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胎儿先天性膈疝产前超声筛查及妊娠结局分析 预览

Retrospective summary for the prenatal ultrasound screening and pregnancy outcomes of fetalcongenital diaphragmatic hernia
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摘要 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.
作者 荆春丽 韩璐 刘彧 刘娇 周乔 Jing Chunli;Han Lu;Liu Yu;Liu Jiao;Zhou Qiao(Department of Ultrasound, Dalian Maternity and Child Health Care Hospital, Dalian 116033, China)
出处 《中华医学超声杂志(电子版)》 CSCD 北大核心 2019年第3期186-192,共7页 Chinese Journal of Medical Ultrasound Celectronic Edition
关键词 超声检查 产前 先天性膈疝 妊娠结局 Ultrasonography,prenatal Congenital diaphragmatic hernia Pregnancy outcomes
作者简介 通信作者:荆春丽,Email:jcl5000@126.com.
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