产前超声诊断先天性膈膨升及漏误诊分析  

Analysis of diagnosis, missed diagnosis and misdiagnosis of congenital diaphragmatic eventration by prenatal ultrasound

作　　者：廖凤琴 穆仲平 黄婷 王今 陈婕 杨好意 LIAO Feng-qin;MU Zhong-ping;HUANG Ting;WANG Jin;CHEN Jie;YANG Hao-yi(Department of Echocardiography,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230036,China;Department of Ultrasound,A nhui Province Maternal and Child Health Hospital,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)心脏超声诊断中心,安徽合肥230036 [2]安徽省妇幼保健院超声科,安徽合肥230001

出　　处：《中国临床医学影像杂志》2021年第2期133-135,139,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:探讨超声诊断胎儿先天性膈膨升的声像图特征并对漏诊、误诊进行分析。方法:分析2014年1月—2018年12月产前超声诊断先天性膈膨升的10例胎儿病例资料及随访结果,总结其胸腔横切面、冠状面、矢状面的产前超声图像特征,观察双侧膈肌的矛盾运动,并与产前MRI、产后胸片、解剖结果对比分析。结果:10例胎儿膈膨升中右侧6例,左侧4例。产前超声正确诊断8例,1例漏诊,1例误诊为左侧膈疝经MRI诊断为膈膨升。伴发其他系统结构畸形6例,其中左、右侧膈膨升各3例。合并羊水增多5例,单脐动脉2例。3例多发畸形胎儿引产经病理证实,其中2例胎儿染色体核型分析为18-三体综合征,余7例分娩后经胸片证实。结论:产前超声是先天性膈膨升筛查及诊断的首选方法,部分病变范围广泛或合并胸腔其它异常难以诊断时,可结合产前MRI进一步评估。发现胎儿膈膨升时需对其它系统进行详细扫查,多发畸形者警惕染色体异常。Objective:To evaluate the value of prenatal ultrasound in the diagnosis of fetal congenital diaphragmatic eventration,and analyze the missed diagnosis and misdiagnosis.Methods:Ten cases of fetal congenital diaphragmatic eventration examined by prenatal ultrasound from January 2014 to December 2018 were analyzed,the prenatal ultrasonic features of the disease in thoracic transverse,coronal and sagittal axis were summarized,paradoxical motion of bilateral diaphragmatic was recorded.Antenatal signs were compared with prenatal MRI,postpartum X-ray and autopsy results.The misdiagnosis and missed diagnosis were analyzed.Results:In ten cases of fetal congenital diaphragmatic eventration,six cases were on the right,four cases on the left.Eight cases were correctly diagnosed by prenatal ultrasound,one case was missed,one case of left diaphragmatic hernia was misdiagnosed while confirmed by MRI as congenital diaphragmatic eventration.Six cases were combined with multiple malformations,including three cases of right diaphragmatic eventration and three cases of left.Five cases were associated with hydramnios,two cases combined with single umbilical artery.Three cases of multiple abnormalities were confirmed by pathology,two cases of them were 18-tresomy syndrome.The other seven cases were confirmed by postpartum X-ray.Conclusion:Prenatal ultrasound is the first choice for screening and diagnosis of congenital diaphragmatic eventration,some foetuses with extensive lesions of diaphragmatic or with other thoracic malformation,which are difficult to distinguish from diaphragmatic hernia,could be further evaluated by prenatal MRI.Once fetal diaphragmatic eventration is confirmed,scanning other systems thoroughly.Chromosomal abnormalities should be noted in patients with multiple malformations.

关 键 词：膈膨出 超声检查 产前 

分 类 号：R714.53[医药卫生—妇产科学]