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中华医学超声杂志(电子版) ›› 2018, Vol. 15 ›› Issue (08) : 605 -611. doi: 10.3877/cma.j.issn.1672-6448.2018.08.008

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

联体双胎的早孕期超声诊断
陈佳佳1, 陈琮瑛1,(), 李胜利1,(), 袁鹰1, 文华轩1, 毕静茹1, 官勇1, 郑美玉1   
  1. 1. 518028 南方医科大学附属深圳市妇幼保健院超声科
  • 收稿日期:2018-06-19 出版日期:2018-08-01
  • 通信作者: 陈琮瑛, 李胜利

Antepartum ultrasonographic diagnosis of conjoined twins in early pregnancy

Jiajia Chen1, Congying Chen1,(), Shengli Li1,(), Ying Yuan1, Huaxuan Wen1, Jingru Bi1, Yong Guan1, Meiyu Zheng1   

  1. 1. Department of Ultrasound, Shenzhen Maternity and Child Healthcare Hospital Affiliated to Nanfang Medical University, Shenzhen 518028, China
  • Received:2018-06-19 Published:2018-08-01
  • Corresponding author: Congying Chen, Shengli Li
  • About author:
    Corresponding author: Chen Congying, Email:
    Li Shengli, Email:
引用本文:

陈佳佳, 陈琮瑛, 李胜利, 袁鹰, 文华轩, 毕静茹, 官勇, 郑美玉. 联体双胎的早孕期超声诊断[J]. 中华医学超声杂志(电子版), 2018, 15(08): 605-611.

Jiajia Chen, Congying Chen, Shengli Li, Ying Yuan, Huaxuan Wen, Jingru Bi, Yong Guan, Meiyu Zheng. Antepartum ultrasonographic diagnosis of conjoined twins in early pregnancy[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2018, 15(08): 605-611.

目的

探讨联体双胎早孕期超声声像图特征,总结早孕期超声诊断联体双胎的技巧。

方法

对2011年1月至2017年12月因早孕期先兆流产在深圳市妇幼保健院超声筛查发现颈项透明层(NT)增厚、规范化超声筛查诊断为联体双胎21例胎儿的超声声像特征、联体部位、联体类型、合并畸形及妊娠结局进行分析,总结早孕期超声诊断联体双胎的技巧。

结果

早孕期超声诊断的21例联体双胎平均头臀径相当于平均孕周;8例获得较满意的NT测量,其中7例NT厚度大于0.3 cm;21例双胎联体部位及联体类型:胸脐联胎12例(12/21),头部联胎3例(3/21),双头联胎3例(3/21),脐部联胎2例(2/21),坐骨联胎1例(1/21)。21例联体双胎二维超声检出合并脊柱畸形、单心室、腹裂、膈疝、脐膨出、脊柱裂等其他畸形;三维超声对联体类型和范围及外观特征的观察更直观。妊娠结局:21例联体双胎中4例胎死宫内,17例超声检查后孕妇选择终止妊娠,产后标本检查证实21例均为联体双胎。

结论

早孕期超声检查可对联体类型及合并畸形做出明确诊断,有利于孕妇进行产前咨询。

Objective

To analyze the ultrasonographic features of conjoined twins and summarize the diagnostic skills in early pregnancy.

Methods

The ultrasonographic features, sites of union, type of fusion, related abnormalities and pregnancy outcomes were analyzed in 21 cases of conjoined twins who were checked up for early vagina bleeding during the first trimester or for 11th-13th+ 6 gestational week scanning between January 2011 and December 2017 Shenzhen Maternity and Child Healthcare Hospital. The diagnostic skills of conjoined twins in early pregnancy were summarized.

Results

Twenty-one cases of conjoined twins were diagnosed in the first trimester, whose gestational age were estimated by crown-rump length. NT measurements were obtained in 8 cases, of which 7 cases had increased nuchal translucency over 3.0 mm. The prenatal ultrasonic results of conjoined twins: there were 12 cases (12/21) of thoraco-omphalopagus, 3 cases (3/21) of cephalopagus, 3 cases (3/21) of parapagus dicephalus, 2 cases (2/21) of omphalopagus and 1 case (1/21) of ischiopagus. All cases were associated with other anomalies, including rachis deformation, single cardiac ventricle, gastroschisis, diaphragmatic hernia, omphalocele and spina bifida. Three-dimensional ultrasound imaging was helpful to confirm the types of fusion and improve facial features, which could be understood more easily. Postpartum examination showed: four cases had intrauterine fetal death, in the other 17 cases parents chose to terminate the pregnancy after ultrasound examination. All cases were confirmed to be conjoined twins by postpartum specimens.

Conclusion

Ultrasound examination in early pregnancy can make a clear diagnosis of the type of fusion and related abnormalities of conjoined twins, which is conducive to pregnant women for prenatal consultation.

图2,3 经阴道二维超声清晰显示联体双胎胸腔内可见两个心脏;经阴道二维超声图像较经腹部二维超声图像更加清晰
表1 21例联体双胎联体类型、产前超声检查及妊娠结局(±s
图4~6 胸脐联胎产前超声声像图。图4经阴道二维超声显示两胎儿的胸部、腹部融合;图5经阴道二维超声显示两胎儿胸部融合,其内仅见一个心脏;图6三维超声显示两胎儿面对面呈拥抱状,胸、腹部互相融合
图7~9 头部联胎产前超声声像图。图7经阴道二维超声显示双胎脐以上腹部、胸部及头部均融合;图8经阴道超声显示两胎儿分别有独立的心脏;图9三维超声显示两胎儿从头部至上腹部广泛相连
图10~12 坐骨联胎产前二维超声声像图。图10经腹部二维超声显示两胎儿胸腔内分别可见一个心脏;图11两胎儿坐骨相联;图12两胎儿均仅有1条脐动脉,脐带出腹壁走行一段距离后即合为1条
图13 三维超声成像示两胎儿坐骨相联,其余部分分离且未见明显结构异常
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