胎儿胸腔内异常强回声的声像图特征在产前诊断隔离肺与先天性肺囊性腺瘤样病变中的价值  

The value of ultrasonographic features of abnormal strong echo in fetal thorax in prenatal diagnosis of pulmonary sequestration and congenital cystic adenomatoid malformation

作　　者：叶早群[1] 韩彬杭 何丹青[1] 郑言言[1] 高传芬[1] YE Zaoqun;HAN Binhang;HE Danqing;ZHENG Yanyan;GAO Chuanfen(Department of Ultrasound,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院超声科,安徽合肥230022

出　　处：《安徽医药》2024年第3期552-555,I0005,共5页Anhui Medical and Pharmaceutical Journal

基　　金：安徽医科大学科研基金(2022xkj145)。

摘　　要：目的 探讨胎儿胸腔内异常强回声的声像图特征在产前诊断隔离肺与先天性肺囊性腺瘤样病变(CCAM)中的价值,为鉴别诊断和评估预后提供依据。方法 对2017年1月至2019年11月安徽医科大学第一附属医院产前超声检查中发现的31例胎儿胸腔内异常强回声的声像图特征及随访结果进行回顾性分析。结果 31例胎儿胸腔内异常强回声中,其中18例Ⅲ型CCAM产前超声显示胸腔内高回声边界清晰,内部回声尚均匀,未见明显的囊泡样回声且显示为肺动脉供血;12例隔离肺产前超声显示胸腔内高回声界限清晰,呈叶状或三角形,大小不一,内部回声尚均匀,未见明显的囊泡样回声,多位于左侧胸腔中下部为主动脉供血;1例隔离肺合并CCAM表现为胸腔内见稍强回声囊实性包块,形态规则,边界清晰,稍强回声内可见多个小囊性回声,透声良好,伴纵隔移位,可追踪源自胸主动脉的滋养血管。8例CCAM及6例隔离肺晚孕随访肿块缩小甚至消失,3例终止妊娠。剩余28例胎儿产后均无明显呼吸窘迫,生存率达100%。结论 产前超声依据胸腔内异常高回声的边界、形态、内部回声有无囊泡样结构以及异常高回声血供来源在鉴别诊断胎儿隔离肺与CCAM有重要意义、并可用于持续观察随访,对临床处理及判断预后有重要的指导意义。Objective To investigate the value of ultrasonographic features of abnormal strong echo in fetal chest cavity in prenatal diagnosis of pulmonary sequestration(PS) and congenital cystic adenomatoid malformation(CCAM) of the lung,and to provide evidence for differential diagnosis and prognosis assessment.Methods A retrospective analysis of the ultrasonographic characteristics and follow-up results of 31 cases with abnormal strong echoes in the chest during prenatal ultrasonography at the First Affiliated Hospital of Anhui Medical University from January 2017 to November 2019 were retrospectively analyzed.Results Among the 31 cases,18 cases of type Ⅲ CCAM showed clear intrathoracic hyperechoic boundary,the internal echo was still uniform,no obvious vesicular echo and showed pulmonary artery blood supply,12 cases of isolated lung showed clear intrathoracic hyperechoic boundary,lobular or triangular shape,different size.The lesions were mostly located in the middle and lower part of the left thoracic artery.One case of isolated lung combined with CCAM showed a slightly echogenic cystic-solid mass in the thoracic cavity,with regular shape and clear boundary.Multiple small cystic echoes were seen within the slightly echogenic mass,with good sound transmission and mediastinal displacement.The nutrient vessels originating from the thoracic aorta can be traced.Eight cases of congenital cystic adenomatoid lesions and six cases of the lung sequestration followed up with reduced or even disappeared masses.Three cases of terminated pregnancy,and the remaining 28 cases had no obvious respiratory distress after delivery,with a survival rate of 100%.Conclusion Prenatal ultrasound is of great significance in the differential diagnosis of fetal pulmonary sequestration and CCMA based on the boundary,shape,internal echo with or without vesicular structure and the source of abnormal hyperechogenic blood supply,and can be used for continuous observation and follow-up,which has important guiding significance for clinical treatment and

关 键 词：超声检查 产前 彩色多普勒血流显像 肺囊性腺瘤样病变 隔离肺 产前诊断 

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