胎儿肾脏发育异常的产前超声诊断结果与病理诊断、随访结果对比分析
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摘要
目的分析产前超声检查诊断胎儿肾脏发育异常结果与病理诊断、新生儿随访结果的符合情况,探讨产前超声检查在诊断胎儿肾脏发育异常的临床价值,提高优生优育水平。方法选择我院2015年1月-2017年1月期间在我院建档行孕期保健的1283例产妇为研究对象,按照孕期保健指南对孕妇行4次(孕6-19周,孕24-28周,孕30-32周,37-41周)产前超声检查,4次超声检查中,若诊断为肾脏发育异常,即按照临床医生医嘱酌情增加超声检查次数,随访病情并进行相应干预。经超声检查共诊断96例胎儿为肾脏发育异常。统计不同孕周超声检查诊断出胎儿肾脏发育异常分布情况,比较不同孕周超声检查对肾脏发育异常的诊断率。将96例孕妇纳入妊娠结局观察和随访系统。对于观察期内发生流产、引产的胎儿行病理检查,统计胎儿肾脏发育异常情况,剖宫产、阴道产新生儿行超声肾脏发育随访检查。统计96例孕妇妊娠结局(流产、引产、剖宫产、阴道产)情况。对96例孕妇流产、引产后胎儿行病理检查,胎儿分娩后行肾脏检查,明确新生儿肾脏发育异常情况。统计胎儿产前检查肾脏发育异常与病理和超声随访检查肾脏发育异常的符合情况。结果经超声检查共诊断96例胎儿为肾脏发育异常。孕24-28周检出肾脏发育异常率显著高于其它孕周检出率(P<0.05)。96例肾脏发育异常孕妇中自然流产3例,引产15例,剖宫产49例,阴道产29例。96例产前超声诊断肾脏发育异常患儿肾脏发育异常以肾积水为主,其次为多囊肾和盆腔异位肾。产前超声检查共96例肾脏发育异常,1187例肾脏发育正常,病理及随访结果98例肾脏发育异常,1185例肾脏发育正常,其中,超声诊断异常但病理及随访正常3例,漏诊率0.25%,超声诊断正常但病理及随访异常4例,误诊率4.00%。结论产前超声规范检查可及时诊断出胎儿肾脏发育异常,采取必要的干预措施确保胎儿预后质量,提高优生优育水平。
Objective:To analyze the compliance of prenatal ultrasound to diagnose fetal renal abnormalities,pathological diagnosis and neonatal follow-up. To explore the clinical value of prenatal ultrasound in diagnosing fetal renal dysplasia and improve the level of prenatal and postnatal care. Methods:From January 2015-January 2017 in our hospital during the cross line of 1283 cases of maternal prenatal care as the research object,according to the pregnancy care guide line for the pregnant woman 4 times(6 to 19 weeks gestation,24 to 28 weeks of pregnancy,30-32 weeks pregnant,37-41 weeks)of prenatal ultrasound,ultrasound 4 times,if a diagnosis of renal dysplasia,or according to the clinical doctor orders take into consideration the number that ultrasound follow-up of their condition and corresponding intervention. A total of 96 cases of renal dysplasia were diagnosed by ultrasonography. The abnormal distribution of fetal kidney was diagnosed by ultrasonic examination of different gestational weeks,and the diagnosis rate of abnormal renal development was compared with the ultrasound examination of different gestational weeks. The 96 pregnant women were included in the pregnancy outcome observation and follow-up system. During the observation period,the fetal renal development abnormality,caesarean section and vaginal birth were examined. Statistics of 96 pregnant women with pregnancy outcomes(miscarriage,induced labor,cesarean section,vaginal birth). In 96 pregnant women with miscarriage and postpartum pathologic examination,the fetal postpartum nephrology was used to determine the abnormal development of newborn kidney. Statistical analysis of fetal prenatal diagnosis and pathological and ultrasonographic follow-up examinations were used to check the abnormalities of renal development. Results:A total of 96 cases of renal development were diagnosed by ultrasonography. The abnormal rate of renal growth was significantly higher than other weeks of pregnancy(P<0.05). In 96 cases of abnormal renal development,3 cases were spontaneous abortion,15 cases were induced,49 were caesarean section and 29 cases were vaginal. The renal development of 96 cases of renal dysplasia was mainly based on renal growth,followed by polycystic kidney and pelvic heterotopic kidney. Prenatal ultrasound examination,a total of 96 cases of renal dysplasia,1187 cases of normal kidney development,pathology and follow-up results of 98 cases of renal dysplasia,1185 cases of normal kidney development,among them,abnormal ultrasonic diagnosis but pathology and follow-up of 3 cases of normal,0.25% missed diagnosis,ultrasonic diagnosis is normal but abnormal pathology and follow-up,4 cases misdiagnosis rate was 4.00%. Conclusion:Prenatal ultrasonography can diagnose the abnormal development of fetal kidney and take necessary intervention measures to ensure the quality of fetal prognosis and improve the quality of eugenics.
Objective:To analyze the compliance of prenatal ultrasound to diagnose fetal renal abnormalities,pathological diagnosis and neonatal follow-up. To explore the clinical value of prenatal ultrasound in diagnosing fetal renal dysplasia and improve the level of prenatal and postnatal care. Methods:From January 2015-January 2017 in our hospital during the cross line of 1283 cases of maternal prenatal care as the research object,according to the pregnancy care guide line for the pregnant woman 4 times(6 to 19 weeks gestation,24 to 28 weeks of pregnancy,30-32 weeks pregnant,37-41 weeks)of prenatal ultrasound,ultrasound 4 times,if a diagnosis of renal dysplasia,or according to the clinical doctor orders take into consideration the number that ultrasound follow-up of their condition and corresponding intervention. A total of 96 cases of renal dysplasia were diagnosed by ultrasonography. The abnormal distribution of fetal kidney was diagnosed by ultrasonic examination of different gestational weeks,and the diagnosis rate of abnormal renal development was compared with the ultrasound examination of different gestational weeks. The 96 pregnant women were included in the pregnancy outcome observation and follow-up system. During the observation period,the fetal renal development abnormality,caesarean section and vaginal birth were examined. Statistics of 96 pregnant women with pregnancy outcomes(miscarriage,induced labor,cesarean section,vaginal birth). In 96 pregnant women with miscarriage and postpartum pathologic examination,the fetal postpartum nephrology was used to determine the abnormal development of newborn kidney. Statistical analysis of fetal prenatal diagnosis and pathological and ultrasonographic follow-up examinations were used to check the abnormalities of renal development. Results:A total of 96 cases of renal development were diagnosed by ultrasonography. The abnormal rate of renal growth was significantly higher than other weeks of pregnancy(P<0.05). In 96 cases of abnormal renal development,3 cases were spontaneous abortion,15 cases were induced,49 were caesarean section and 29 cases were vaginal. The renal development of 96 cases of renal dysplasia was mainly based on renal growth,followed by polycystic kidney and pelvic heterotopic kidney. Prenatal ultrasound examination,a total of 96 cases of renal dysplasia,1187 cases of normal kidney development,pathology and follow-up results of 98 cases of renal dysplasia,1185 cases of normal kidney development,among them,abnormal ultrasonic diagnosis but pathology and follow-up of 3 cases of normal,0.25% missed diagnosis,ultrasonic diagnosis is normal but abnormal pathology and follow-up,4 cases misdiagnosis rate was 4.00%. Conclusion:Prenatal ultrasonography can diagnose the abnormal development of fetal kidney and take necessary intervention measures to ensure the quality of fetal prognosis and improve the quality of eugenics.
引文
[1]张梅玉,杨裕辉,李荣,等.产前超声诊断胎儿肾脏发育异常的价值[J].临床超声医学杂志,2013,15(9):658-659.
[2]Majumdar K,Chakrabarti I,Giri A.Pediatric hydronephrotic segmental renal dysplasia with ipsilateral ureterovesical obstruction--rare coincidence or a consequence[J]?Fetal Pediatr Pathol,2012,Aug,31(4):202-9.
[3]Gokce I,Biyikli N,Tugtepe H,Tarcan T,Alpay H.Clinical spectrum of antenatally detected urinary tract abnormalities with respect to hydronephrosis at postnatal ultrasound scan[J].Pediatr Surg Int,2012,May;28(5):543-52.
[4]李萍.产前超声诊断胎儿肾脏发育异常173例临床分析[J].中国卫生标准管理,2015,(4):54-55.
[5]Lidefelt KJ,Herthelius M,Soeria-Atmadja S.Antenatal renal pelvis dilatation:2-year follow-up with DMSA scintigraphy[J].Pediatr Nephrol,2009,Mar;24(3):533-6.
[6]吴新凤,高昆,钮雪峰,等.产前超声诊断胎儿肾脏发育异常临床应用意义探究[J].世界最新医学信息文摘(连续型电子期刊),2015,(66):119-119,120.
[7]连丽娟.产前超声诊断胎儿肾脏发育异常临床分析[J].大家健康(中旬版),2015,(7):59-60.
[8]van Vuuren SH,van der Doef R,Cohen-Overbeek TE,Goldschmeding R,Pistorius LR,de Jong TP.Compensatory enlargement of a solitary functioning kidney during fetal developm ent[J].Ultrasound Obstet Gynecol,2012 Dec,40(6):665-8.
[9]王旭芳.产前超声应用在胎儿肾脏发育异常诊断中的临床分析[J].中国社区医师,2017,33(6):94,97.
[10]朱玉兰.产前超声诊断胎儿肾脏发育异常临床价值观察[J].哈尔滨医药,2015,35(z1):78.
[11]刘蕾.产前超声诊断胎儿肾脏发育异常的临床分析(35例)[J].医疗装备,2017,30(6):143-144.
[12]李晚晴.产前超声对胎儿肾脏发育异常的诊断效果分析[J].世界临床医学,2017,11(13):210.
[13]梁建蓉.产前超声诊断对胎儿肾脏发育异常的应用价值[J].世界临床医学,2017,11(1):164-165.
[14]蔡群花.各种类型的胎儿肾脏发育异常在产前进行超声诊断的临床意义[J].母婴世界,2016,(10):49.
[15]吴幼平.超声三切面法对胎儿肾脏发育异常的诊断价值[J].中国医药指南,2016,14(18):57-58.
[2]Majumdar K,Chakrabarti I,Giri A.Pediatric hydronephrotic segmental renal dysplasia with ipsilateral ureterovesical obstruction--rare coincidence or a consequence[J]?Fetal Pediatr Pathol,2012,Aug,31(4):202-9.
[3]Gokce I,Biyikli N,Tugtepe H,Tarcan T,Alpay H.Clinical spectrum of antenatally detected urinary tract abnormalities with respect to hydronephrosis at postnatal ultrasound scan[J].Pediatr Surg Int,2012,May;28(5):543-52.
[4]李萍.产前超声诊断胎儿肾脏发育异常173例临床分析[J].中国卫生标准管理,2015,(4):54-55.
[5]Lidefelt KJ,Herthelius M,Soeria-Atmadja S.Antenatal renal pelvis dilatation:2-year follow-up with DMSA scintigraphy[J].Pediatr Nephrol,2009,Mar;24(3):533-6.
[6]吴新凤,高昆,钮雪峰,等.产前超声诊断胎儿肾脏发育异常临床应用意义探究[J].世界最新医学信息文摘(连续型电子期刊),2015,(66):119-119,120.
[7]连丽娟.产前超声诊断胎儿肾脏发育异常临床分析[J].大家健康(中旬版),2015,(7):59-60.
[8]van Vuuren SH,van der Doef R,Cohen-Overbeek TE,Goldschmeding R,Pistorius LR,de Jong TP.Compensatory enlargement of a solitary functioning kidney during fetal developm ent[J].Ultrasound Obstet Gynecol,2012 Dec,40(6):665-8.
[9]王旭芳.产前超声应用在胎儿肾脏发育异常诊断中的临床分析[J].中国社区医师,2017,33(6):94,97.
[10]朱玉兰.产前超声诊断胎儿肾脏发育异常临床价值观察[J].哈尔滨医药,2015,35(z1):78.
[11]刘蕾.产前超声诊断胎儿肾脏发育异常的临床分析(35例)[J].医疗装备,2017,30(6):143-144.
[12]李晚晴.产前超声对胎儿肾脏发育异常的诊断效果分析[J].世界临床医学,2017,11(13):210.
[13]梁建蓉.产前超声诊断对胎儿肾脏发育异常的应用价值[J].世界临床医学,2017,11(1):164-165.
[14]蔡群花.各种类型的胎儿肾脏发育异常在产前进行超声诊断的临床意义[J].母婴世界,2016,(10):49.
[15]吴幼平.超声三切面法对胎儿肾脏发育异常的诊断价值[J].中国医药指南,2016,14(18):57-58.