多学科联合诊治模式在胎儿神经外科产前诊断实践中的探索  

Explorations of multidisciplinary therapy mode in prenatal diagnostic practice of fetal neurosurgery

作　　者：蒋飞 侯利民 梁中华 王大庆 Jiang Fei;Hou Limin;Liang Zhonghua;Wang Daqing(Department of Pediatric Neurosurgery,Dalian Women&Children's Medical Group,Dalian 116012,China)

机构地区：[1]大连妇女儿童医疗中心(集团)小儿神经外科,大连116012

出　　处：《中华小儿外科杂志》2024年第2期102-106,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨多学科联合诊治模式在胎儿神经系统疾病诊治中的有效性。方法收集大连市妇女儿童医疗中心(集团)2015年1月1日至2019年12月31日产前超声筛查怀疑为神经系统异常胎儿的临床资料,记录母孕期情况,超声、磁共振、染色体组型诊断、侵入性检查结果,产前诊断中心诊断情况。结果 1 065例胎儿经产前诊断中心诊断发育异常,其中胎儿神经系统疾病(fetal neurosurgical disease,FND)有27.3%(291/1 065),完整随访占74.91%(218/291),全部完成超声检查,磁共振检查占84.8%(185/218),产妇年龄为(27.3±5.4)岁,年龄范围是20~43岁,孕周为(26.6±1.4)周,范围在22.1~34.8周。其中侧脑室扩张占72.93%(159/218),无脑儿、露脑儿占5.50%(12/218),脑膨出占4.13%(9/218),脊髓脊膜膨出占10.09%(22/218),胼胝体发育不良占4.13%(9/218),后颅窝囊性畸形占7.34%(16/218),小头畸形占0.92%(2/218)。生后临床诊断符合率为42.66%(93/218)。终止妊娠占16.97%(37/218),引产占1.38%(3/218),死胎占5.50%(12/218)。结论规范的多学科联合诊治产前诊断模式可提供清晰准确的预后判断,对于减少严重神经系统出生缺陷具有重要意义。Objective To explore the effectiveness of multidisciplinary diagnosis of fetal neurological diseases.Methods From January 2015 to December 2019,a retrospective study was conducted for fetuses with abnormal nervous system.The relevant clinical data were recorded,including maternal pregnancy,ultrasonic findings,magnetic resonance imaging(MRI),chromosome group diagnosis,invasive examinations,prenatal diagnosis,treatments,delivery mode,postpartum diagnosis and outcomes.Results Among 1065 fetal anomalies diagnosed antenatally,27.3%(291/1065)were primarily neurological in origin.Complete follow-ups accounted for 74.91%(218/291),all completed ultrasonic examinations and MRI accounted for 84.8%(185/218).Maternal age was(27.3±5.4)(20-43)year and gestational age(26.6±1.4)(22.1-34.8)weeks.Among them,ventriculomegaly accounted for 72.93%(159/218),encephalless&deuded 5.50%(12/218),encephalocele 4.13%(9/218),myelomeningocele 10.09%(22/218),corpus callosum dysplasia 4.13%(9/218),posterior fossa cystic malformation 7.34%(16/218)and microcephaly 0.92%(2/218).The postpartum clinical diagnostic coincidence rate was 42.66%(93/218).Termination of pregnancy accounted for 16.97%(37/218),labor induction 1.38%(3/218)and stillbirth 5.50%(12/218).Conclusion The standardized prenatal diagnostic model of MDT provides an accurate prognosis.It is of great significance for reducing severe neurological birth defects.

关 键 词：神经系统疾病 产前筛查 多学科联合诊治 

分 类 号：R714.5[医药卫生—妇产科学]