胎儿结构畸形产前超声诊断分析  

Prenatal ultrasound assessment for fetal structural abnormalities

作　　者：王凤兰[1,2] 王建华[3] 张云亭[1] 寇世和[2] 易建平[4] 杜明桢[2] 张伟[2] 周钰昆 

机构地区：[1]天津医科大学研究生学院,300070 [2]唐山市妇幼保健院超声科,063000 [3]北京军区总医院超声科,北京100700 [4]唐山市妇幼保健院妇产科,063000

出　　处：《中华医学超声杂志（电子版）》2015年第6期483-489,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：河北省重点科研课题11276102D

摘　　要：目的探讨产前超声诊断胎儿结构畸形的价值。方法对2010年1月至2014年6月于唐山市妇幼保健院进行产前超声检查、诊断并经引产或出生后证实的3 101例患儿和漏诊的856例患儿的临床资料进行回顾性分析,记录超声检出及漏诊胎儿结构畸形种类和数量,计算超声检查胎儿结构畸形的检出率、漏诊率,并分析漏诊原因。结果产前超声检出胎儿结构畸形3 101例(4 171处畸形),检出率为11.51‰(3 101/269 501)。超声漏诊856例(947处畸形),漏诊率为3.18‰(856/269 501)。胎儿结构畸形发生率为14.68‰(3 957/269 501)。按解剖系统分类,超声检出的胎儿结构畸形居前5位的依次为心血管系统(851例)、中枢神经系统(691例)、颜面部(562例)、泌尿系统(476例)及呼吸系统(134例)。超声检出的胎儿结构畸形居前5位的依次为唇腭裂(549例)、室间隔缺损(519例)、肾积水(331例)、脊柱裂(212例)、心内膜垫缺损等(163例)。超声漏诊的前5位胎儿结构畸形依次为多、并指(趾)(285例)、耳畸形(108例)、尿道下裂(93例)、足异常(92例)、室间隔缺损(52例)。结论产前超声对胎儿结构畸形有较高的检出率,但其对多、并指(趾)、耳畸形、尿道下裂等畸形漏诊率高。Objective To explore the feasibility of contrast-enhanced ultrasonograhy（CEUS） in preoperative classification of hepatocellular carcinoma（HCC） microvascular morphology. MethodsTotally 94 HCC patients who underwent CEUS were analyzed retrospectively. And the offline Timeintensity curve（TIC） were drawn using Sono Tumor. The tumor size, alpha fetoprotein（AFP）, cirrhosis, Child-Pugh classification, tumor differentiation and TNM stage were statistically analyzed. The intratumoral microvessels of HCC in 94 cases were evaluated by CD34 immunohistochemical staining. The relationship between intratumoral microvessel morphology and CEUS parameters were analyzed. Results CD34 immunohistochemical staining showed three distinct microvessel types in 94 cases of HCC： 28 cases of capillary-like type, 14 cases of sinusoid-like type and 52 cases of mixed type. There were no significant differences of clinical data among three microvascular morphology types. The parameters of peak strength（PE）, rise time（RT）, wash-in rate（Wi R）, wash-in perfusion index（Wi PI）, wash-in area under the curve（Wi AUC） and mean transit time（MTT） in 28 cases of capillary-like type were（4350.7±2566.0） a.u,（10.7±3.2）s,（717.0±489.9） a.u,（12820.3±8331.6）a.u,（128 240.8±74 487.1） a.u,（71.9±33.1）s. Those parameters in 14 cases of sinusoid-like type were（2471.6±1107.1） a.u,（16.2±4.2）s,（321.9±171） a.u,（5 561.4±2 938.0）a.u,（86 780.1±47 563.7） a.u,（117.8±69.6）s. And in 52 cases of mixed type they were（3563.2±2343.1） a.u,（14.1±4.8）s,（519.4±403.2） a.u,（9 015.3±6 884.7）a.u,（128 240.8±74 487.1） a.u,（71.9±33.1） s respectively. The CEUS parameters of Wi R, Wi PI in capillary-like type HCC patients were higher than sinusoid-like type and mixed type HCC patients, while RT was lower than sinusoid-like type and mixed type HCC patients, and the differences were significant（Wi R： t=3.87, 3.3, both P=0.05; Wi PI： t=2.96, 2.06, both P=0.05; RT�

关 键 词：先天畸形 超声检查 产前 诊断 胎儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]