摘要
目的探讨胎儿先天性胆总管囊肿的产前诊断和生后结局。方法回顾性分析2009年6月至2015年5月在金华市中心医院行产前常规胎儿超声检查并诊断的23例胎儿先天性胆总管囊肿病例的临床资料。记录这些孕妇的孕龄、首次诊断囊肿时胎龄、囊肿位置及大小，以及患儿生后检查、干预治疗和随访等情况。采用Wilcoxon秩和检验对数据进行统计学分析。结果（1）23例中，终止妊娠6例（26％），继续妊娠至分娩17例（74％）。（2）23例超声均显示囊肿与肝门部动静脉关系紧密，其中囊肿与胆囊相通者6例，囊肿与肝内胆管相通者8例。囊肿的最大径16．0—31．0mm，平均为（24．7±3．7）mm。晚孕期诊断囊肿的最大径明显大于中孕期诊断者[分别为27．0（22．0±31．0）和23．0（21．0-25．0）mm，Z=-2．134，P〈0．05]。（3）17例继续妊娠至分娩者中l例于孕35周^＋行官产分娩，其余16例均妊娠至足月分娩，平均分娩孕周（38．2±1．1）周。所有患儿生后均在1～2周内复查腹部B超，提示先天性胆总管囊肿。（4）17例患儿在生后2周内复查，其中4例囊肿大小较宫内相比无明显变化，1例生后囊肿缩小，其余12例囊肿大小随孕周增大而逐渐增大。16例生后诊断为先天性胆总管囊肿的患儿中，12例接受手术治疗，其中11例（Ia型6例，IC型3例，Ⅳb型2例）于1岁以内[平均（123．3±28．0）d]、1例（Ic型）于18月龄手术，术后预后良好；4例拒绝手术治疗，继续随访观察。1例生后诊断为先天性胆道闭锁的患儿，转外院行手术治疗。结论当胎儿腹部囊肿超声表现为肝门部囊性肿块，与胆囊或肝管相通等特征，应考虑先天性胆总管囊肿的可能，但需要排除胆道闭锁。对生后无症状的胆总管囊肿，建议3个月左右手术治疗。胆总管囊肿术后预后多理想，故产前咨询时无需建议终止妊娠。
Objective To investigate the prenatal diagnosis and postnatal clinical outcomes of fetal congenital choledochal cyst （CCC） to improve the recognition and treatment of fetal CCC. Methods Clinical data of 23 cases of fetal CCC which were diagnosed during routine prenatal ultrasonic examination in Jinhua Municipal Central Hospital from June 2009 to May 2015 were retrospectively analyzzed. Maternal age, gestational age at diagnosis of CCC, location and size of cyst, postnatal examination, age at operation and follow-up outcomes were recorded and statistically analyzed by Wilcoxon rank-sum test. Results （1） Among the 23 cases, six （26%） were terminated and the rest 17 continued their pregnancies （74%）. （2） Results of the prenatal ultrasonography of the 23 cases indicated that hepatic portal cysts were closely related to hepatic portal veins or arteries. Six of the cysts communicated with gall bladder and eight connected to intrahepatic bile duct. The maximum diameter of the cysts in the 23 cases was 16.0-31.0 mm, averagely （24.7± 3.7） mm. The maximum diameter of cysts diagnosed in the third trimester was significantly larger than that in the second trimester [ 27.0 （22.0-31.0） vs 23,0 （21.0-25.0） mm, Z= - 2.134, P〈0.05]. （3）Among the 17 cases of continued pregnancy, one underwent cesarean section at 35＇ weeks of gestation and 16 delivered at term with the average gestational age at delivery of （38.2 4-1.1） weeks. All neonates were re-examined by abdominal ultrasound at 1-2 postnatal weeks and confimed prenatal diagnosed of CCC. （4） The 17 neonates were re-examined by abdominal ultrasound during the second postnatal week and the results showed that cyst size remained the same in four, decreased in one and gradually increased with the gestational age in 12 neonates. Among the 16 cases of confirmed CCC, 12 received surgery, including 11 （ I a, 6; I c, 3; IV b, 2） within one year-old and one （ I c） around 18 months old. The prognosis was uneventful. Four out of the 16 cases rejected surgical operation and were followed up in outpatient. One neonate was diagnosed with congenital biliary atresia and transferred to Children＇s Hospital for operation. Conclusions When fetal abdominal cyst presented with hepatic portal cyst which communicates with gallbladder or intra-hepatic duct in ultrasonography, a congenital choledochal cyst should be taken into consideration by excluding the possibility of biliary atresia in the first place. Surgery for CCC infants without symptoms or signs is suggested to be performed around three months after birth. The postoperative prognosis of CCC is favorable, so termination is not recommended for gravidas with fetal CCC in prenatal consultation.
出处
《中华围产医学杂志》
CAS
CSCD
2017年第6期407-413,共7页
Chinese Journal of Perinatal Medicine
关键词
胆总管囊肿
超声检查
产前
胆道外科手术
Choledochal cyst
Ultrasonography, prenatal
Biliary tract surgical procedures
