胎儿肾脏囊性病变的产前诊断和临床预后  

Prenatal diagnosis and clinical prognosis of fetal renal cystic disease

作　　者：李辉[1] 施展[1] 刘明颖[1] 金良怡[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004

出　　处：《中华围产医学杂志》2008年第6期361-364,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨胎儿。肾脏囊性病变的原因和临床意义。方法对64例产前超声发现胎儿。肾脏囊性病变孕妇进行临床管理，如果选择终止妊娠放弃胎儿，则对患儿进行尸体解剖，并于引产时取脐血进行染色体核型分析；如果选择继续妊娠，则定期随访，严密监测。结果（1）8例患儿表现为单侧肾脏单发囊肿，其中3例出生后行囊肿切除术，5例无特殊治疗。（2）1例患儿为肾内局部多房性囊肿，1岁时行囊肿切除术。（3）55例患者产前诊断为胎儿多囊性肾病变，其中多囊性肾发育不良36例（27例选择了终止妊娠放弃胎儿；9例选择继续妊娠，分别于出生后3个月～2．5岁时行患侧肾脏切除）；婴儿型多囊肾6例（4例选择终止妊娠放弃胎儿；2例患者选择继续妊娠，但患儿分别于新生儿期死亡和出生后13个月死亡）；成人型多囊肾10例（3例选择终止妊娠放弃胎儿，2例患儿分别于出生后1个月和7个月死亡，其余5例目前临床无不适症状，正严密观察中）。结论胎儿肾脏囊性病变类型多样，病因不尽相同，临床结局也不相同，建议产前仔细鉴别胎儿肾脏囊肿类型，根据囊肿类型对胎儿可能出现的预后给予产前合理评价及咨询意见。Objective To investigate the clinical significance of prenatal diagnosis of fetal renal cystic disease and its clinical prognosis. Methods Sixty-four pregnant women with fetal renal cystic disease were enrolled. Fetal autopsy was performed if the pregnancy was terminated required by the parents; otherwise, closed follow-up was provided and umbilical blood samples were collected for fetal karyotypes. Results Eight infants showed unilateral renal single cyst, 3 of which had the cyst removed after birth and the rest 5 infants received no treatment. One case presented with local and multilocular cyst in the kidney, and the cyst was removed at one year old. Fifty-five infants were prenatally diagnosed as renal multiple cyst disease, 36 of them were multicystic dysplastic kidney （27 pregnancies were terminated, 9 continued and nephrectomy was perfomed at 3 - 18 months after birth）. Six cases of infant polycystic kidney disease were identified （4 cases were terminated, 2 died at neonatal period and 13 months after birth, respectively）. Adult multicystic dysplastic kidney was diagnosed in 10 cases （3 were terminated, 1 died at neonatal period and 1 at 7 months after birth）. Conclusions Fetal renal cystic disease has various types with different etiologies and clinical outcomes. It is important to differentiate the types and causes of fetal cystic disease before appropriate prenatal consultation.

关 键 词：产前诊断 肾脏 囊肿 预后 

分 类 号：R714[医药卫生—妇产科学]