孕11～13~(+6)周行超声检查对胎儿前腹壁畸形的诊断价值
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摘要
目的探讨孕11～13~(+6)周行超声检查在胎儿前腹壁畸形诊断中的应用价值。方法 9 608例孕11～13~(+6)周孕妇,均行超声检查,对检出胎儿前腹壁畸形者行染色体核型分析,随访观察超声检出正确率。结果超声检出胎儿前腹壁畸形57例(0.59%),其中脐膨出34例、腹裂3例、体蒂异常9例、Cantrell五联征6例、梅干腹综合征4例、泄殖腔外翻综合征1例;52例终止妊娠(脐膨出胎儿31例、腹裂胎儿1例、体蒂异常胎儿9例、Cantrell五联征胎儿6例、梅干腹综合征胎儿4例、泄殖腔外翻综合征胎儿1例),5例(脐膨出胎儿3例、腹裂胎儿2例)继续妊娠;随访结果示9 556例继续妊娠者超声漏诊6例,误诊2例,检出准确率为90.1%。结论孕11～13~(+6)周行超声检查对胎儿前腹壁畸形有较高的检出正确率。
Objective To investigate the application of ultrasonography in the diagnosis of fetal anterior abdominal wall defects at 11-13~(+6) weeks of gestation. Methods Totally 9 608 pregnant women at 11-13~(+6) weeks of gestation were examined by ultrasonography. Gene detection or chromosome karyotype analysis was performed for those with fetal anterior abdominal wall defects. The correct rate of ultrasonography detection was calculated after delivery. Results In 9 608 cases, 57 cases(0.59%) of fetal anterior abdominal wall defects of fetus were detected at 11-13~(+6) weeks of gestation, including 34 cases of omphalocele, 3 cases of gastroschisis, 9 cases of body stalk anomaly, 6 cases of pentalogy of Cantrell, 4 cases of prune belly syndrome, and 1 case of cloacal exstrophy. In 57 cases of fetal anterior abdominal wall, defects, 52 pregnancies were terminated, including 31 cases of omphalocele, 1 case of gastroschisis, 9 cases of body stalk anomaly, 6 cases of pentalogy of Cantrell, 4 cases of prune belly syndrome, and 1 case of cloacal exstrophy, while the other 5 cases continued pregnancy including 3 cases of omphalocele and 2 cases of gastroschisis. Six cases were missed diagnosed, and 2 cases were misdiagnosed. The diagnostic accuracy of ultrasonography was 90.1%. Conclusion Ultrasonography has high detection accuracy in the diagnosis of fetal anterior abdominal wall defects at 11-13~(+6) weeks of gestation.
Objective To investigate the application of ultrasonography in the diagnosis of fetal anterior abdominal wall defects at 11-13~(+6) weeks of gestation. Methods Totally 9 608 pregnant women at 11-13~(+6) weeks of gestation were examined by ultrasonography. Gene detection or chromosome karyotype analysis was performed for those with fetal anterior abdominal wall defects. The correct rate of ultrasonography detection was calculated after delivery. Results In 9 608 cases, 57 cases(0.59%) of fetal anterior abdominal wall defects of fetus were detected at 11-13~(+6) weeks of gestation, including 34 cases of omphalocele, 3 cases of gastroschisis, 9 cases of body stalk anomaly, 6 cases of pentalogy of Cantrell, 4 cases of prune belly syndrome, and 1 case of cloacal exstrophy. In 57 cases of fetal anterior abdominal wall, defects, 52 pregnancies were terminated, including 31 cases of omphalocele, 1 case of gastroschisis, 9 cases of body stalk anomaly, 6 cases of pentalogy of Cantrell, 4 cases of prune belly syndrome, and 1 case of cloacal exstrophy, while the other 5 cases continued pregnancy including 3 cases of omphalocele and 2 cases of gastroschisis. Six cases were missed diagnosed, and 2 cases were misdiagnosed. The diagnostic accuracy of ultrasonography was 90.1%. Conclusion Ultrasonography has high detection accuracy in the diagnosis of fetal anterior abdominal wall defects at 11-13~(+6) weeks of gestation.
引文
[1] 李胜利.胎儿产前超声诊断学[M].北京:人民军医出版社,2004:374-401.
[2] 隋霜,何惠丽,张艳梅.产前系统超声检查在胎儿畸形筛查中价值[J].中华实用诊断与治疗杂志,2014,28(4):394-395.
[3] 柴青芬.胎儿动脉导管狭窄超声心动图诊断分析[J].中华实用诊断与治疗杂志,2016,30(8):769-771.
[4] 张素阁,王惠,牟楠楠,等.超声诊断双胎妊娠并胎儿畸形的价值[J].中华实用诊断与治疗杂志,2012,26(10):1005-1006.
[5] 邓芳,许玉敏.产前超声诊断胎儿眼部畸形价值[J].中华实用诊断与治疗杂志,2013,27(8):796-797.
[6] 卢琳.彩超筛查胎儿心脏病的价值[J].中华实用诊断与治疗杂志,2015,29(7):724-725.
[7] 谢玉珏,杨育菲,周安连,等.B超测NT联合母体血清AFP、F-β-HCG筛查胎儿唐氏综合征的临床价值分析[J].中华全科医学,2011,9(8):1298-1299.
[8] 严英榴.胎儿结构异常的早孕期超声筛查[J].中国实用妇科与产科杂志,2008,24(2):102-106.
[9] MICHAILIDIS G D, PAPAGEORGIOU P, ECONOMIDES D L. Assessment of fetal anatomy in the first trimester using two- and three-dimensional ultrasound[J]. Br J Radiol,2002,75(89):215-219.
[10] SMITH D W. Recognizable patterns of human deformation: identification and management of mechanical effects on morphogenesis[J]. Major Probl Clin Pediatr,1981,21:1-151.
[11] BLAZER S, ZIMMER E Z, GOVER A, et al. Fetal omphalocele detected early in pregnancy: associated anomalies and outcomes[J]. Radiology,2004,232(1):191-195.
[12] 赵新美,吴春燕,陈雷.彩色多普勒超声产前诊断胎儿前腹壁畸形[J].中国医学影像技术,2011,27(1):147-150.
[13] 何花,冯洁玲,谢红宁,等.产前超声诊断胎儿脐膨出及其相关异常研究[J].影像诊断与介入放射学,2012,21(6):442-445.
[14] VAN ZALEN-SPROCK R M, VUGT J M, VAN GEIJN H P. First-trimester sonography of physiological midgut herniation and early diagnosis of omphalocele[J]. Prenat Diagn,2015,17(6):511-518.
[15] KHALIL A, ARNAOUTOGLOU C, PACILLI M, et al. Outcome of fetal exomphalos diagnosed at 11-14 weeks of gestation[J]. Ultrasound Obstet Gynecol,2012,39(4):401-406.
[2] 隋霜,何惠丽,张艳梅.产前系统超声检查在胎儿畸形筛查中价值[J].中华实用诊断与治疗杂志,2014,28(4):394-395.
[3] 柴青芬.胎儿动脉导管狭窄超声心动图诊断分析[J].中华实用诊断与治疗杂志,2016,30(8):769-771.
[4] 张素阁,王惠,牟楠楠,等.超声诊断双胎妊娠并胎儿畸形的价值[J].中华实用诊断与治疗杂志,2012,26(10):1005-1006.
[5] 邓芳,许玉敏.产前超声诊断胎儿眼部畸形价值[J].中华实用诊断与治疗杂志,2013,27(8):796-797.
[6] 卢琳.彩超筛查胎儿心脏病的价值[J].中华实用诊断与治疗杂志,2015,29(7):724-725.
[7] 谢玉珏,杨育菲,周安连,等.B超测NT联合母体血清AFP、F-β-HCG筛查胎儿唐氏综合征的临床价值分析[J].中华全科医学,2011,9(8):1298-1299.
[8] 严英榴.胎儿结构异常的早孕期超声筛查[J].中国实用妇科与产科杂志,2008,24(2):102-106.
[9] MICHAILIDIS G D, PAPAGEORGIOU P, ECONOMIDES D L. Assessment of fetal anatomy in the first trimester using two- and three-dimensional ultrasound[J]. Br J Radiol,2002,75(89):215-219.
[10] SMITH D W. Recognizable patterns of human deformation: identification and management of mechanical effects on morphogenesis[J]. Major Probl Clin Pediatr,1981,21:1-151.
[11] BLAZER S, ZIMMER E Z, GOVER A, et al. Fetal omphalocele detected early in pregnancy: associated anomalies and outcomes[J]. Radiology,2004,232(1):191-195.
[12] 赵新美,吴春燕,陈雷.彩色多普勒超声产前诊断胎儿前腹壁畸形[J].中国医学影像技术,2011,27(1):147-150.
[13] 何花,冯洁玲,谢红宁,等.产前超声诊断胎儿脐膨出及其相关异常研究[J].影像诊断与介入放射学,2012,21(6):442-445.
[14] VAN ZALEN-SPROCK R M, VUGT J M, VAN GEIJN H P. First-trimester sonography of physiological midgut herniation and early diagnosis of omphalocele[J]. Prenat Diagn,2015,17(6):511-518.
[15] KHALIL A, ARNAOUTOGLOU C, PACILLI M, et al. Outcome of fetal exomphalos diagnosed at 11-14 weeks of gestation[J]. Ultrasound Obstet Gynecol,2012,39(4):401-406.