胎儿左侧异构综合征产前超声诊断及预后分析  

Prenatal Ultrasound Diagnosis and Prognosis Analysis of Fetal Left Atrial Isomerism

作　　者：翁宗杰[1] 凌文[1] 邱秀青 马宏[3] 党婷婷[1] 刘敏[1] 吴秋梅[1] Weng Zongjie;Ling Wen;Qiu Xiuqing;Ma Hong;Dang Tingting;Liu Min;Wu Qiumei(Department of Ultrasound,Fujian Provincial Maternity and Children's Hospital,Fuzhou 350001,China;Department of Gynecology and Obstetrics,Fujian Provincial Maternity and Children's Hospital,Fuzhou 350001,China;Department of Pathology,Fujian Provincial Maternity and Children's Hospital,Fuzhou 350001,China)

机构地区：[1]福建省妇幼保健院超声科,福州市350001 [2]福建省妇幼保健院妇产科,福州市350001 [3]福建省妇幼保健院病理科,福州市350001

出　　处：《中国超声医学杂志》2021年第3期311-314,共4页Chinese Journal of Ultrasound in Medicine

基　　金：福建省自然科学基金(No.2017J01235)。

摘　　要：目的探讨产前超声五步法在胎儿左侧异构综合征中的诊断价值并分析预后。方法回顾分析28例左侧异构综合征胎儿产前超声资料,与生后影像学检查、引产标本解剖铸型及标本超声检查等对比,总结诊断思路并分析预后。结果28例左侧异构综合征胎儿中,胃泡与心脏位置不同侧64.3%(18/28);下腔静脉肝段缺如92.9%(26/28);合并复杂心内畸形67.8%(19/28),其中房室间隔缺损67.8%(19/28)、右室流出道梗阻35.7%(10/28)、左室流出道梗阻25.0%(7/28);缓慢型心律失常35.7%(10/28);合并严重心外畸形10.7%(3/28)。28例中活产4例、胎死宫内2例、终止妊娠22例;引产标本行解剖8例、铸型4例、标本超声12例。超声误诊1处心外畸形,漏诊2处心内畸形。结论产前超声五步法对左侧异构综合征具有重要的诊断价值;左侧异构综合征胎儿预后取决于合并的心内外畸形严重程度。Objective To explore the diagnostic value of Five-Step Method of prenatal ultrasound evaluation in fetal Left Atrial Isomerism(LAI)and analyze the prognosis.Methods Prenatal ultrasound examinations of 28 fetuses diagnosed with LAI were retrospectively analyzed and compared with neonatal imaging examinations,the findings of autopsy and vascular casting and the specimens′ultrasonic results.The prenatal ultrasonic diagnosis and prognosis of LAI were concluded.Results Among the 28 fetuses,64.3%(18/28)were found to have gastric and cardiac apex on different sides;The hepatic segment of inferior vena cava was absent for 92.9%(26/28).There were 67.8%(19/28)complicated intracardiac malformations,including atrioventricular septal defect(67.8%),right ventricular outflow tract obstruction(35.7%)and left ventricular outflow tract obstruction(25.0%).Bradyarrhythmia was present in 10 fetuses,combined serious extra-cardiac anomalies taking up 10.7%(3/28).There were 4 live-births and 2 intrauterine deaths.A higher proportion of parents(22/28)chose termination of pregnancy.In 22 cases of termination of pregnancy,8 specimens underwent partial anatomy,4 underwent thoracic-abdominal vessel casting and 12 underwent ultrasound examination.1 extra-cardiac malformation was misdiagnosed,And 2 cases of cardiac malformation were missed.Conclusions Five-Step Method of prenatal ultrasound evaluation is of great value in the diagnosis of LAI.The prognosis of LAI depends on the combined cardiac and extra-cardiac malformations.

关 键 词：胎儿 左侧异构综合征 产前超声 病理解剖 血管铸型 预后分析 

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]