目的

探讨胎儿眼睑及睑裂的产前超声检查方法和声像图特征。

方法

前瞻性采集2023年1月至2024年3月在深圳市龙华区妇幼保健院常规产前超声检查的不同孕周胎儿眼睑、睑裂图像，观察其显示切面（眼睑冠状切面和经眼睑中部矢状切面）及声像特征。采用χ²检验比较同孕周胎儿左右眼睑裂声像特征在矢状切面和冠状切面的差异，采用Fisher检验比较不同孕周胎儿左右眼睑裂声像特征在矢状切面和冠状切面的差异。追踪并随访胎儿娩出后眼部情况。

结果

本研究纳入15～40孕周正常胎儿125例，在胎儿眼睑冠状切面及经眼睑中部矢状切面观察250只眼，左眼125只，右眼125只。15周前的胎儿眼睑、睑裂回声大多无法显示。随孕周增加，眼睑从小叶片状中等回声逐渐过渡到高回声。胎儿睑裂冠状切面显示率为98.4%（左眼）、96.0%（右眼）；经眼睑中部矢状切面显示率为96.8%（左眼）、94.4%（右眼）。睑裂呈线状高回声、低回声、带状无回声。20周前，上下眼睑未分离，睑裂呈线状高回声；20～28周，上下眼睑逐渐分离，睑裂可表现为线状高回声、线状低回声、带状无回声3种超声声像；28周后，睑裂仍可见线状高回声、线状低回声、带状无回声3种超声声像，其中线状低回声及带状无回声检出率较28周前增加。相同孕周，在矢状切面和冠状切面，胎儿左、右眼睑裂回声比较，差异均无统计学意义（P均＞0.05）。不同孕周间比较，胎儿左、右眼睑裂超声声像的特征中不同切面的线状高回声及线状低回声表现差异均具有统计学意义（P均＜0.05），不同切面的带状无回声表现在不同孕周间差异均无统计学意义（P均＞0.05）。经娩出后证实，125例胎儿双侧眼睑、睑裂均正常。

结论

产前超声可以对胎儿眼睑、睑裂发育情况进行评估，有助于提高胎儿眼睑、睑裂发育异常的产前检出率。

Objective

To investigate prenatal ultrasonographic methods for evaluating fetal eyelids and palpebral fissures and their imaging characteristics.

Methods

Ultrasonographic images of fetal eyelids and palpebral fissures in fetuses at various gestational weeks were prospectively collected from January 2023 to March 2024 at Shenzhen Longhua Maternal and Child Health Hospital. The imaging planes （coronal plane of the eyelids and mid-eyelid sagittal plane） and sonographic characteristic were systematically analyzed. Chi-square tests were used to compare left-right eyelid fissure echoic patterns in sagittal and coronal planes within the same gestational week， and the Fisher’s exact test was used to compare differences across gestational weeks. Postnatal ocular outcomes were tracked.

Results

A total of 125 normal fetuses at 15-40 gestational weeks were included， with 250 eyes （125 left， 125 right） evaluated via coronal and mid-eyelid sagittal planes. Eyelid and palpebral fissure echogenicity was rarely detectable before 15 weeks. With advancing gestation， eyelid echogenicity transitioned from flake-like moderate to hyperechoic.Visualization rates for palpebral fissures were 98.4% （left） and 96.0% （right） in coronal planes， and 96.8%（left） and 94.4% （right） in sagittal planes. Palpebral fissures manifested as linear hyperechoic， hypoechoic，or band-like anechoic structures. Before 20 weeks， fused eyelids displayed linear hyperechoic fissures. From 20-28 weeks， gradual eyelid separation yielded three patterns： linear hyperechoic， hypoechoic， or band-like anechoic. After 28 weeks， hypoechoic and anechoic patterns increased in prevalence. No significant left-right differences were observed in echoic patterns within the same gestational week （P＞0.05）. Across gestational weeks， significant differences were noted in linear hyperechoic and hypoechoic patterns （P＜0.05）， while band-like anechoic patterns showed no statistical variation （P＞0.05）. Postnatal follow-up confirmed normal eyelid and fissure development in all 125 cases.

Conclusion

Prenatal ultrasound enables effective evaluation of fetal eyelid and palpebral fissure development， enhancing prenatal detection of abnormalities.