孤立性血管环胎儿气管受压及预后情况分析  

Analysis of fetal tracheal compression and prognosis of isolated vascular ring

作　　者：吴娟[1] 胡圆榘 王铭[1] 尚红磊 林杉[1] 刘云[1] 姜竹 栗河舟[1] WU Juan;HU Yuan-ju;WANG Ming;SHANG Hong-lei;LIN Shan;LIU Yun;JIANG Zhu;LI He-zhou(The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院,河南郑州450052

出　　处：《中国临床医学影像杂志》2022年第4期287-290,共4页Journal of China Clinic Medical Imaging

基　　金：河南省医学科技攻关计划项目(2018020208);2020年郑州大学医学科学院研究生教育改革研究及课程建设项目。

摘　　要：目的:探讨孤立性血管环胎儿气管受压及预后情况。方法:选取经我院超声心动图检查诊断为孤立性血管环的82例胎儿作为病例组,包括右位主动脉弓伴左锁骨下动脉迷走(RAA+ALSA)63例,双主动脉弓(DAA)16例,肺动脉吊带(PAS)3例。选取同孕周90例正常胎儿作为正常组。超声测量病例组及正常组气管前后径、左右径、周长和面积,并随访病例组产前染色体及MRI检查情况、妊娠结局及产后患儿情况。结果:RAA+ALSA组气管左右径、周长、面积较正常组小,DAA组气管前后径、左右径、面积、周长均较正常组、RAA+ALSA组小(P<0.05)。3例PAS胎儿气管的形态发生显著改变,其中1例PAS胎儿超声及MRI检查均提示合并支气管桥。DAA组出生后10例(62.50%,10/16)患儿出现呼吸道症状,其中1例产前超声及MRI检查均提示气管受压严重,出生后CT血管造影显示受压程度较产前轻;RAA+ALSA组出生后1例(1.67%,1/60)患儿出现呼吸道症状;PAS组胎儿出生后均出现呼吸道症状。孤立性血管环胎儿检出染色体异常3例(5.56%,3/54)。结论:产前超声心动图检查可清晰显示胎儿气管的形态及受压情况,结合胎儿心脏MRI和染色体检查可为产前咨询和预后评估提供帮助。Objective:To investigate the tracheal compression and outcome of fetuses with isolated vascular ring.Methods:Eighty-two fetuses diagnosed with isolated vascular rings by echocardiography in our hospital were selected as the case group,including 63 cases of right aortic arch with aberrant left subclavian artery(RAA+ALSA),16 cases of double aortic arch(DAA)and 3 cases of pulmonary artery sling(PAS).Ninety normal fetuses at the same gestational week were selected as the normal group.The anterior and posterior internal,left and right internal diameters of the trachea,trachea circumference and trachea area in the fetuses of the DAA group,RAA+ALSA group,PAS group,and normal group were measured by ultrasound.The prenatal chromosome and MRI examination,pregnancy outcome and postpartum children in the case group were followed up.Results:The left-to-right diameters,area and circumference of trachea in the RAA+ALSA group were smaller than those in the normal group,the anterior-to-posterior diameters,left-to-right diameters,area and circumference of trachea in the DAA group were smaller than those in the normal group and RAA+ALSA group.and the difference was statistically significant(P<0.05).Three cases of PAS fetal trachea morphology changed significantly,1 case of PAS both ultrasound and MRI showed combined with bronchial bridge.In DAA group,10 cases(62.50%,10/16)had respiratory symptoms after birth,of which 1case both ultrasound and MRI showed severe tracheal compression before delivery and CT angiography showed that the degree of compression was lighter than that before delivery.In RAA+ALSA group,1 case(1.67%,1/60)occurred respiratory symptoms after birth.All PAS fetuses occurred respiratory symptoms after birth.Abnormalities were detected in 3 cases(5.56%,3/54)by chromosomal examination in vascular ring fetuses.Conclusion:Prenatal echocardiography examination can clearly show the fetal trachea and compression,combined with fetal cardiac MRI and chromosome examination can provide help for prenatal consultation and progno

关 键 词：血管畸形 气管疾病 胎儿 超声心动描记术 

分 类 号：R714.53[医药卫生—妇产科学] R540.45[医药卫生—临床医学]