早孕期胎儿孤立性血管环的超声诊断及预后分析  

Diagnosis and prognosis of fetal isolated vascular ring by ultrasonography in the first trimester

作　　者：杨水华[1] 覃桂灿 何桂丹 梁蒙凤 杨祚建 庞玉兰 黎新艳[1] 田晓先[1] 唐娟松 刘萍萍[1] 汤璐[2] 何升 Yang Shuihua;Qin Guican;He Guidan;Liang Mengfeng;Yang Zuojian;Pang Yulan;Li Xinyan;Tian Xiaoxian;Tang Juansong;Liu Pingping;Tang Lu;He Sheng(Department of Ultrasound,Guangxi Maternity&Child Healthcare Hospital,Nanning 530000,China;Department of Maternal-fetal Medicine,Guangxi Maternity&Child Healthcare Hospital,Nanning 530000,China;Guangxi Key Laboratory of Basic Research on Birth Defects Prevention and Treatment,Nanning 530000,China)

机构地区：[1]广西壮族自治区妇幼保健院超声科,南宁530000 [2]广西壮族自治区妇幼保健院母胎医学科,南宁530000 [3]广西出生缺陷防治基础研究重点实验室,南宁530000

出　　处：《中华超声影像学杂志》2021年第3期225-230,共6页Chinese Journal of Ultrasonography

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2019032);广西医药卫生自筹经费计划课题(Z20200142,Z20201194)。

摘　　要：目的探讨产前超声对11~13+6周胎儿孤立性血管环诊断的可行性及预后分析。方法选择2016年1月至2020年1月孕11~13+6周在广西壮族自治区妇幼保健院行早孕期超声结构筛查的36996例胎儿,对比20~24周超声结果,总结早孕期超声对胎儿孤立性血管环的诊断特征及漏误诊的原因。结果早孕期诊断孤立性血管环35例,其中右位主动脉弓并迷走左锁骨下动脉形成"U"形血管环19例,双主动脉弓"O"形血管环7例,迷走右锁骨下动脉"C"形血管环9例;孕20~24周超声诊断孤立性血管环155例,右位主动脉弓并迷走左锁骨下动脉形成"U"形血管环18例,双主动脉弓"O"形血管环9例,迷走右锁骨下动脉"C"形血管环126例,肺动脉吊带2例,诊断符合率分别为94.74%、77.78%、7.14%、0(Kappa值分别为0.97、0.88、0.13、0)。早孕期超声诊断右位主动脉弓并迷走左锁骨下动脉、双主动脉弓、迷走右锁骨下动脉的特异性分别为99.99%、100%、100%,敏感性为100%、77.78%、7.14%,假阳性分别为0.01%、0、0,假阴性分别为0、22.22%、92.86%,Youden指数分别为0.99、0.78、0.07。结论早孕期超声对右位主动脉弓并迷走左锁骨下动脉及双主动脉弓诊断符合率高,对孤立性迷走右锁骨下动脉诊断符合率较低;早孕期超声筛查为孤立性血管环,仍需在中孕期超声除外微小心脏畸形及早孕期难以诊断的心外畸形。Objective To explore the feasibility and prognosis of prenatal ultrasonic diagnosis of fetal isolated vascular ring at 11-13+6 weeks.Methods A total of 36996 fetuses were selected to compare the results of ultrasound screening at 11-13+6 weeks and 20-24 weeks of pregnancy in Guangxi Maternity&Child Healthcare Hospital from January 2016 to January 2020,the reasons for missed diagnosis and misdiagnosis of fetal isolated vascular ring by ultrasonography in the first trimester were summarized.Results Thirty-five cases were diagnosed as isolated vascular ring in the first trimester,including 19 cases right aortic arch combined with aberrant left subclavian artery with"U-shaped"vascular ring,7 cases double aortic arch with"O-shaped"vascular ring,and 9 cases aberrant right subclavian artery with"C-shaped"vascular ring.While 155 cases were diagnosed as isolated vascular ring at 20-24 weeks of pregnancy,consisting of 18 cases of combined with aberrant left subclavian artery,9 cases of double aortic arch,126 cases of aberrant right subclavian artery and 2 cases of pulmonary artery sling,the diagnosis coincidence rates were 94.74%,77.78%,7.14%,0(Kappa value were 0.97,0.88,0.13,0).For the diagnosis of right aortic arch combined with aberrant left subclavian artery,double aortic arch and aberrant right subclavian artery in the first trimester,the specificities were 99.99%,100%,100%,the sensitivities were 100%,77.78%,7.14%,the false-positive rates were 0.01%,0,0,the false-negative rates were 0,22.22%,92.86%,and the Youden′s indices were 0.99,0.78,0.07.Conclusions Right aortic arch combined with aberrant left subclavian artery and double aortic arch have high coincidence rate by ultrasonography in the first trimester,while the diagnostic coincidence rate of isolated aberrant right subclavian artery was low.Ultrasound screening for isolated vascular ring in the first trimester still needs ultrasound examination in the second trimester to exclude the minor cardiac malformations that are difficult to diagnose in the first trimes

关 键 词：超声检查 血管环 早孕期 

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]