产前超声诊断脐带囊肿合并胎儿结构异常的预后:109例分析  

Prognosis of fetal umbilical cord cyst with structural abnormalities indicated by prenatal ultrasound: analysis of 109 cases

作　　者：王文迪 吴青青[1] 王晶晶[1] Wang Wendi;Wu Qingqing;Wang Jingjing(Department of Ultrasonography,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院超声科,北京100026

出　　处：《中华围产医学杂志》2023年第2期97-102,共6页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金(81971619)。

摘　　要：目的分析产前超声诊断脐带囊肿合并胎儿结构异常情况及其预后。方法回顾性收集2016年1月至2020年12月在首都医科大学附属北京妇产医院超声诊断为脐带囊肿的病例109例, 根据超声表现将其分为孤立性脐带囊肿组、脐带囊肿合并超声软指标组, 以及脐带囊肿合并胎儿畸形组。分析脐带囊肿胎儿的预后情况。对数据资料采用χ^(2)检验进行组间比较。结果 (1)孤立性脐带囊肿55例(55/109, 50.5%), 脐带囊肿合并超声软指标20例(20/109, 18.3%), 合并胎儿畸形34例(34/109, 31.2%)。除2例位置多发外, 其余107例脐带囊肿胎盘端、游离段、胎儿端脐带囊肿合并其他超声异常的发生率依次升高[分别为27.5%(14/51)、10/17和76.9%(30/39), χ^(2)=22.20, P<0.001]。发生于胎儿端的脐带囊肿合并其他超声异常发生率明显高于发生于胎盘端者(χ^(2)=21.65, P<0.001)。(2)共检出60种畸形, 主要累及心血管系统、泌尿生殖系统、前腹壁和骨骼系统。常见的畸形包括胎儿室间隔缺损、脐膨出、巨膀胱、胎儿水肿和颈部水囊瘤等。(3)89例随访到妊娠结局, 共21例(23.6%)结局不良。孤立性脐带囊肿组未发生不良结局, 脐带囊肿合并超声软指标组中引产2例(2/18), 而脐带囊肿合并胎儿畸形组中引产、胎儿宫内死亡及围产期死亡共19例(19/26, 73.1%)。结论孤立性脐带囊肿预后相对较好, 脐带囊肿合并超声软指标和合并胎儿畸形可能发生不良预后, 合并胎儿畸形者不良预后发生率更高。产前超声发现脐带囊肿时, 应系统地检查是否合并其他超声异常。Objective To explore the prognosis of umbilical cord cysts in fetuses with structural abnormalities diagnosed by prenatal ultrasonography.Methods This retrospective study involved 109 cases of umbilical cord cysts diagnosed by ultrasound at Beijing Obstetrics and Gynecology Hospital from January 2016 to December 2020.According to the ultrasound findings,these cases were divided into the isolated umbilical cord cyst,umbilical cord cyst with soft ultrasound markers,and umbilical cord cyst with fetal malformation groups.Chi-square was performed for statistical analysis to compare the prognosis.Results(1)Among 109 cases of umbilical cord cysts,55 cases(50.5%)were isolated,20(18.3%)were complicated by soft ultrasound markers,and 34(31.2%)cases were complicated by fetal malformation.After excluding two cases of multiple cysts at different locations,the incidence of umbilical cord cysts at the placental end,free segment,and fetal terminal with other ultrasound abnormalities in the remaining 107 cases increased sequentially[27.5%(14/51),10/17,and 76.9%(30/39),χ^(2)=22.20,P<0.001].The incidence of umbilical cord cysts with other ultrasound abnormalities at the fetal end was higher than at the placental end(χ^(2)=21.65,P<0.001).(2)A total of 60 fetal malformations were detected,dominated by fetal ventricular septal defect,omphalocele,giant bladder,fetal edema,and nuchal cystic hygroma,et al.,mainly involving the cardiovascular system,urogenital system,anterior abdominal wall,and skeletal system.(3)Eighty-nine cases were followed up to the end of the pregnancy,and 21(23.6%)of them had adverse outcomes.The prognoses of isolated umbilical cord cyst cases were all good.Two pregnancies(2/18)were terminated in the umbilical cord cyst with ultrasound soft markers group.In the group of umbilical cord cyst with fetal malformation,19 pregnancies(19/26,73.1%)had adverse outcomes,including pregnancy termination,intrauterine fetal demise,and perinatal death.Conclusions The prognosis of isolated umbilical cord cysts is generally good.

关 键 词：脐带囊肿 超声检查 产前 先天畸形 妊娠结局 

分 类 号：R714.5[医药卫生—妇产科学]