CAJ | 학술논문

目的探讨单纯性轻度侧脑室扩张胎儿的宫内转归及预后.方法前瞻性选择2006年1月至2009年12月于温州医学院附属第二医院行常规产前检查的单胎孕妇共18 200例,自妊娠第20周开始,由专职B超医师仔细测量胎儿侧脑室后角宽度,将胎儿单纯性轻度侧脑室扩张(即侧脑室增宽10～15 mm,不合并胎儿结构畸形)者纳入本研究,共148例.根据首次检查侧脑室扩张的程度,将单纯性轻度侧脑室扩张分为2组:A组:侧脑室宽度为10～11 mm,99例,B组:侧脑室宽度为12～15 mm,49例,每2～4周动态观察胎儿侧脑室宽度的变化及其他异常情况,并对新生儿出生后神经行为发育情况进行随访.结果 (1)发生率:胎儿单纯性轻度侧脑室扩张发生率为0.08%(148/18 200),其中双侧脑室扩张45例,A组双侧脑室扩张发生率为20%(20/99),B组为51%(25/49),两组比较,差异有统计学意义(P＜0.05);(2)宫内转归:148例中139例至少进行过2次或2次以上的超声随访,单纯性轻度侧脑室扩张宫内消失占41.7%(58/139),缩小占7.9%(11/139),稳定占36.7%(51/139),进展占13.7%(19/139);A组进展者5例,B组进展者14例,两组比较,差异有统计学意义(P＜0.05);(3)新生儿神经行为发育情况:111例新生儿出生后随访5～12个月,神经行为发育异常率为5.4%(6/111);进展者新生儿出生后神经行为发育异常率(3/15)明显高于消失者(2.5%,1/40)、减少者(0,0/8)和稳定者(4.2%,2/48),分别比较,差异均有统计学意义(P＜0.05).结论 85%以上的胎儿单纯性轻度侧脑室扩张在宫内消失、缩小或稳定,预后良好;脑室扩张≥12 mm,且宫内有进展者提示预后不良,应引起高度重视.
목적 탐토단순성경도측뇌실확장태인적궁내전귀급예후.방법 전첨성선택2006년1월지2009년12월우온주의학원부속제이의원행상규산전검사적단태잉부공18 200례,자임신제20주개시,유전직B초의사자세측량태인측뇌실후각관도,장태인단순성경도측뇌실확장(즉측뇌실증관10～15 mm,불합병태인결구기형)자납입본연구,공148례.근거수차검사측뇌실확장적정도,장단순성경도측뇌실확장분위2조:A조:측뇌실관도위10～11 mm,99례,B조:측뇌실관도위12～15 mm,49례,매2～4주동태관찰태인측뇌실관도적변화급기타이상정황,병대신생인출생후신경행위발육정황진행수방.결과 (1)발생솔:태인단순성경도측뇌실확장발생솔위0.08%(148/18 200),기중쌍측뇌실확장45례,A조쌍측뇌실확장발생솔위20%(20/99),B조위51%(25/49),량조비교,차이유통계학의의(P＜0.05);(2)궁내전귀:148례중139례지소진행과2차혹2차이상적초성수방,단순성경도측뇌실확장궁내소실점41.7%(58/139),축소점7.9%(11/139),은정점36.7%(51/139),진전점13.7%(19/139);A조진전자5례,B조진전자14례,량조비교,차이유통계학의의(P＜0.05);(3)신생인신경행위발육정황:111례신생인출생후수방5～12개월,신경행위발육이상솔위5.4%(6/111);진전자신생인출생후신경행위발육이상솔(3/15)명현고우소실자(2.5%,1/40)、감소자(0,0/8)화은정자(4.2%,2/48),분별비교,차이균유통계학의의(P＜0.05).결론 85%이상적태인단순성경도측뇌실확장재궁내소실、축소혹은정,예후량호;뇌실확장≥12 mm,차궁내유진전자제시예후불량,응인기고도중시.
Objective To investigate outcome and prognosis of isolated mild fetal ventriculomegaly (IMV) of fetus in uterus. Methods From Jan. 2006 to Dec. 2009, 18 200 singleton pregnancy women from 20 weeks gestation underwent prenatal ultrasonography examination in Department of Obstetrics and Gynecology, Second Affiliated Hospital of Wenzhou Medical College. One hundred and forty-eight women with IMV (transverse diameter of the atrium of the lateral ventricle measuring between 10 and 15 mm with no other abnormalities) were studied prospectively, which were divided into two groups: 99 women with transverse diameter of the lateral ventricle of 10 - 11 mm in group A and 49 women with transverse diameter lateral ventricle of 12 - 15 mm in group B. The changes of ventriculomegaly and the associated intracranial and extracranial anomalies were observed regularly every 2 or 4 weeks until delivery. The development of neurological system was also followed up. Results ( 1 ) The overall incidence of IMV was 0. 08% (148/18 200). The rate of bilateral ventriculomegaly were 20% (20/99) in group A and 51% (25/49) in group B, which reached statistical difference (P＜ 0. 05). (2) Prognosis of fetus: 139 cases with 2 or more ultrasonographic examinations, IMV resolved throughout pregnancy in 41. 7% (58/139) ,regressed in 7. 9% (11/139) ,remained stable in 36. 7% (51/139)and progressed in 13. 7% ( 19/139). Five cases in group A and 11 cases in group B present progress, which reached significantly difference (P ＜ 0. 05). (3) One hundred and eleven cases infant were followed up for 5-12 months,the rate of psycho-motor developmental delay was 5. 4% (6/111). The rate of neuro-developmental delay in progressed group (3/15) was higher than 2. 5% ( 1/40) in resolved group, 0 (0/8) in regressed group and 4. 2% (2/48) in remained stable group, which reached significantly difference (P＜0. 05). Conclusions About 85% of cases of IMV resolved, regressed or remained stable in utero would exhibited good prognosis. IMV with a transverse atrial size ≥ 12 mm or progression in utero was usually associated with a poor prognosis, which should be observed carefully.