九切面节段分析法在胎儿复杂先天性心脏病诊断中的应用价值  

Clinical value of nine-section segmental analysis in the diagnosis of complex fetal congenital heart disease

作　　者：凌文[1] 翁宗杰[1] 邱秀青 马宏[3] 吴秋梅[1] 赖远芳 陈锦文 刘敏[1] LING Wen;WENG Zongjie;QIU Xiuqing;MA Hong;WU Qiumei;LAI Yuanfang;CHEN Jinwen;LIU Min(Department of Ultrasound,Fujian Maternity and Child Health Hospital,Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350001,China)

机构地区：[1]福建省妇幼保健院福建医科大学附属医院超声科,福州350001 [2]福建省妇幼保健院福建医科大学附属医院妇产科,福州350001 [3]福建省妇幼保健院福建医科大学附属医院病理科,福州350001

出　　处：《福建医药杂志》2020年第6期9-13,共5页Fujian Medical Journal

基　　金：福建省自然科学基金资助项目(2017J01235)。

摘　　要：目的评价产前超声九切面节段分析法在诊断胎儿复杂先天性心脏病中的临床应用价值。方法回顾性分析119例复杂先天性心脏病产前超声图像,以解剖及铸型为金标准,分析四切面节段分析法和九切面节段分析法的诊断效能差异。结果四切面法与九切面法的诊断准确率分别为84.5%和93.1%。四切面法和九切面法在静脉与心房连接处异常、心房与心室连接处异常、心室与大动脉连接处异常以及心脏其他畸形方面一致性良好(Kappa≥0.4),诊断准确率差异无统计学意义(P>0.05);在胎儿内脏心房位置异常、主动脉与肺动脉及其分支异常方面,四切面法与九切面法的一致性差(Kappa<0.4),两者诊断准确率的差异有统计学意义(P<0.05)。四切面法漏诊29处畸形,误诊7处畸形;九切面法漏诊9处畸形,误诊7处畸形与四切面法完全相同。九切面法诊断复杂先天性心脏畸形的漏诊率明显低于四切面法(P<0.05)。结论产前超声四切面法可用于低危胎儿的心脏筛查;九切面法可获得更多切面信息,对复杂心脏畸形的诊断具有重要价值。Objective To evaluate the clinical value of nine-section segmental analysis in prenatal ultrasound diagnosis ofcomplex fetal congenital heart disease.Methods Through taking anatomy and vascular casting as the gold standard,the prenatal ultrasound images of 119 patients with complex fetal congenital heart disease were analyzed retrospectively.Thus the diagnostic efficiency differences between four-section segmental analysis and nine-section segmental analysis were analyzed.Results The diagnostic accuracy of four-section segmental analysis and nine-section segmental analysis were 84.5%and 93.1%respectively.The four-section segmental analysis and nine-section segmental analysis showed good consistency in abnormal connection between veins and atria,abnormal connection between atria and ventricles,abnormal connection between ventricles and great arteries,and other cardiac malformations(Kappa≥0.4),and the difference in diagnostic accuracy was not statistically significant(P>0.05).In terms of abnormal location of fetal viscera and atrium,as well as abnormalities of the aorta/pulmonary artery and their branches,the four-section segmental analysis and the nine-section segmental analysis showed poor consistency(Kappa<0.4),and the difference in diagnostic accuracy was statistically significant(P<0.05).The four-section segmental analysis missed 29 malformations and misdiagnosed 7 malformations.The nine-section segmental analysis missed 9 malformations and misdiagnosed 7 malformations the same as the four-section segmental analysis.The rate of missed diagnosis of complex fetal congenital heart malformations by nine-section segmental analysis was significantly lower than that by four-section segmental analysis(P<0.05).Conclusion The four-section segmental analysis can be used for heart screening of low-risk fetuses,and the nine-section segmental analysis can obtain more section information,which is of great value in the diagnosis of complex fetal congenital heart disease.

关 键 词：胎儿先天性心脏病 超声 病理解剖 血管铸型 

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