单根脐动脉栓塞的产前超声特征与临床分析  

Prenatal Ultrasonic Characteristics and Clinical Analysis of Umbilical Artery Embolization

作　　者：肖菊花[1] 周欣[1] 柏萍娟 赖华[3] 谭志文 Xiao Juhua;Zhou Xin;Bai Pingjuan;Lai Hua;Tan Zhiwen(Department of Ultrasound,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China;Department of Pathology,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China;Department of Obstetrics,Jiangxi Maternal and Child Health Hospital,Nanchang 330006,China)

机构地区：[1]江西省妇幼保健院超声科,南昌市330006 [2]江西省妇幼保健院病理科,南昌市330006 [3]江西省妇幼保健院产科,南昌市330006

出　　处：《中国超声医学杂志》2024年第5期595-597,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨脐动脉栓塞的产前超声特征,并与病理情况做对照,旨在提高超声医师对脐动脉栓塞的认识。方法回顾性分析经产后病理诊断为单根动脉栓塞的病例7例,分析产前超声表现及特征。结果2例于中孕期诊断,4例于晚孕期诊断,1例误诊。主要的超声表现为:仅膀胱一侧见脐动脉血流信号,5例存在脐带螺旋密集,脐带横切面见脐静脉包绕脐动脉,其中1根脐动脉窄细,呈闭塞状,部分可见低、等及或高回声充填,彩色多普勒血流成像(CDFI)内未见血流信号。妊娠结局:2例胎死宫内,3例期待观察中出现宫内窘迫行剖宫产术。1例孕35周生长缓慢。1例给予肝素治疗妊娠结局好。产后脐带病理主要表现为:5例脐带螺旋密集,脐带剖面均见3根血管,其中1根脐动脉细窄,呈闭塞状;光镜所见:7例脐血管均为3根,2根动脉1根静脉,其中1根动脉狭窄,呈闭塞状,部分内可见血栓。结论膀胱水平横切面仅见1根脐动脉,不应盲目诊断为单脐动脉,应常规回顾孕妇历史超声记录,同时应多切面多角度对脐带进行扫查,警惕脐动脉栓塞的发生。Objective To explore the prenatal ultrasonographic characteristics of umbilical artery embolization and compare the results with the pathologic manifestations,in order to improve the doctors'understanding of umbilical artery embolization.Methods A retrospective analysis was performed including 7 cases of single umbilical artery embolization,which were diagnosed by postpartum pathology.The prenatal ultrasound manifestations and characteristics were analyzed.Results Two cases occurred in the middle pregnancy,4 occurred in the late pregnancy,and 1 was misdiagnosed by ultrasound.The main ultrasonic manifestations included:flow signal of only 1 umbilical artery on the fetal bladder's side.hypercoiled cord in 5 cases,and umbilical arteries surrounded by umbilical vein on the transverse section of the cord,among which one umbilical artery was narrow and occluded,and some were filled with low,equal or high echogenicity.There was no blood flow signal inside.Pregnancy outcome:intrauterine fetal death in two cases,intrauterine distress in 3 cases and cesarean section was performed;and 1 case of slow growth after 35 weeks of gestation.1 case was treated with heparin and had a good outcome.The manifestations of postpartum pathology were as follows:5 cases of hypercoiled cord,and that all 3 blood vessels could be found in the umbilical cord profile,among which 1 umbilical artery was narrow and occluded.Light microscopy showed that there were 3 umbilical blood vessels in all of the cases,including 2 arteries and 1 vein,and 1 artery was narrow and occluded,with thrombus in part.Conclusions The sign of only 1 umbilical artery found in the transverse section of the bladder was clues of umbilical artery embolization,and should not be simply diagnosed as single umbilical artery.The patient's medical history and ultrasonography should be combined for a right diagnosis.Meanwhile,the umbilical cord should be scanned in multiple sections and angles to guard against the occurrence of umbilical artery embolization.

关 键 词：脐动脉栓塞 产前超声 病理 

分 类 号：R71[医药卫生—妇产科学]