57例先天性膈疝胎儿的产前诊断特点及其预后  

Prenatal diagnosis and fetal outcome of 57 cases of congenital diaphragmatic hernia

作　　者：祝菁[1] 杨祖菁[1] 王磊[1] 王蓓[1] 

机构地区：[1]上海交通大学医学院附属新华医院产科,200092

出　　处：《中华围产医学杂志》2014年第9期590-593,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的 探讨先天性膈疝胎儿的产前诊断特点及影响胎儿预后的相关因素. 方法 回顾性分析2006年1月1日至201 3年3月31日存上海交通大学医学院附属新华医院产前诊断中心诊断的57例先天性膈疝胎儿的病历资料,结合超声检查特点和新生儿存活情况,分析先天性膈疝胎儿预后不良的危险因素.采用t检验、x2检验及Logistic回归进行统计学分析. 结果 57例膈疝胎儿中左侧膈疝45例（79％）,右侧膈疝12例（21％）.57例膈疝胎儿中,引产终止妊娠14例;33例出生后手术治疗,术后存活23例,死亡10例,总体存活率为40％（23/57）;另10例胎儿生后未行手术治疗,均死亡.存活新生儿出生体重明显高于死亡新生儿[（3 173±348）与（2 846±568）g,t=2.238,P=0.033],而引产组的诊断孕周明显早于存活组[（24.0±4.1）与（30.0±6.0）周,t=3.181,P=0.003].存活组肺头比（lung-to head ratio,LHR）≥1.4的比例为91％ （21/23）.线性趋势检验显示,LHR值与膈疝胎儿的预后之间存在线性相关关系（x2=9.223,P=0.002）,相关系数为-0.730（P=0.000）.LHR＜1.4时新生儿死亡的危险是LHR≥1.4者的35.867倍（95％CI：1.861～691.341,P=0.018）;羊水过多的新生儿死亡危险是无羊水过多者的9.285倍（95％CI：1.102～78.212,P=0.040）.而右侧膈疝（OR=0.158,95％CI：0.009～2.824,P=0.210）、肝脏疝人胸腔（OR=1.730,95％CI：0.144～20.707,P=0.665）和新生儿出生体重（OR=1.002,95％CI：0.999～1.005,P=0.135）不是膈疝胎儿生后死亡的危险因素. 结论 先天性膈疝胎儿的存活率仍较低,胎儿膈疝出现的孕周、羊水量以及LHR与胎儿的预后不良密切相关.Objective To explore the prenatal diagnosis and factors influencing prognosis of congenital diaphragmatic hernia （CDH）.Methods Fifty seven cases of CDH prenatally diagnosed by ultrasound in the Department of Obstetrics,Xinhua Hospital from January 1,2006 to March 31,2013 were retrospectively reviewed.Prognosis and risk factors were analyzed by ultrasound characteristics and newborn status.Statistical analysis was performed using t test,x2 test and Logistic regression.Results Forty-five （79%）of all cases were left-side CDH and the rest 12 （21%）were right-side.Fourteen fetuses were aborted.Thirty three were delivered and treated surgically,twenty-three infants survived after surgery and ten died,with an overall survival rate of 40% （23/57）.The other ten cases were delivered,but died of no treated surgically.The birth weight of the surviving neonates was heavier than that of those who died [（3 173 ±348） vs （2 846±568）g,t=2.238,P=0.033].The gcstational age at diagnosis of the aborted fetuses was younger than that of the surviving neonates [（24.0 ± 4.1） vs （30.0± 6.0） weeks,t=3.181,P=0.003].Twenty-one （91%,21/23） of the surviving neonates had a lung-to-head ratio （LHR） ≥ 1.4.A linear trend test showed a negative correlation between LHR and adverse outcome （x2=9.223,P=0.002） with a correlation coefficient-0.730 （P=0.000）.LHR〈1.4 （OR=35.867,95%CI：1.861-691.341,P=0.018） and polyhydramnios （OR=9.285,95%CI：1.102-78.212,P=0.040） were risk factors for neonatal death.Right-side CDH （OR=0.158,95%CI：0.009-2.824,P=0.210）,liver herniation into the thorax （OR=1.730,95%CI：0.144 20.707,P=0.665） and birth weight （OR=l.002,95%CI：0.999-1.005,P=0.135） were not risk factors.Conclusions The survival rate of CDH is still low.Gestational age on diagnosis,presence of polyhydramnios and LHR〈 1.4 predict an adverse outcome.

关 键 词：疝 横膈 超声检查 产前 预后 

分 类 号：R714.5[医药卫生—妇产科学]