双胎反向动脉灌注序列征半心畸形的超声影像学研究  

Study on the ultrasonic imaging characteristics of the twin reversed arterial perfusion sequence-hemiacardius

作　　者：路小军[1] 杨小红[1] 陈欣林[1] 赵胜[1] 陈佩文[1] 杨帆[1] 戢秀勤[1] 

机构地区：[1]湖北省妇幼保健院超声影像科,武汉430070

出　　处：《中华超声影像学杂志》2016年第10期854-859,共6页Chinese Journal of Ultrasonography

基　　金：湖北省自然科学基金（2014CFB210）

摘　　要：目的探讨双胎反向动脉灌注序列征（TRAP）半心畸形的超声影像学特征。方法回顾性分析9例TRAP半心畸形的临床资料，观察双胎及其附属物的超声特点，并与产后病理结果对照。结果9例TRAP产前超声声像图表现：9例半心畸胎儿胸腔内均可见遗迹心脏搏动，并探测到上下方向的动脉频谱；发育较好（多腔型）的遗迹心脏处心率较慢，发育较差（即管道型及单腔型）的遗迹心脏心率较快；9例半心畸胎儿均有全身皮肤水肿，淋巴水囊肿，发育不良的头、脊柱、腹部器官（双‘肾、肠管等），7例有膈肌；8例有双下肢，1例有单下肢；7例有上肢。9例泵血儿中7例心功能不全，5例羊水过多。9例TRAP半心畸胎儿中1例中孕期宫内血流自然阻断，泵血儿存活；8例泵血儿死亡（2例宫内死胎，5例心功能不全引产，1例羊水过多早产后夭折）。结论TRAP半心畸形自然病程泵血儿预后差，宫内易发生心功能不全。超声能准确诊断TRAP半心畸形，可用于指导临床医生早期进行宫内治疗，从而有效提高泵血儿生存率。Objective To explore the ultrasonic characteristics of the twin reversed arterial perfusion （TRAP） sequence-hemiacardius. Methods A retrospective analysis of the clinical data and ultrasonic characteristics of 9 cases with the TRAP was made, which were compared with the pathlogical result after delivery. Results The prenatal ultrasonic imaging characteristics showed：The vestigial heart＇s pulsating was seen in all the hemiacardius twin＇s thoracic cavity, and the Doppler spectrum in it went up and down. It was noted that the heart rate was slower in the better （multicavity） development of the heart and faster in the poor development （pipe type and single cavity） of the heart. Nine hemiacardius twin had hydroderma and cystic hygroma. The head, spine, abdominal organs （both kindenys and intestines） of all the 9 cases were hypogenetic. The diaphragm was present in 7 cases ; lower limbs was present in 8 cases, single leg was seen in one case ; upper limbs was present in 7 cases. Seven cases of the pump twin suffered from the cardiac insufficiency. Polyhydramnios were seen in 5 cases. Prognosis of the 9 cases of the TRAP pump twin：the cessation of blood flow spontaneous was seen in one case, the pump twin was survived and delivered at term. Eight cases were demise （2 cases with intrauterine demise, 5 cases induced labor with cardiac insufficiency, 1 case died from polyhydramnios after premature birth）. Conclusions The pump twin of the TRAP hemiacardiacs have a poor prognosis with the nautural course, and are easy to suffer from the cardiac insufficiency in utero. The ultrasonography can diagnose the TRAP hemiacardius accurately, which can be used to guide the clinical doctors to choose a reasonable timing to take intrauterine treatment, that will effectively improve the survival rate of the pump twin.

关 键 词：超声检查 双胎反向动脉灌注序列征 半心畸形 无心畸形 

分 类 号：R445.1[医药卫生—影像医学与核医学]