[1]姜书情,邱文倩,张超学.产前超声在左侧先天性膈疝的诊断价值[J].医学信息,2020,33(09):158-161.[doi:10.3969/j.issn.1006-1959.2020.09.053]
　JIANG Shu-qing,QIU Wen-qian,ZHANG Chao-xue.Diagnostic Value of Prenatal Ultrasound in Left Congenital Diaphragmatic Hernia[J].Medical Information,2020,33(09):158-161.[doi:10.3969/j.issn.1006-1959.2020.09.053]
点击复制

产前超声在左侧先天性膈疝的诊断价值()

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年09期
页码:
158-161
栏目:
诊疗技术
出版日期:
2020-05-01

文章信息/Info

Title:
Diagnostic Value of Prenatal Ultrasound in Left Congenital Diaphragmatic Hernia
文章编号:
1006-1959（2020）09-0158-04
作者:
姜书情; 邱文倩; 张超学
（安徽医科大学第一附属医院超声科，安徽 合肥 230022）
Author(s):
JIANG Shu-qing; QIU Wen-qian; ZHANG Chao-xue
(Department of Ultrasound,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui,China)
关键词:
产前超声; 先天性膈疝; 彩色多普勒血流显像
Keywords:
Prenatal ultrasound; Congenital diaphragmatic hernia; Color Doppler flow imaging
分类号:
R445.1
DOI:
10.3969/j.issn.1006-1959.2020.09.053
文献标志码:
A
摘要:
目的 探讨产前超声在左侧先天性膈疝（CDH）的诊断价值。方法 选取2016年8月~2019年8月我院产前超声诊断为胎儿左侧CDH的70例超声影像资料，分析其声像图特征、超声表现及预后情况。结果 70例左侧CDH胎儿，灰阶声像图表现为胸腔内实性或囊实性占位、纵膈移位、肺发育不良、腹围缩小、膈肌回声缺损、胸腔积液，59例胸腔内可见胃泡，11例胃泡仍位于腹腔内；54例膈肌显示不完整，可见胸腔内包块经过膈肌的缺损与腹部相通，其余16例因孕周偏小和胎儿体位原因，膈肌显示不佳。70例诊断为胎儿左侧CDH的产妇，38例选择引产，足月妊娠26例，早产6例。32例分娩后的胎儿中，24例经手术后存活，3例手术后死亡，5例未经手术即死亡，总死亡率为25%（8/32）；出生后 LHR≤1.0的CDH患儿死亡率为71.43%，高于LHR 1.0~1.4和≥1.4的患儿的16.67%和7.69%，差异有统计学意义（P＜0.05）；出生后O/E LHR≤35%的CDH患儿死亡率为85.71%，高于O/E LHR 35%~45%、45%~65%和≥65%患儿的16.67%、10.00%和0，差异有统计学意义（P＜0.05）。结论 产前超声可用于诊断CDH，并可评估健侧肺发育情况及胎儿预后。
Abstract:
Objective To investigate the diagnostic value of prenatal ultrasound in left congenital diaphragmatic hernia (CDH).Methods From August 2016 to August 2019, 70 cases of ultrasound image data of fetal left-sided CDH diagnosed by prenatal ultrasound in our hospital were selected, and analyze its sonogram characteristics, ultrasound performance and prognosis.Results 70 cases of left-sided CDH fetus, grayscale sonogram showed solid chest or cystic solid space occupying, mediastinal displacement, lung dysplasia, abdominal circumference reduction, diaphragmatic echo defect, pleural effusion, 59 cases of intrapleural Gastric vesicles can be seen, 11 cases are still located in the abdominal cavity; 54 cases of diaphragm muscles are incomplete, and the mass in the chest cavity can be seen to communicate with the abdomen through the diaphragm defect. The remaining 16 cases have poor diaphragm performance due to small gestation and fetal position. 70 cases of maternal diagnosis of CDH on the left side of the fetus, 38 cases of induced labor, 26 cases of full-term pregnancy, 6 cases of premature delivery. Of the 32 fetuses after delivery, 24 survived after surgery, 3 died after surgery, and 5 died without surgery,with a total mortality rate of 25%(8/32);children with CDH with LHR≤1.0 after birth mortality rate was 71.43%, higher than 16.67% and 7.69% of children with LHR 1.0 ~ 1.4 and≥1.4, the difference was statistically significant(P<0.05);The mortality rate of CDH children with O/E LHR≤35% after birth is 85.71%, which is higher than 16.67%, 10.00% and 0 of O/E LHR 35% ~ 45%, 45%~65% and≥65% children,the difference was statistically significant(P<0.05).Conclusion Prenatal ultrasound can be used to diagnose CDH, and can assess the development of the healthy lung and the prognosis of the fetus.

参考文献/References:

[1]Malowitz JR,Hornik CP,Laughon MM,et al.Management Practice and Mortality for Infants with Congenital Diaphragmatic Hernia[J].Am J Perinatol,2015,32(9):887-894.[2]李胜利,邓学东.产前超声检查指南(2012)[J].中华医学超声杂志(电子版),2012,9(7):574-580.[3]夏波,俞钢,陈福雄.产前超声和MRI评估先天性膈疝的价值[J].中华围产医学杂志,2014(12):845-848.[4]Woodbury JM,Bojanic K,Grizelj R,et al.Incidence of congenital diaphragmatic hernia in Olmsted County, Minnesota: a population-based study[J].The Journal of Maternal-Fetal&Neonatal Medicine,2017,32(5):742-748.[5]Sperling J,Sparks T,Berger V,et al.Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?[J].American Journal of Perinatology,2018,35(10):919-924.[6]张勇,杨汉丰,杜勇.先天性膈疝产前诊断及预后的影像学评价研究进展[J].中华妇幼临床医学杂志(电子版),2010,6(2):123-125.[7]邱文倩,张超学,张嘉靖,等.彩色多普勒超声在胎儿胸腔占位性病变鉴别诊断中的应用[J].中国超声医学杂志,2018,34(6):543-547.[8]Morgan TA,Basta A,Filly RA.Fetal stomach and gallbladder in contact with the bladder wall is a common ultrasound sign of stomach-down left congenital diaphragmatic hernia[J].Journal of Clinical Ultrasound,2017,45(1):8-13.[9]胡海云,谭莹,周颖,等.产前超声诊断先天性膈疝及超声征象分析[J].中国医学影像技术,2018,34(11):1744-1746.[10]王合锋,刘兴峰,王洪轩,等.胸腔镜手术治疗新生儿先天性膈疝47例[J].浙江大学学报(医学版),2018,47(3):283-288.[11]卢洪涛,李清.产前超声检查诊断胎儿先天性膈疝[J].中国医学影像技术,2014,30(12):1893-1896.[12]Aydin E,Lim F,Kingma P,et al.Congenital diaphragmatic hernia:the good, the bad, and the tough[J].Pediatric Surgery International,2019,35(3):303-313.

相似文献/References:

[1]帅秀芳,郑 慧.彩色多普勒超声诊断帆状胎盘和血管前置的临床价值及漏诊误诊原因分析[J].医学信息,2019,32(20):164.[doi:10.3969/j.issn.1006-1959.2019.20.052]
　SHUAI Xiu-fang,ZHENG Hui.Clinical Value of Color Doppler Ultrasound in Diagnosis of Spiral Placenta and Vascular Preposition and Analysis of Misdiagnosis Causes of Missed Diagnosis[J].Medical Information,2019,32(09):164.[doi:10.3969/j.issn.1006-1959.2019.20.052]

更新日期/Last Update: 2020-05-01