产前超声评估先天性膈疝预后  

Prenatal ultrasound in prognosis assessment of congenital diaphragmatic hernia

作　　者：肖祎炜[1] 俞钢[2] 尚宁[1] 马小燕[1] 张江宇[3] 马秋萍[1] 安思微 

机构地区：[1]广东省妇幼保健院超声科,广东广州511442 [2]广东省妇幼保健院胎儿医学科,广东广州511442 [3]广东省妇幼保健院病理科,广东广州511442

出　　处：《中国医学影像技术》2017年第4期566-570,共5页Chinese Journal of Medical Imaging Technology

基　　金：广东省医学科学技术研究基金项目(A2016170)

摘　　要：目的探讨产前超声在先天性膈疝预后评估中的应用价值。方法分析65例出生后经手术或随诊证实为先天性膈疝的胎儿的产前超声声像图特征,测量胎儿健侧肺的肺头比(LHR)、与该孕周正常胎儿的LHR进行比较,计算O/E LHR,探讨其与新生儿预后的关系。结果 65例中,45例出生后行手术治疗后存活,8例手术后死亡,12例未行手术即死亡,总死亡率30.77%(20/65)。肝上型膈疝死亡率66.67%(8/12);肝下型膈疝死亡率22.64%(12/53)。合并其他结构异常共9例,死亡8例,其中6例合并胸腔内结构异常。LHR为0.40~2.72,平均1.59±0.69;不同LHR膈疝胎儿出生后死亡率差异有统计学意义(χ~2=19.360,P<0.001),LHR≤1.0的膈疝胎儿出生后死亡率高于LHR>1.0的膈疝胎儿。O/E LHR为23%~90%,平均(58.25±17.61)%,不同O/E LHR膈疝胎儿出生后死亡率差异有统计学意义(χ~2=15.261,P=0.002),O/E LHR≤45%的膈疝胎儿出生后死亡率高于O/E LHR>45%的膈疝胎儿。结论产前超声可用于诊断胎儿先天性膈疝,并评估健侧肺的发育情况及患儿预后。Objective To investigate the value of prenatal ultrasound in prognosis assessment of congenital diaphragmatic hernia. Methods The ultrasonographic features of 65 fetuses with congenital diaphragmatic hernia were analyzed, which were confirmed by after birth surgery or examination. The lung-to-head ratio （LHR） of unaffected side and O/E LHR （LHR compared to normal fetuses on same gestational weeks） were obtained, and then the relationship with the prognosis of neonates were analyzed. Results In 65 cases, 45 fetuses survived and 8 fetuses died after surgery, while 12 cases did not undergo surgery and death promptly. Overall mortality was 30.77% （20/65）. In 12 hepatic intrathoracic type of diaphragmatic hernia cases, the mortality rate was 66.67% （8/12）. In 53 hepatic intra-abdominal type of diaphragmatic hernia cases, the mortality rate was 22.64% （12/53）. In 9 cases combined with other structural abnormalities, there were 8 cases were dead and 6 cases （6/8） with abnormal chest structure. LHR values were from 0.40 to 2.72, the average value was 1.59±0.69. It showed statistical difference on the mortality rate in fetus of congenital diaphragmatic hernia with different LHR （χ^2=19.360, P〈0.001）, The mortality rate in fetal of congenital diaphragmatic hernia with LHR 1.0 or less was higher than that with LHR 〉1.0. O/E LHR measurement values were from 23% to 90% and the average value was （58.25±17.61）%. It showed statistical difference on the mortality rate in fetus of congenital diaphragmatic hernia with different O/E LHR （χ^2=15.261, P=0.002）. The mortality rate in fetal of congenital diaphragmatic hernia with O/E LHR ≤ 45% was higher than that with O/E LHR〉45%. Conclusion The prenatal ultrasound can be used to diagnose congenital diaphragmatic hernia, and to assess the development of unaffected lung and prognosis.

关 键 词：超声检查 产前 先天性膈疝 胎儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R682.1[医药卫生—诊断学]