产前超声诊断胎儿胆道囊性病变的价值  

Value of prenatal ultrasonography in diagnosis of fetal biliary cystic malformation

作　　者：张一休[1] 孟华[1] 欧阳云淑[1] 姜玉新[1] 戴晴[1] 徐钟慧[1] 杨萌[1] 袁岩[1] 李鹏[1] 楼海亚[1] 杨筱[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院超声科,北京100730

出　　处：《中华超声影像学杂志》2010年第5期427-430,共4页Chinese Journal of Ultrasonography

基　　金：国家科技支撑计划＂重大出生缺陷和遗传病的防治研究-严重胎儿结构异常影像学产前筛查和诊断新技术的研究＂资助项目（2006BAI 05A 04）

摘　　要：目的 探讨产前超声对胎儿胆道囊性病变的诊断价值.方法 回顾性分析孕期于我院产前超声检出的3例胆道囊性病变,并随访至生后手术.结果 3例胎儿分别于孕16周、孕26周、孕34周检出右上腹囊性包块,诊断为胆道囊性病变.生后手术确诊2例为胆总管囊肿,1例为月日道闭锁.2例胆总管囊肿最大径分别为3.9 cm及4.2 cm且随孕周逐渐增大,胆囊清晰显示.1例胆道闭锁囊肿最大径1.7cm且整个孕期无明显变化,胆囊不显示或偶尔显示时体积小.3例患儿均在生后4个月内行肝管空肠Roux-en-Y吻合术,术后恢复良好.结论 囊肿的体积及其变化、胆囊形态可以帮助鉴别胎儿胆道囊性病变.囊肿体积小且无增大伴胆囊不显示或胆囊体积小提示胆道闭锁.产前超声诊断可使患儿得到早期手术治疗,改善预后.Objective To investigate the diagnositic value of ultrasonography in fetuses with cystic biliary malformation. Methods Three cases of cystic biliary malformation diagnosed in our hospital by prenatal ultrasound were followed up until surgery after birth. Results In all three cases.an anechoic cystic lesion was detected in the right upper abdomen at 16,26,34 weeks＇ gestation respectively, which were diagnosed as biliary cystic malformation by prenatal ultrasound. Two cases were confirmed as choledochal cyst by surgery, one case as biliary atresia. The maximum diameter during pregnancy of choledochal cyst were 3. 9 cm and 4.2 cm respectively, which increased steadily as gestational age advanced, with normal gallbladder in continuity with the choledochal cyst. But the largest diameter of the cyst in congenital biliary atresia was 1.7 cm and remained unchanged throughout the remaining pregnancy, the gallbladder could not be detected or an irregular small gallbladder was shown. Excision of the cyst and Roux-en-Y hepaticojejunostomy were successfully performed in all three cases. Postoperative course were uneventful. Conclusions Cyst diameter, change in size, gallbladder ultrasound pattern may allow to make a prenatal differential diagnosis of biliary tree cystic malformation. Small and stable cyst with an undetected gallbladder or small gallbladder is more suggestive of biliary atresia than choledochal cyst. Precise imaging may facilitate prenatal counseling and perinatal management. The outcomes had improved with earlier operations.

关 键 词：超声检查 产前 胆总管囊肿 胆道闭锁 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]