子版) ›› 2015, Vol. 12 ›› Issue (12) : 943 -950. doi: 10.3877/cma.j.issn.1672-6448.2015.12.010

所属专题: 妇产科超声影像学 产前超声 文献 妇产科超声

妇产科超声影像学

经前囟侧脑室横切面尾侧偏斜法在11~13+6周胎儿颜面部筛查中的应用
顾莉莉1, 李胜利2,(), 文华轩2, 欧阳淑媛3   
  1. 1. 518028 南方医科大学附属深圳市妇幼保健院超声科(现在安徽医科大学第二附属医院超声诊断科工作)
    2. 518028 南方医科大学附属深圳市妇幼保健院超声科
    3. 518028 南方医科大学附属深圳市妇幼保健院中心实验室
  • 收稿日期:2015-03-29 出版日期:2015-12-01
  • 通信作者: 李胜利
  • 基金资助:
    国家自然科学基金青年科学基金项目(61101026); 2011年深圳市科技计划项目(201101013)

Prenatal ultrasonographic screening for fetal facial anomalies using cross-sectional view of the fetal lateral ventricle with probe tilting at the 11th-13th+6 gestational week

Lili Gu1, Shengli Li2,(), Huaxuan Wen2, Shuyuan Ouyang3   

  1. 1. Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University, Shenzhen 518028, China (?Now in Department of Ultrasound, the Second Hospital of Anhai Medical University)
    2. Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University, Shenzhen 518028, China
    3. Central Laboratory, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University, Shenzhen 518028, China
  • Received:2015-03-29 Published:2015-12-01
  • Corresponding author: Shengli Li
  • About author:
    Corresponding author: Li Shengli, Email:
引用本文:

顾莉莉, 李胜利, 文华轩, 欧阳淑媛. 经前囟侧脑室横切面尾侧偏斜法在11~13+6周胎儿颜面部筛查中的应用[J]. 中华医学超声杂志(电子版), 2015, 12(12): 943-950.

Lili Gu, Shengli Li, Huaxuan Wen, Shuyuan Ouyang. Prenatal ultrasonographic screening for fetal facial anomalies using cross-sectional view of the fetal lateral ventricle with probe tilting at the 11th-13th+6 gestational week[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2015, 12(12): 943-950.

目的

总结早孕期(11~13+ 6周)胎儿颜面部异常超声声像图特征,分析颈项透明层(NT)增厚与颜面部异常相关性。

方法

对2008年10月至2012年12月在深圳市妇幼保健院产前检查的10 518例胎儿行早孕期常规NT测量和经前囟侧脑室横切面尾侧偏斜法颜面部扫查,与活产儿产后检查或引产胎儿尸检结果对照,对早孕期颜面部异常胎儿的超声图像特征、NT增厚与颜面异常相关性进行总结和分析。

结果

10 518例胎儿产前超声检查结果:运用经前囟侧脑室横切面尾侧偏斜法早孕期超声检出颜面部结构正常胎儿10 343例(98.3%,10 343/10 518),颜面部异常28例(唇腭裂8例、鼻骨缺失14例,全前脑面容5例,不规则面裂1例);引产或出生后检查及随访证实胎儿颜面部异常49例(发生率0.47%,49/10 518),早孕期超声漏诊21例(唇腭裂11例,耳异常7例,小下颌2例,不规则面裂1例);中孕期超声补充检出颜面部异常11例(唇腭裂10例,不规则面裂1例);产前超声共检出颜面部异常39例(79.6%,39/49);超声检查后失访126例。49例颜面部异常胎儿合并NT增厚和其他超声软指标异常34例(69.4%,34/49),其中合并NT增厚23例(46.9%,23/49),合并其他结构异常22例,合并染色体异常2例。颜面部异常与NT增厚相关性:本组超声检出颜面部异常合并其他结构异常的胎儿NT平均测值[(4.7±3.1)mm]>单纯颜面部异常胎儿[(2.0±1.6)mm]>正常胎儿[(1.8±0.4)mm],表明颜面部异常与NT增厚有一定相关性。

结论

经前囟侧脑室横切面尾侧偏斜法是早孕期诊断胎儿颜面部异常准确、可靠的检查方法,早孕期发现胎儿全前脑、心脏异常、结构畸形伴NT增厚,应仔细检查有无颜面部异常,并于中孕期补充检查以减少漏诊。唇腭裂表现为鼻后三角形态改变,侧脑室横切面、正中矢状切面及双眼球冠状切面的改变则为全前脑面容的表现。

Objective

To analyze the prenatal sonographic features of facial anomalies and evaluate the relationship between facial anomalies and increased nuchal translucency.

Methods

Pregnant women coming to Shenzhen Maternity and Child Healthcare Hospital affiliated to Nanfang Medical University between October 2008 and December 2012 for the 11th-13th+6 gestational week scanning were included in this study. Fetal facial region was evaluated by the technique of cross-sectional view of the fetal lateral ventricle with probe tilting. Comparative analysis was performed on autopsy and prenatal ultrasonograpgy.

Results

The prenatal ultrasonic results of 10 518 fetus: 10 343 fetus (98.3%, 10 343/10 518) were confirmed as facial normal with the technique of cross-sectional view of the fetal lateral ventricle with probe tilting at the first trimester. Twenty-eight cases of facial malformation were confirmed at the first trimester (8 cases of cleft lip/plate, 14 cases of absence of nasal bone, 5 cases of holoprosencephaly facial feature and 1 cases of irregular facial cleft). Forty-nine cases of facial malformation were confirmed by postnatal evaluation or autopsy (the incidence was 0.47%, 49/10 518 ). Twenty-one cases were misdiagnosed (11 cases of cleft lip/plate, 7 cases of ear deformity, 2 cases of micrognathia and 1 cases of irregular facial cleft). Ultrasonic soft marker: 34 cases were combined with abnormal soft marker (69.4%, 34/49), 22 cases of various kinds of facial malformation were combined with other structural deformity. Twenty-three cases were combined with increased nuchal translucency. Fourteen cases of absence of nasal bone were detected in the first trimester, including twelve cases of increased nuchal translucency, six cases of structural deformity, two cases of chromosomal abnormalities (21-trisomy). Five cases of holoprosencephaly facial feature were detected in the first trimester, including three cases of increased nuchal translucency and structural deformity. Eight cases of cleft lip/plate were detected in the first trimester, including five cases of increased nuchal translucency. One cases of irregular facial cleft were detected in the first trimester, who was combined with structural deformity and increased nuchal translucency. Postpartum examination showed: there were 25 cases of simple facial anomaly, 22 cases were combined with structural deformity (9 cases of cardiac defect and 8 cases of holoprosencephaly), there were 2 cases of chromsomal abnormalities. The results showed that increased nuchal translucency had certain relationship with facial anomaly. The value of nuchal translucency of facial anomalies fetus was apparently higher than that of normal fetus and fetus with simply facial anomalies. There was no significant difference between normal fetus and fetus with simply facial anomalies.

Conclusions

Findings of holoprosencephaly and cardiac defects is a significant clue for diagnosing facial anomalies. Fetuses with cleft palate/lip have an abnormal configuration of the retronasal triangle. Cross-sectional view of the fetal lateral ventricle with probe tilting caudal slightly technique is an important method to screen fetal facial malformation in the first trimester.

图6 鼻唇冠状切面可观察到上唇、下唇及鼻等结构
表1 10 392例胎儿产前NT及CRL测值结果(mm,±s
图10 双侧唇腭裂胎儿早孕期颜面部扫查显示鼻后形态失常,硬腭可见左右对称的两处连续性回声中断
表2 49例颜面部异常胎儿超声软指标检查结果及各类畸形构成比(检出例数/畸形例数)
表3 49例颜面部异常胎儿围产期检查结果及胎儿临床结局(检出例数/异常例数)
[1]
李胜利. 胎儿畸形产前诊断学[M]. 北京: 人民军医出版社, 2004: 432-458.
[2]
Seeds JW, Cefalo RC. Technique of early sonographic diagnosis of bilateral cleft lip and palate [J]. Obstet Gynecol, 1983, 62(3 Suppl): 2s-7s.
[3]
毕静如, 李胜利, 陈琮瑛, 等. 三平面正交超声扫查诊断胎儿唇腭裂的价值 [J]. 中国妇幼保健, 2005, 10(16): 2082-2083.
[4]
Sepulveda W, Wong AE, Martinez-Ten P, et al. Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimester [J]. Ultrasound Obstet Gynecol, 2010, 35(1): 7-13.
[5]
Sepulveda W, Wong AE, Viñals F, et al. Absent mandibular gap in the retronasal triangle view: a clue to the diagnosis of micrognathia in the first trimester [J]. Ultrasound Obstet Gynecol, 2012, 39(2): 152-156.
[6]
Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan [J]. Ultrasound Obstet Gynecol, 2013, 41(1): 102-113.
[7]
Brizot ML, Schultz R, Patroni LT, et al. Trisomy 10: ultrasound features and natural history after first trimester diagnosis [J]. Prenat Diagn, 2001, 21(8): 672-675.
[8]
Teoh M, Meagher S. First-trimester diagnosis of micrognathia as a presentation of Pierre Robin syndrome [J]. Ultrasound Obstet Gynecol, 2003, 21(6): 616-618.
[9]
Sepulveda W, Dezerega V, Be C. First-trimester sonographic diagnosis of holoprosencephaly: value of the ʺbutterflyʺ sign [J]. J Ultrasound Med, 2004, 23(6): 761-765.
[10]
Shprintzen RJ, Siegel-Sadewitz VL, Amato J, et al. Retrospective diagnoses of previously missed syndromic disorders among 1, 000 patients with cleft lip, cleft palate, or both [J]. Birth Defects Orig Artic Ser, 1985, 21(2): 85-92.
[11]
Nicolaides KH, Azar G, Byrne D, et al. Fetal nuchal translucency: ultrasound screening for chromosomal defects in first trimester of pregnancy [J]. BMJ, 1992, 304(6831): 867-869.
[12]
Paladini D. Fetal micrognathia: almost always an ominous finding [J]. Ultrasound Obstet Gynecol, 2010, 35(4): 377-384.
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