胎儿肠管增宽的产前超声诊断、预后及染色体分析  

Prenatal ultrasound diagnosis, prognosis and chromosome analysis of fetal bowel dilatation

作　　者：杨瑞琦[1] 刘宗谕 张嘉玲[1] 南钰 范丽梅[1] 

机构地区：[1]吉林大学第二医院妇产科,长春130041 [2]吉林大学白求恩医学部临床医学专业

出　　处：《中华医学杂志》2016年第33期2648-2651,共4页National Medical Journal of China

基　　金：吉林省科技厅重点科技攻关项目（20132068SF）

摘　　要：目的通过产前超声对胎儿肠管增宽的诊断，结合其预后和染色体结果，评估此三者间的内在联系，以期进一步提高产前染色体检查侵入性操作的阳性率，同时减少漏诊风险。方法选取2013年6月至2015年12月于吉林大学第二医院妇产科就诊，超声检查肠管扩张的胎儿，共90例。产前向孕妇交代胎儿可能预后，对继续妊娠者行羊膜腔穿刺、脐血穿刺进行胎儿染色体核型分析，同时定期超声观察胎儿肠管变化，产后新生儿正常排便为预后良好，产后新生儿未正常排便者行腹部X线或钡剂造影，明确诊断后行手术或保守治疗；对于吉林大学第二医院引产的胎儿，于引产前进行羊膜腔穿刺、脐血穿刺进行胎儿染色体核型分析，引产后行尸体解剖明确诊断，对未在吉林大学第二医院引产而继续检查者行电话随访。结果90例胎儿中11例胎儿十二指肠段肠管扩张，38例空回肠段肠管扩张，41例结直肠段肠管扩张，其中十二指肠段肠管扩张11例中10例引产，尸体解剖检查结果和超声结果吻合，1例失访。染色体检查3例21-三体综合征，1例18一三体综合征，1例染色体异位；38例胎儿空回肠段肠管扩张，其中26例孕期肠管扩张减轻或未见大辐度增加，预后良好，6例引产，3例生后手术，2例术后存活，3例失访，染色体检查回报1例21-三体，1例染色体异位；结直肠段肠管扩张胎儿41例，29例预后良好，5例引产，1例胎死宫内，2例出生后1个月内死亡，2例出生后手术，术后存活，2例失访。结论胎儿肠管扩张根据其扩张部位和程度不同，临床上预后和其所合并染色体异常风险并不相同，需要具体情况具体分析。Objective To investigate the relationship among the prenatal ultrasound, prognosis and chromosome results of fetal bowel dilatation. And in order to further improve the positive rate of prenatal chromosome examination operation, and reduce the risk of missed diagnosis. Methods Ninety fetuses who were diagnosed as fetal bowel dilatation by prenatal ultrasound from June 2013 to December 2015 in the Second hospital of Jilin University were enrolled. Chromosomes were examined by amniotic cavity puncture or umbilical cord blood puncture. The change of fetus＇s bowel was monitored periodically by prenatal ultrasound. The normal bowel movement of newborns was a good prognosis. The abdominal X ray or barium contrast radiography was performed in the newborns who did not have normal bowel movement after delivery. Patients underwent surgery or conservative treatment after diagnosis. Fetal karyotype analysis of aborted fetus was carried out by amniotic cavity puncture and umbilical cord blood before induction of labor. Autopsy was performed after induced labor. Patients who were not continued examination in our hospital were followed up by telephone. Results Among the 90 fetuses, there are 11 cases of duodenum dilatation, 38 cases of jejunum and ileum dilatation, 41 cases of colorectal dilatation. Ten cases of duodenum dilatation were confirmed by autopsy after induced labor, and one case was lost in follow-up. Chromosome examination revealed 3 cases of 21- three body syndrome, 1 case of 18- three body syndrome, 1 case of chromosomal translocation. In 38 cases of jejunum and ileum dilatation, bowel dilatation of 26 cases had decrease or no obvious increase with good prognosis. Six cases of induced labor, 3 cases of receive surgery after birth, 2 cases of postoperative survival, and 3 cases of loss of follow-up. Chromosome examination revealed 1 case of 21- three body syndrome and 1 case of chromosomal translocation. In 41 cases of colorectal dilatation, 29 cases had good prognosis. Five cases were aborted, 1 case of fetal d

关 键 词：超声 胎儿 肠管增宽 

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