超声引导下脐静脉穿刺用于产前诊断的临床分析  

Application of Cordocentesis Guided by Transabdominal Ultrasound in Prenatal Diagnosis

作　　者：李晓峰[1] 龚斐[1,2] 肖红梅[1,2] 谭跃球[1,2] 林戈[1,2] 

机构地区：[1]中信湘雅生殖与遗传专科医院,长沙410008 [2]中南大学生殖与干细胞工程研究所

出　　处：《国际生殖健康／计划生育杂志》2013年第4期278-280,共3页Journal of International Reproductive Health/Family Planning

摘　　要：目的:探讨超声引导下脐静脉穿刺术在产前诊断中的应用。方法:收集中信湘雅生殖与遗传专科医院2004—2012年行超声引导下脐静脉穿刺检测胎儿染色体核型的158份病例(夫妇一方有染色体异常携带组21例,超声发现胎儿异常或可疑畸形、羊水量异常组58例,妊娠妇女血清学筛查高风险组38例,不良生育史组41例),分析手术指征、穿刺并发症等,并追踪其妊娠结局。结果:穿刺成功率100%。异常染色体检出率为6.96%(11/158)。4组间异常染色体检出率比较差异无统计学意义(χ2=7.377,P=0.061)。术后胎儿一过性心动过缓17例(10.8%);短暂性脐带或胎盘出血97例(61.4%),无早产、宫内感染、胎盘早剥等严重并发症。引产11例,出生畸形3例。结论:超声引导下脐静脉穿刺是一种较为安全、有效的产前诊断方法;经产前诊断检查正常也可能出现后期出生缺陷,因此需结合超声等进一步检查以提高诊断效率,有效减少患儿出生。Objective： To evaluate the efficacy and safety of cordocentesis guided by transabdominal ultrasound during pregnancy for prenatal diagnosis.Methods：The cordocenteses under transabdominal ultrasound guidance were performed in 158 cases with proper indications for fetal chromosome analysis at Reproductive Genetic Hospital of CITIC-XIANGYA during 2004 to 2012（21 cases of chromosomal anomaly of gravida or her husband,58 cases of hinting abnormal by ultrasound,38 cases of bad pregnancies history,41 cases of serology screening is positive of gravid）.The abnormal karyotypes rate,operational indications,complications and pregnancy outcomes were analyzed.Results： The success rate of cordocentesis was 100%.There were 11 abnormal karyotypes in those 158 cases（6.96%）detected by cordocentesis.The difference in the abnormal karyotypes rate among four groups was not significant（χ2=7.377,P=0.061）.There were 97 cases with the blood leakage from placentas or umbilical cords（61.4%）,and 17 cases with transient fetal bradycardia（10.8%）after cordocentesis.There was not a preterm delivery,intrauterine infection or placental abruption.In those 11 cases treated by the induced labour,and 3 birth defects were diagnosed.Conclusions：Cordocentesis guided by transabdominal ultrasound is a useful,relatively safe and effective procedure for prenatal diagnosis.Birth defects can not be completely diagnosed by the cordocentesis and genetic analysis at present,so it is necessary to use ultrasonography as the further follow-up diagnosis for reducing the rate of birth defect.

关 键 词：产前诊断 超声检查 产前 脐静脉 染色体畸变 先天畸形 

分 类 号：R714.5[医药卫生—妇产科学]