胎儿胆囊结石样回声的产前超声诊断分型及产后随访情况  

Prenatal ultrasonic diagnosis and postpartum follow-up of fetal gallstone

作　　者：项小苗[1] 姜培娟[1] 刘远慧[1] 王军梅[1] Xiang Xiaomiao;Jiang Peijuan;Liu Yuanhui;Wang Junmei(Department of Ultrasonography,Women′s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院超声诊断科,杭州310006

出　　处：《中华超声影像学杂志》2019年第12期1071-1075,共5页Chinese Journal of Ultrasonography

基　　金：浙江省教育厅科研项目(Y201636060)。

摘　　要：目的探讨胎儿胆囊内结石样回声特点及随孕周变化的超声图像特征,并对出生后新生儿是否患高胆红素血症及胆囊内结石样回声消失情况进行随访,为产前咨询及出生后新生儿出现黄疸相关疾病提供更多诊治信息。方法选取2014年1月至2017年12月在浙江大学医学院附属妇产科医院行产前超声诊断并有随访结果的82例胎儿胆囊内结石样回声病例,总结分析胎儿胆囊内结石样回声分型、声像图特征及胆囊内结石样回声随孕周变化特点,并对孕妇情况进行分析。产后随访新生儿是否存在高胆红素血症及胆囊结石样回声消退情况。结果82例产前诊断胆囊结石样回声胎儿中,2例引产,80例出生。82例中呈泥沙样回声13例,强回声充满型19例,多发强回声型42例,散在或单发强回声8例。80例中8例胎儿胆囊结石样回声于宫内消失,72例出生后3 d内、42 d、1年或2年行超声复查,胆囊结石样回声均消失;80例中至出生前胆囊结石样回声数目减少9例。出生后患高胆红素血症新生儿20例(其中4例合并ABO溶血,2例合并新生儿败血症),经蓝光治疗预后良好;余60例随访期间均无异常情况出现。结论胎儿胆囊结石样回声是常发生于晚孕期的自限性疾病,部分胎儿出生后出现高胆红素血症,通过蓝光治疗预后良好,后续随访新生儿无异常情况出现。Objective To explore the characteristics of gallstone-like echo in fetal gallbladder and its changes with gestational age,and following up its prognosis as well as the relationship with bilirubin after birth so as to provide more information for prenatal consultation about neonatal jaundice related diseases.Methods A total of 82 fetuses from January 2014 to December 2017 at Women′s Hospital of Zhejiang University School of Medicine,who had prenatal ultrasound diagnosis and follow-up results with gallstone-like echo in fetal gallbladder,were included in this study.The characteristics of gallstone-like echo in fetal gallbladder were summarized,its change with gestational age,and its association with the status of pregnant mother were analyzed.Bilirubin and the prognosis of the gallstone-like echo were followed up after birth.Results Four different types of prenatal ultrasound characteristics of gallstone-like echo in fetal gallbladder were observed:sediment-like type(n=13),full of hyperechoic type(n=19),multiple hyperechoic type(n=42),and single or scattered hyperechoic type(n=8).Of the total 82 cases,2 fetus were induced abortion.In the 80 normal-born fetuses,the number of gallstone-like echo were reduced in 9 cases during pregnancy,the gallstone-like echo disappeared in uterus in 8 cases.During the follow up,the gallstone-like echoes disappeared at 3 days,42 days,1 year and 2 years after birth in the rest 72 cases,respectively.In the 80 fetuses,20 cases of neonates with hyperbilirubinemia after birth(4 males and 16 females)including 4 cases of ABO hemolytic,2 cases of neonatal sepsis.No abnormalities occurred in the remaining 60 neonates during the follow-up period.Conclusions Gallstone-like echo in fetus is a self-limiting disease that occurs in late pregnancy.Some neonates develop hyperbilirubinemia after birth with good prognosis.After phototherapy,the jaundice index decreased to the normal standard and the serum bilirubin content decreased.

关 键 词：超声检查 产前 胎儿 胆囊 结石样回声 

分 类 号：R44[医药卫生—诊断学] R714[医药卫生—临床医学]