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中华医学超声杂志(电子版) ›› 2024, Vol. 21 ›› Issue (08) : 819 -822. doi: 10.3877/cma.j.issn.1672-6448.2024.08.012

病例报告

产前超声诊断脐静脉-门静脉-体静脉分流三例
颜晓一1, 吕珂1, 杨萌1, 鲁嘉1, 张一休1,(), 孟华1,()   
  1. 1. 中国医学科学院 北京协和医学院 北京协和医院 协和转化医学中心 超声医学科
  • 收稿日期:2024-05-23 出版日期:2024-08-01
  • 通信作者: 张一休, 孟华
  • 基金资助:
    中央高水平医院临床科研业务费资助(2022-PUMCH-A-028)

Prenatal ultrasound diagnosis of umbilical-portal-systemic venous shunt: report of three cases

Xiaoyi Yan, Ke Lyu, Meng Yang   

  • Received:2024-05-23 Published:2024-08-01
引用本文:

颜晓一, 吕珂, 杨萌, 鲁嘉, 张一休, 孟华. 产前超声诊断脐静脉-门静脉-体静脉分流三例[J]. 中华医学超声杂志(电子版), 2024, 21(08): 819-822.

Xiaoyi Yan, Ke Lyu, Meng Yang. Prenatal ultrasound diagnosis of umbilical-portal-systemic venous shunt: report of three cases[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(08): 819-822.

病例1 孕妇,31岁,孕1产0。曾于孕17+6、19+4周出现发热、鼻塞、流涕、头晕、乏力等症状,自行物理降温后缓解。中孕期胎儿常规系统性超声检查提示:胎儿生物学参数小于孕龄,肠管回声稍增强,胎儿大脑中动脉阻力偏低。孕24+2周羊水穿刺示胎儿染色体核型未见异常。孕37周超声检查:胎儿右上腹横切面血管走行杂乱,门静脉左支与肝中静脉稍扩张,二者之间可见吻合支,频谱多普勒显示近吻合口处门静脉左支血流频谱呈波动性(图1);门静脉右支及静脉导管可见,余未见其他结构异常。超声提示:门静脉-体静脉分流。孕39+1周经阴道分娩一男婴,出生体质量2590 g。新生儿腹部超声检查提示:门静脉左支及肝中静脉扩张,均宽约0.4 cm,二者之间可见数处吻合支(图2)。生后2个月外院超声复查,提示原门静脉左支与肝中静脉分流处未见明确分流血管影。

图1 病例1孕37周胎儿超声检查。图a为胎儿上腹部横切面,彩色多普勒示门静脉左支与肝中静脉间可见吻合血管;图b为频谱多普勒显示近吻合口处门静脉左支血流频谱呈波动性频谱特征注:MHV为肝中静脉;LPV为门静脉左支
图2 病例1新生儿腹部超声检查。图a为剑突下横切面,二维超声示门脉左支及肝中静脉扩张,二者之间可见数处吻合支(箭头所示);图b为彩色多普勒显示门静脉左支与肝中静脉吻合(箭头所示);图c为频谱多普勒显示门静脉左支血流频谱呈波动性频谱特征注:MHV为肝中静脉;LPV为门静脉左支
图3 病例2孕24+1周胎儿超声检查。图a为二维灰阶超声下胎儿脐静脉腹内段扩张,走行迂曲,门静脉左支稍扩张;图b为彩色多普勒可见门静脉左支分支与肝左静脉吻合注:LHV为肝左静脉;LPV为门静脉左支
图4 病例2新生儿腹部超声检查。图a为二维灰阶超声下门静脉左支稍扩张,可见3支细小分支;图b为门静脉左支及肝左静脉之间可见吻合支注:LHV为肝左静脉;LPV为门静脉左支;ALPV为门静脉左支分支
图5 病例3孕32周胎儿超声检查。图a,b分别为二维灰阶超声和彩色多普勒示胎儿腹部横切面脐静脉走行迂曲,先于肝表面走行,入肝后与异常走行的粗大血管连接;图c~e分别为二维灰阶超声和彩色多普勒示异常粗大的血管向上走行并汇入上腔静脉;图f为二维灰阶超声示胎儿腹部矢状切面下腔静脉注:AAV为腹部异常血管;IVC为下腔静脉
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