| 肖祎炜,俞钢,尚宁,马小燕,张江宇,马秋萍,安思微.产前超声评估先天性膈疝预后[J].中国医学影像技术,2017,33(4):566~570 |
| 产前超声评估先天性膈疝预后 |
| Prenatal ultrasound in prognosis assessment of congenital diaphragmatic hernia |
| 投稿时间：2016-08-29 修订日期：2016-12-28 |
| DOI：10.13929/j.1003-3289.201608124 |
| 中文关键词: 超声检查,产前 先天性膈疝 胎儿 |
| 英文关键词:Ultrasonography, prenatal Congenital diaphragmatic hernia Fetus |
| 基金项目:广东省医学科学技术研究基金项目（A2016170）。 |
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| 中文摘要: |
| 目的 探讨产前超声在先天性膈疝预后评估中的应用价值。方法 分析65例出生后经手术或随诊证实为先天性膈疝的胎儿的产前超声声像图特征，测量胎儿健侧肺的肺头比（LHR）、与该孕周正常胎儿的LHR进行比较，计算O/E LHR，探讨其与新生儿预后的关系。结果 65例中，45例出生后行手术治疗后存活，8例手术后死亡，12例未行手术即死亡，总死亡率30.77%（20/65）。肝上型膈疝死亡率66.67%（8/12）；肝下型膈疝死亡率22.64%（12/53）。合并其他结构异常共9例，死亡8例，其中6例合并胸腔内结构异常。LHR为0.40~2.72，平均1.59±0.69；不同LHR膈疝胎儿出生后死亡率差异有统计学意义（χ2=19.360，P<0.001），LHR≤1.0的膈疝胎儿出生后死亡率高于LHR>1.0的膈疝胎儿。O/E LHR为23%~90%，平均（58.25±17.61）%，不同O/E LHR膈疝胎儿出生后死亡率差异有统计学意义（χ2=15.261，P=0.002），O/E LHR≤45%的膈疝胎儿出生后死亡率高于O/E LHR>45%的膈疝胎儿。结论 产前超声可用于诊断胎儿先天性膈疝，并评估健侧肺的发育情况及患儿预后。 |
| 英文摘要: |
| Objective To investigate the value of prenatal ultrasound in prognosis assessment of congenital diaphragmatic hernia. Methods The ultrasonographic features of 65 fetuses with congenital diaphragmatic hernia were analyzed, which were confirmed by after birth surgery or examination. The lung-to-head ratio (LHR) of unaffected side and O/E LHR (LHR compared to normal fetuses on same gestational weeks) were obtained, and then the relationship with the prognosis of neonates were analyzed. Results In 65 cases, 45 fetuses survived and 8 fetuses died after surgery, while 12 cases did not undergo surgery and death promptly. Overall mortality was 30.77% (20/65). In 12 hepatic intrathoracic type of diaphragmatic hernia cases, the mortality rate was 66.67% (8/12). In 53 hepatic intra-abdominal type of diaphragmatic hernia cases, the mortality rate was 22.64% (12/53). In 9 cases combined with other structural abnormalities, there were 8 cases were dead and 6 cases (6/8) with abnormal chest structure. LHR values were from 0.40 to 2.72, the average value was 1.59±0.69. It showed statistical difference on the mortality rate in fetus of congenital diaphragmatic hernia with different LHR (χ2=19.360, P<0.001), The mortality rate in fetal of congenital diaphragmatic hernia with LHR 1.0 or less was higher than that with LHR >1.0. O/E LHR measurement values were from 23% to 90% and the average value was (58.25±17.61)%. It showed statistical difference on the mortality rate in fetus of congenital diaphragmatic hernia with different O/E LHR (χ2=15.261, P=0.002). The mortality rate in fetal of congenital diaphragmatic hernia with O/E LHR ≤ 45% was higher than that with O/E LHR>45%. Conclusion The prenatal ultrasound can be used to diagnose congenital diaphragmatic hernia, and to assess the development of unaffected lung and prognosis. |
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