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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (03) : 186 -192. doi: 10.3877/cma.j.issn.1672-6448.2019.03.006

所属专题: 文献

妇产科超声影像学

胎儿先天性膈疝产前超声筛查及妊娠结局分析
荆春丽1,(), 韩璐1, 刘彧1, 刘娇1, 周乔1   
  1. 1. 116033 大连市妇幼保健院超声科
  • 收稿日期:2018-05-27 出版日期:2019-03-01
  • 通信作者: 荆春丽

Retrospective summary for the prenatal ultrasound screening and pregnancy outcomes of fetalcongenital diaphragmatic hernia

Chunli Jing1,(), Lu Han1, Yu Liu1, Jiao Liu1, Qiao Zhou1   

  1. 1. Department of Ultrasound, Dalian Maternity and Child Health Care Hospital, Dalian 116033, China
  • Received:2018-05-27 Published:2019-03-01
  • Corresponding author: Chunli Jing
  • About author:
    Corresponding author: Jing Chunli, Email:
引用本文:

荆春丽, 韩璐, 刘彧, 刘娇, 周乔. 胎儿先天性膈疝产前超声筛查及妊娠结局分析[J/OL]. 中华医学超声杂志(电子版), 2019, 16(03): 186-192.

Chunli Jing, Lu Han, Yu Liu, Jiao Liu, Qiao Zhou. Retrospective summary for the prenatal ultrasound screening and pregnancy outcomes of fetalcongenital diaphragmatic hernia[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(03): 186-192.

目的

总结先天性膈疝(CDH)产前超声筛查结果及妊娠结局。

方法

2014年1月至2017年12月大连市妇幼保健院产前超声诊断胎儿膈疝51例,总结膈疝胎儿超声声像图特点及相关妊娠结局。

结果

产前超声筛查结果:51例疑诊胎儿中产前超声以胎儿腹围切面未发现胃泡为首发线索筛查出膈疝40例(78.4%,40/51);以心脏移位、腹腔内胃泡位置和形态异常为首发线索筛查出膈疝9例(17.6%,9/51);其中左侧43例(84.3%,43/51),双侧5例(9.8%,5/51),右侧1例(2.0%,1/51);合并其他异常33例(64.7%,33/51)。超声诊断膈疝49例(96.1%,49/51),误诊2例(3.9%,2/51,生后证实为膈膨升1例,肺囊腺瘤1例)。妊娠结局:51例超声检查后继续妊娠15例(29.4%,15/51),肺头比(LHR)最小值为1.9,死亡6例(40.0%,6/15),存活9例(60.0%,9/15)均接受手术治疗,愈后较好。

结论

产前以胎儿腹围切面未发现胃泡、心脏移位、腹腔内胃泡位置及形态发生异常为线索诊断胎儿膈疝符合率较高;多学科会诊、产时干预和及时救治可提高先天性膈疝的生存率。

Objective

To summarize the clinical experience of the prenatal ultrasound for fetal diaphragmatic hernia and pregnancy outcomes.

Methods

The characteristics of prenatal ultrasound images and related pregnancy outcomes of congenital diaphragmatic hernia in 51 cases were summarized, who were diagnosed by ultrasound in Dalian Maternity and Child Health Care Hospital from January 2014 to December 2017.

Results

There were 51 fetuses with diaphragmatic hernia suspected by prenatal ultrasonography. Of them, 49 cases were confirmed, and the coincidence rate was 96.1% (49/51). Two cases were misdiagnosed, which included 1 case of diaphragmatic swelling and 1 case of pulmonary cystic adenoma. The rate of misdiagnosis was 3.9% (2/51). The most common sign of diaphragmatic hernia was the absence of stomach in fetal abdomen, which was found in forty cases (78.4%, 40/51). Another diagnostic sign was heart and stomach displacement, which was found in 9 cases (17.6%, 9/51). Among the 49 cases of diaphragmatic hernia, there were 29 males and 20 females. And 43 cases occurred on the left side (84.3%, 43/51), 5 cases occurred on both sides (9.8%, 5/51), 1 case occurred on the right side (2.0%, 1/51). In 33 cases, diaphragmatic hernia was accompanied with other abnormalities (64.7%, 33/51). In 15 cases with a minimum LHR of 1.9, parents decided to continue pregnancy. Of them, fetal death was found in 6 cases. All Of the 9 (60.0%, 9/15) live births underwent surgical treatment with good prognosis.

Conclusions

According to the sign of stomach absence in fetal abdomen as well as the heart and stomach displacement, prenatal screening for fetal diaphragmatic hernia had a high coincidence rate. Multidisciplinary consultation, intrapartum interventions and timely treatment can improve the survival rate of congenital diaphragmatic hernia.

图4 孕24+6周先天性膈疝胎儿,胸腔横切面声像图示心脏被挤压移位(白色箭头所示)、大量肠管疝入左侧胸腔(绿色箭头所示)
图9,10 孕39周胎儿产前超声声像图。图9为躯干纵切面示胃泡紧贴脊柱前方疝入胸腔(白色箭头所示);图10为胸廓横切面显示左侧胸腔内见3.2 cm×2.2 cm高回声团块,产前考虑肺囊腺瘤Ⅲ型(绿色箭头所示)
图13~16 孕37+1周胎儿产前超声声像图。图13为左肾大小及回声未见异常;图14为右侧肾上腺平卧征(白色箭头所示);图15为彩色多普勒血流成像示右肾动脉向上走行穿过横膈(绿色箭头所示);图16为胸腔脊柱右前方显示右肾回声(RK)、右侧胸腔显示肠管回声(红色箭头所示)
图17,18 孕40+1周胎儿产前超声声像图。图17为产前胸腔纵切面声像图示胃泡疝入胸腔(白色箭头所示)、心脏稍有移位(绿色箭头所示);图18为出生后X线平片示胃泡疝入胸腔(红色箭头所示)
表1 49例CDH产前超声表现及妊娠结局(例)
表2 15例继续妊娠CDH胎儿产前超声表现及妊娠结局
图20 孕40周胎儿心脏被挤压移位、肝脏位置(*)与心脏同一水平,生后证实为膈膨升
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