四例胎儿肠扭转的产前超声诊断特点  

Sonographic characteristics of fetal intestinal volvulus:report of four cases

作　　者：张晓红[1] 宋兵[1] 刘阿庆[1] 范东晨[1] 张忠路[1] 孟慧敏[1] Zhang Xiaohong;Song Bing;Liu Aqing;Fan Dongchen;Zhang Zhonglu;Meng Huimin(Department of Ultrasound,Affiliated Hospital of Jining Medical College,Jining 272029,China)

机构地区：[1]济宁医学院附属医院超声科,272029

出　　处：《中华围产医学杂志》2020年第9期594-599,共6页Chinese Journal of Perinatal Medicine

基　　金：济宁医学院附属医院"苗圃"科研计划项目(MP-2017-014)。

摘　　要：目的探讨胎儿肠扭转的产前超声诊断特点。方法回顾性纳入2015年4月至2018年5月济宁医学院附属医院产前超声提示胎儿肠扭转且经生后手术或引产后尸体解剖证实的病例4例。分析超声仪器中储存的4例肠扭转胎儿的11次超声检查动态及静态图像,总结声像图特点。随访妊娠结局及伴发畸形。采用描述性统计分析。结果4例胎儿共11次产前超声检查声像图中,肠扭转直接征象—肠管排列呈whirlpool征6次、肠系膜上动脉和肠系膜上静脉分支血流呈漩涡样改变5次以及咖啡豆征3次,检出间接征象—肠管扩张11次、腹腔积液8次、羊水过多5次、腹膜钙化4次、假性囊肿1次。3次处于扭转初期阶段,均可见肠管排列呈whirlpool征及血流呈旋涡样改变,但随病程进展,进入胎粪性腹膜炎阶段,该2种征象可消失,间接征象出现。出生后手术或引产后尸体解剖均证实节段性肠扭转,均不合并肠旋转不良,3例合并小肠闭锁。结论胎儿肠扭转超声检查有典型的直接征象与不典型的间接征象,是诊断胎儿肠扭转的重要手段。Objective To investigate the characteristic of ultrasound in diagnosing fetal intestinal volvulus.Methods From April 2015 to May 2018,four cases of fetal intestinal volvulus indicated by prenatal ultrasound in the Affiliated Hospital of Jining Medical College and confirmed either by autopsy or by postnatal surgery,were retrospectively analyzed.A total of 11 ultrasound scans had been performed on the four cases,and the dynamic and static ultrasound features were summarized.Pregnancy outcomes and concomitant malformations were also followed up.Descriptive statistical analysis was used.Results The direct ultrasonographic patterns of intestinal volvulus in the four cases were"whirlpool"signs(six times),clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery(five times),and"coffee bean"sign(three times);the indirect signs included dilated small intestine(11 times),ascites(eight times),polyhydramnios(five times),peritoneal calcification(four times),pseudocysts(once).Out of the 11 ultrasound examinations,early-stage volvulus was detected on three occasions,all with"whirlpool"signs and clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery.As the disease progressed to the meconium peritonitis stage,indirect signs emerged while the initial two signs can diminished.Postnatal surgery or autopsy after labor induction confirmed the segmental volvulus in the four cases,of which three were complicated by intestinal atresia.No intestinal malrotation was found.Conclusion Typical direct signs and atypical indirect signs could be identified in the sonogram findings of fetal volvulus,and are important for diagnosing fetal volvulus.

关 键 词：肠扭转 超声检查 产前 胎儿疾病 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]