先天性肺气道畸形与支气管肺隔离症产前超声表现用于预测新生儿不良转归  

Prenatal ultrasonic manifestations of congenital pulmonary airway malformation and bronchopulmonary sequestration for predicting adverse outcomes of neonates

作　　者：黄田田 孔德明 肖海艳 韦卫中[1] HUANG Tiantian;KONG Deming;XIAO Haiyan;WEI Weizhong(Department of Maternal and Child Ultrasound,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430019,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院)妇幼超声科,湖北武汉430019

出　　处：《中国医学影像技术》2024年第7期1062-1066,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察先天性肺气道畸形(CPAM)与支气管肺隔离症(BPS)产前超声表现用于预测新生儿不良转归的价值。方法回顾性分析51胎CPAM、BPS或混合型病变单胎胎儿,观察其产前超声表现,测算肺部肿块体积与头围比(CVR);绘制受试者工作特征曲线,计算曲线下面积(AUC),评估CVR预测肺部肿块胎儿新生儿期不良转归的效能。结果产前超声于51胎均检出肺部肿块,平均最大径(35.9±12.3)mm;其中28胎(28/51,54.90%)合并纵隔移位,3胎(3/51,5.88%)合并胸腔积液,3胎(3/51,5.88%)合并羊水过多,5胎(5/51,9.80%)合并其他肺外畸形;均未见胎儿水肿;根据病变供血动脉诊断29胎(29/51,56.86%)CPAM、20胎(20/51,39.22%)BPS及2胎(2/51,3.92%)混合型病变。以胎儿肺部肿块初次CVR(CVR_(1))、最大CVR(CVR_(2))及末次CVR(CVR_(3))测值预测新生儿呼吸窘迫及接受肺部手术治疗的AUC为0.907~0.993。CVR_(3)≥1.25为肺部肿块胎儿出生后发生新生儿呼吸窘迫的独立预测因素(OR=40.000,P=0.016)。结论CPAM及BPS产前超声表现具有一定特征性;CVR为预测CPAM及BPS胎儿出生后新生儿期不良转归的可靠指标。Objective To observe the value of prenatal ultrasonic manifestations of congenital pulmonary airway malformation(CPAM)and bronchopulmonary sequestration(BPS)for predicting adverse outcomes of neonates.Methods Data of 51 singletons with CPAM,BPS or mixed malformations were retrospectively analyzed.The prenatal ultrasonic manifestations were observed,and the pulmonary mass volume to head circumference ratio(CVR)were measured.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated,and the efficacy of CVR for predicting adverse outcomes of neonates was evaluated.Results Pulmonary mass were detected in all 51 fetuses by prenatal ultrasound,with an average maximum diameter of(35.9±12.3)mm.Mediastinal displacement was observed in 28 fetuses(28/51,54.90%),pleural effusion and polyhydramnios each in 3 fetuses(3/51,5.88%),while other extrapulmonary malformations were noticed in 5 fetuses(5/51,9.80%).No fetal edema was found.According to the feeding artery of the mass,CPAM was diagnosed in 29(29/51,56.86%)fetuses,BPS in 20(20/51,39.22%),and mixed lesions were diagnosed in 2 fetuses(2/51,3.92%).The AUC of the initial CVR(CVR_(1)),the maximum CVR(CVR_(2))and the last CVR(CVR_(3))of fetal pulmonary mass for predicting occurrence of neonatal respiratory distress and lung surgery were 0.907—0.993.CVR_(3)≥1.25 was an independent predictive factors for neonatal respiratory distress in fetuses with pulmonary masses(OR=40.000,P=0.016).Conclusion CPAM and BPS had typical prenatal ultrasonic manifestations.CVR was a reliable indicator for predicting adverse neonatal outcomes of fetuses with CPAM and/or BPS.

关 键 词：先天性畸形 肺 支气管肺隔离症 婴儿 新生儿 超声检查 

分 类 号：R714.53[医药卫生—妇产科学] R445.1[医药卫生—临床医学]