摘要
目的探讨胎儿静脉导管异常的产前超声图像特征及临床意义.方法回顾性分析我院产前诊断的15例胎儿静脉导管异常的病例,未测及正常静脉导管时,沿脐静脉追踪扫查,记录脐静脉回流的途径,收集其临床资料并随访出生结局.结果14例为静脉导管缺失,其中6例脐静脉回流至门静脉,5例脐静脉回流至下腔静脉,3例脐静脉回流至右房;余1例为静脉导管闭锁.静脉导管缺失表现为胎儿上腹部各切面均无正常静脉导管显示,脐静脉进入腹腔后可通过门静脉、下腔静脉、右房回流.静脉导管闭锁表现为之前血流通畅的静脉导管呈现条索样强回声且无血流信号通过.3例同时合并心内、心外畸形,4例仅合并心外畸形,8例未合并心内外畸形.2例为21‐三体.4例引产;2例胎死宫内;8例出生后儿科常规检查未发现明显异常;1例出生后因心外畸形接受手术治疗,术后恢复好.结论胎儿静脉导管异常有特征性超声表现,可以产前诊断,其血流动力学与脐静脉回流途径和异常引流管道的内径有关,其预后与染色体及合并畸形有关,如继续妊娠,建议行染色体检查及超声监测.
Objective To explore the prenatal ultrasound image features and clinical significance of fetal ductus venosus abormalities. Methods Fifteen fetuses with ductus venosus abormalities diagnosed by prenatal ultrasonography at Peking University Third Hospital were retrospective review. The prenatal findings, umbilical shunting type, perinatal outcomes, and autopsy reports were analyzed. Results Fourteen fetuses were found with absence of ductus venosus. In 6 fetuses the umbilical vein connected to the portal vein, 5 fetuses the umbilical vein connected to the inferior vena cava and 3 fetuses the umbilical vein connected to the right atrium. The remaining 1 fetus was found obliteration of ductus venosus. Absence of ductus venous showed no normal ductus venous and the umbilical vein almost always drained directly into portal vein, inferior vena cava or right atrium. Obliteration of ductus venous showed normal ductus venous was replaced by a tiny echogenic string without blood flow. Three cases had intracardiac and extracardiac abnormalities;4 cases had extracardiac abnormalities only;8 of these, ductus venosus abormality were isolated. Two cases had trisomy 21 syndrome. Four patients underwent legal termination of pregnancy;2 were intrauterine fetal death;and 8 carried to term wit normal outcome;the remaining one underwent operation due to extracardiac abnormality and postoperative course was uneventful. Conclusions Prenatal ultrasound can be used to diagnose fetal ductus venosus abormalities. Hemodynamic depends on umbilical venous drainage site and diameter. The prognosis for this group of anomalies depends on the chromosomal abnormalities and additional findings. Chromosome and ultrasonic monitoring are suggested for following pregnancy.
作者
童春
张爱青
刘朝晖
龚丽君
卢珊
张春妤
Tong Chun;Zhang Aiqing;Liu Zhaohui;Gong Lijun;Lu Shan;Zhang Chunyu(Ultrasound of Obstetrics and Gynecology Department,Peking University Third Hospital,Beijing 100191,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2019年第7期606-610,共5页
Chinese Journal of Ultrasonography
关键词
超声检查
胎儿
静脉导管缺失
静脉导管闭锁
Ultrasonography
Fetus
Absence of ductus venosus
Obliteration of ductus venosus
