CAJ | 학술논문

目的探讨产前胎儿心脏超声检查对室间隔缺损(ventricular septal defect,VSD)的诊断价值及局限性. 方法 2009年1月1日至2010月10月31日,在复旦大学附属妇产科医院进行系统产前检查的孕妇于妊娠20～24周进行胎儿心脏超声检查,产后48 h新生儿接受心脏超声检查；引产终止妊娠者行胎儿尸体解剖以明确心脏畸形的诊断,共纳入孕妇4392例(1例双胎妊娠,胎儿4393例).计算产前超声对于VSD的检出率及漏诊率. 结果 (1)复杂性VSD检出情况:产前胎儿心脏超声检查共检出23例复杂性VSD,其中1例合并部分性心内膜垫缺损,但产后新生儿心脏超声未见异常,另22例均引产终止妊娠,引产胎儿尸体解剖证实产前诊断.(2)单纯性VSD检出情况:产前胎儿心脏超声检出16例单纯性VSD,其中15例产后新生儿心脏超声未见异常,另1例产后新生儿心脏超声证实为单纯性VSD.(3)检出率:产前胎儿心脏超声检查中未检出VSD的4354例胎儿中,产后新生儿心脏超声检出54例VSD,均为单纯性.产前检出产后证实的及产后诊断的VSD共77例,发生率为1.8％ (77/4393),单纯性VSD发生率为1.3％(55/4393),复杂性VSD发生率为0.5％(22/4393).产前胎儿心脏超声检查对于复杂性VSD的检出率为100.0％(22/22),漏诊率为0.0％(0/22),误诊率为0.2‰(1/4371).产前单纯性VSD的检出率为1.8％(1/55),漏诊率较高(98.2％,54/55),误诊率为3.5‰(15/4338). 结论产前胎儿心脏超声检查对于合并有其他心脏结构异常的复杂性VSD的检出率及准确率高；而对于单纯性VSD,有较高的漏诊率及误诊率.
목적 탐토산전태인심장초성검사대실간격결손(ventricular septal defect,VSD)적진단개치급국한성. 방법 2009년1월1일지2010월10월31일,재복단대학부속부산과의원진행계통산전검사적잉부우임신20～24주진행태인심장초성검사,산후48 h신생인접수심장초성검사；인산종지임신자행태인시체해부이명학심장기형적진단,공납입잉부4392례(1례쌍태임신,태인4393례).계산산전초성대우VSD적검출솔급루진솔. 결과 (1)복잡성VSD검출정황:산전태인심장초성검사공검출23례복잡성VSD,기중1례합병부분성심내막점결손,단산후신생인심장초성미견이상,령22례균인산종지임신,인산태인시체해부증실산전진단.(2)단순성VSD검출정황:산전태인심장초성검출16례단순성VSD,기중15례산후신생인심장초성미견이상,령1례산후신생인심장초성증실위단순성VSD.(3)검출솔:산전태인심장초성검사중미검출VSD적4354례태인중,산후신생인심장초성검출54례VSD,균위단순성.산전검출산후증실적급산후진단적VSD공77례,발생솔위1.8％ (77/4393),단순성VSD발생솔위1.3％(55/4393),복잡성VSD발생솔위0.5％(22/4393).산전태인심장초성검사대우복잡성VSD적검출솔위100.0％(22/22),루진솔위0.0％(0/22),오진솔위0.2‰(1/4371).산전단순성VSD적검출솔위1.8％(1/55),루진솔교고(98.2％,54/55),오진솔위3.5‰(15/4338). 결론 산전태인심장초성검사대우합병유기타심장결구이상적복잡성VSD적검출솔급준학솔고；이대우단순성VSD,유교고적루진솔급오진솔.
Objective To investigate the diagnostic value and limitations of prenatal echocardiography on fetal ventricular septal defect (VSD).Methods Fetal echocardiography was performed on 4392 pregnant women (including one twin pregnancy) during their 20 to 24 weeks of gestation who accepted routine prenatal care in Obstetrics and Gynecology Hospital of Fudan University from January 1,2009 to October 31,2010.Neonatal echocardiography was performed within 48 hours after birth; and fetal autopsy was done for mid-trimester terminated cases to confirm the diagnosis.Detection rate and missed diagnosis rate of prenatal echocardiography on VSD were calculated.Results (1) Complicated VSD (associated with other cardiac defects):Twenty-three cases of complicated VSD were detected prenatally,among which 22 cases were terminated at midtrimester and another one was suspected as VSD complicated with partial endocardial cushion defect,while it was finally diagnosed as normal after birth.(2)Isolated VSD:Sixteen prenatally suspected VSD were confirmed after birth as 15 normal cases and one case of isolated VSD.(3)Detection rate of prenatal echocardiography:Among the rest 4354 cases without VSD in prenatal echocardiography,there were 54 cases of isolated VSD by neonatal echocardiography.A total of 77 cases of VSD were confirmed by prenatal and postnatal two-dimension echocardiography or autopsy.The incidence of VSDwas 1.8％ (77/4393),isolated VSD was 1.3％ (55/4393),and complicated VSD was 0.5％(22/4393).Prenatal detection rate of complicated VSD was 100.0％ (22/22) ; missed diagnosis rate and misdiagnosis rate was 0.0％ (0/22) and 0.2‰ (1/4371) respectively.Prenatal detection rate of isolated VSD was 1.8％ (1/55),missed diagnosis rate and misdiagnosis rate was 98.2％ (54/55) and 3.5‰ (15/4338) respectively.Conclusions Prenatal detection rate of VSD by echocardiography on fetus with complicated VSD is high,while prenatal detection rate of fetal isolated VSD is very low.