产前超声诊断胎儿肝血管畸形引流及随访  

Prenatal ultrasound diagnosis and follow-up of fetal hepatic vascular malformation

作　　者：王允芹[1] 赵艳[1] 李传红[1] WANG Yun-qin;ZHAO Yan;LI Chuan-hong(Yantaishan Hospital of Yantai,Yantai Shandong 264000,Chin)

机构地区：[1]烟台市烟台山医院,山东烟台264000

出　　处：《中国临床医学影像杂志》2018年第7期501-504,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨胎儿肝血管畸形引流的产前超声图像特征,并结合随访讨论其临床意义。方法:回顾分析我院产前超声诊断的7例胎儿肝内血管畸形引流的声像图特点,并随访肝内肝动脉-肝静脉瘘及门静脉-肝静脉瘘胎儿预后情况。结果:7例胎儿胎龄为29~39周,产前超声诊断肝内肝动脉-肝静脉瘘4例,门静脉-肝静脉瘘2例,肝动脉-肝静脉瘘合并门静脉-肝静脉瘘1例。随访至生后2年,4例肝内肝动脉-肝静脉瘘生后无临床症状,其中2例做介入手术封堵后痊愈,1例生后半年复查病灶消失,1例半年后复查病灶略缩小(继续随访中)。2例肝门静脉-肝静脉瘘中,1例生后死亡,1例合并食道闭锁、颅内蛛网膜囊肿引产。1例肝动脉-肝静脉瘘合并门静脉-肝静脉瘘引产。本组胎儿肝内血管畸形引流超声图像均表现为肝动脉或门静脉与肝静脉间的囊状、管状或者不规则形无回声,彩色多普勒充满血流信号,肝动脉-肝静脉瘘可见增粗的肝固有动脉,频谱多普勒显示病灶内探及高速低阻的动脉样频谱;门静脉-肝动脉瘘相连引流肝静脉频谱改变,呈单相连续性血流,可见两个波峰和两个波谷,类似静脉导管的频谱形态。结论:产前胎儿肝内血管畸形的病例有特征性超声图像,超声可作为首选检查方法,对临床选择治疗方案具有重要的指导意义。Objective： To investigate the prenatal ultrasonographic features of fetal hepatic vascular malformation and discuss its clinical value combining with outcome follow-up. Methods： We retrospectively analyzed sonographic features of 7 cases of fetal liver vascular malformation diagnosed by prenatal ultrasound in our hospital, and performed follow-up for the prognosis of intrahepatic arteriovenous fistula and portoveinous fistula. Results： Seven fetuses with gestational age of 29 ~39 weeks were diagnosed including 4 cases of intrahepatic arteriovenous fistula, 2 cases of portovenous fistula, 1 case of intrahepatic arteriovenous fistula with portovenous fistula. According to 2-year follow-up after birth, 4 cases of intrahepatic arteriovenous fistula had no clinical symptoms after birth. Among them, 2 cases were cured after interventional operation, the lesion of 1 case disappeared after six months, and the size of the lesion decreased in 1 case six months after birth. In 2 cases of hepatic portovenous fistula, 1 infant died after birth, the other one which was combined with esophageal atresia and intracranial arachnoid cyst underwent induced labor. One case of intrahepatic arteriovenous fistula combined with portovenous fistula underwent induced labor. The ultrasound images of fetal hepatic vascular malformation showed cystic, tubular or irregular anechoic drainage between hepatic artery or portal vein and hepatic vein, filled with blood flow signal in CDFI. Thickened hepatic proper arteries were found in intrahepatic arteriovenous fistula, spectral Doppler showed lesions of high speed low resistance artery-like spectrum. The portoveinous fistula was connected with the hepatic vein, and the spectrum changed into a single-phase continuous blood flow. There were two peaks and two troughs, which were similar to the spectrum of the venous catheter. Conclusion： Prenatal fetal hepatic vascular malformation has characteristic ultrasound findings, and ultrasonography could be used as the first choice of examination mo

关 键 词：胎儿疾病 超声检查 产前 

分 类 号：R714.53[医药卫生—妇产科学] R445.1[医药卫生—临床医学]