胎儿脐-门-体静脉分流的产前超声特征及预后:14例分析  

Prenatal ultrasonographic characteristics and prognosis of fetal umbilical-portal-systemic venous shunt:analysis of 14 cases

作　　者：陈澄 张晓航[1] 董虹美[1] 冉素真[1] Chen Cheng;Zhang Xiaohang;Dong Hongmei;Ran Suzhen(Department of Ultrasonography,Chongqing Health Center for Women and Children,Chongqing 401120,China)

机构地区：[1]重庆市妇幼保健院超声科,重庆401120

出　　处：《中华围产医学杂志》2022年第5期349-354,共6页Chinese Journal of Perinatal Medicine

基　　金：重庆市卫生适宜技术推广项目(2021jstg041)。

摘　　要：目的总结胎儿脐-门-体静脉分流(umbilical-portal-systemic venous shunt,UPSVS)的产前超声扫查思路、图像特征及预后。方法回顾性分析2018年1月至2020年9月在重庆市妇幼保健院产前超声诊断的14例UPSVS胎儿的产前超声特征、合并畸形情况、染色体检查结果及随访结果。采用描述性统计分析。结果14例UPSVS胎儿中Ⅰ型2例,超声特征为脐静脉绕过肝脏直接汇入体静脉;Ⅱ型2例,超声特征为脐静脉入肝后经异常走向的静脉导管汇入远端下腔静脉,而非对准左心房;Ⅲa型10例,超声特征为肝内门静脉-体循环短路。14例胎儿中4例早孕期唐氏综合征血清学筛查低风险,4例无创产前检测低风险,3例产前遗传学诊断未发现异常。6例合并其他系统畸形。4例在宫内出现心力衰竭的表现。4例合并胎儿生长受限。4例因其他异常引产终止妊娠,另外10例活产且预后良好。结论产前超声检查发现不明原因的胎儿生长受限、心力衰竭或在胎儿腹部横切面发现异常血管时,要特别关注胎儿脐-门-体静脉系统是否有异常。胎儿UPSVS具有典型的超声图像特征,产前超声可以确定分流类型、判断是否存在完整的肝内门静脉系统,评估胎儿宫内生长情况及合并畸形情况,对预后咨询具有重要价值。Objective To summarize the prenatal ultrasonographic features and prognosis of fetal umbilical-portal-systemic venous shunt(UPSVS).Methods This retrospective study retrieved the records of 14 fetuses with UPSVS from Chongqing Health Center for Women and Children from January 2018 to September 2020,to describe their ultrasonographic features,concomitant malformations,chromosomal examination results,and follow-up.Results All the 14 cases were classified into three types:TypeⅠ(n=2),the umbilical vein directly connected to the systemic venous detouring around the liver;TypeⅡ(n=2),the umbilical vein connected to the distal inferior vena cava instead of the left atrium after entering the liver through the ductus venosus;and TypeⅢa(n=10),those with an intrahepatic shunt,between the intrahepatic portal venous system and the hepatic vein.Of the 14 fetuses,11 had normal chromosome test results,including four had serum screening of Down syndrome in the first trimester,four had non-invasive prenatal testing,and three had prenatal genetic diagnosis.Six cases were complicated by other system malformations.Fetal growth restriction and heart failure were found in four cases each.Four pregnancies were terminated due to other anomalies and the other 10 ended in live births with good prognosis for the fetuses.Conclusions Special attention should be paid to the fetal umbilical-portal-venous system when there are unexplained fetal growth restriction,fetal heart failure,or abnormal blood vessels in the abdominal section of the fetus.UPSVS has typically ultrasonographic features,which can prenatally determine the shunt type and the integrity of the intrahepatic portal venous system.A full assessment of the intrauterine fetal condition and other malformations are of great value in prognostic counseling.

关 键 词：畸形 多发性 脐静脉 门静脉 门脉系统 超声检查 产前 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]