孕中晚期胎儿主静脉系统畸形漏误诊分析  

Analysis of prenatal misdiagnosis and missed diagnosis of fetal cardinal venous system malformations

作　　者：苟中山[1] 何怡华[1] 张烨[1] 孙琳[1] 陈娇阳[1] 郝晓艳[1] 满婷婷[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所超声科,100029

出　　处：《心肺血管病杂志》2014年第6期861-865,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨胎儿超声心动图对孕中晚期胎儿主静脉系统漏误诊原因,以提高产前诊断率。方法:连续入选2010年8月至2013年12月间,于北京安贞医院行产前胎儿超声心动图检查并对引产或出生后死亡胎儿行病理解剖,产后存活婴幼儿行超声心动图随访胎儿共718例,最终确诊主静脉系统畸形121例。结果:1经病理解剖或出生后随访确诊主静脉系统畸形胎儿121例,其中永存左上腔静脉占78.4%,复杂型主静脉系统畸形占11.2%,下腔静脉近心段缺如占8%,永存左下腔静脉占0.8%,而文献所报道的双下腔静脉在本研究中未得到证实。2根据各种类型主静脉系统畸形的解剖变异不同,各种畸形误诊内容差异较大。3产前诊断对永存左上腔静脉和下腔静脉近心段缺如的误诊率较高,而复杂型主静脉系统畸形和永存左上腔静脉约登指数相对较高。结论:提高各种类型主静脉畸形的病理解剖及血流动力学改变,熟悉常见主静脉系统常规及非常规切面,并掌握各类主静脉畸形超声诊断要点是提高产前诊断率的有效途径。Objective： To discuss reasons of misdiagnosis and missed diagnosis of fetal cardinal venous system malformations and improve prenatal diagnostic rate. Methods： Non-consecutive 718 fetuses referred for fetal echocardiography examination in Beijing Anzhen hospital were included, of which 121 cases were diagnosed cardinal venous system malformations. Autopsy was performed on fetuses induced labor or died after birth. Postnatal survivals were followed-up by neonatal echocardiography. Results ：（1）121 cases were diagnosed cardinal venous system malformations, of which morbidity of complex type, persistent left superior vena cava, interrupted inferior vena cava and persistent left superior vena cava respectively was 78. 4% , 11.2% ,8% and 0. 8%. （2）As anatomic variation of every type of cardinal venous system malformations, misdiagnosed situation was greatly different. （3）Misdiagnosed rate of persistent left superior vena cava and interrupted inferior vena cava were relatively higher, and Youden index of complex type and persistent left superior vena eava were relatively higher than others. Conclusion： Awareness-raising of pathological anatomy and hemodynamic changes and mastering special ultrasound scan techniques of various types cardinal venous malformations are effective ways to improve prenatal diagnostic rate.

关 键 词：胎儿超声心动图 主静脉系统畸形 病理解剖 漏诊 误诊 产后随访 

分 类 号：R540.45[医药卫生—心血管疾病]