CAJ | 학술논문

目的探讨产前超声对于胎儿右位主动脉弓(right aortic arch,RAA)的诊断价值.方法 2009年3月5日至2012年9月2日在广东省佛山市3家医院就诊的孕妇18 600例(RAA高危组5000例,低危组13 600例),于妊娠18～42周产前超声观察胎儿主动脉弓及其分支是否存在异常以及主动脉弓畸形类型.所有病例产后婴儿15个月内行超声心动图、CT或MRI检查观察心脏情况,引产病例行胎儿尸体解剖.采用x2检验比较组间胎儿RAA类型,是否合并心内和(或)心外结构异常及妊娠结局的差异.结果低危组产前诊断胎儿RAA 15例,检出率为0.11％(15/13 600),明显低于高危组胎儿RAA的检出率(0.60％,30/5000),差异有统计学意义(x2=98.20,P＜0.01).产前超声对胎儿RAA的检出正确率为96％(43/45).另外2例胎儿产前超声均诊断为RAA并迷走左锁骨下动脉,生后1例确诊为双主动脉弓,另1例确诊为RAA并镜像样分支、左位导管.高危组胎儿发生RAA并镜像样分支、合并心内和(或)心外异常的比例分别为73％(22/30)、67％(20/30)和27％(8/30),高于低危组(分别为0/15、1/15和0/15),RAA并迷走左锁骨下动脉和15个月的生存率分别为20％(6/30)和40％(12/30),低于低危组(分别为12/15和15/15),差异均有统计学意义(x2=30.000、25.200、28.000、7.700和15.610,P均＜0.05).结论高危孕妇发生胎儿RAA的比例远高于低危孕妇,且以RAA并镜像样分支多见,常合并心内和(或)心外异常,预后不良.
목적 탐토산전초성대우태인우위주동맥궁(right aortic arch,RAA)적진단개치.방법 2009년3월5일지2012년9월2일재광동성불산시3가의원취진적잉부18 600례(RAA고위조5000례,저위조13 600례),우임신18～42주산전초성관찰태인주동맥궁급기분지시부존재이상이급주동맥궁기형류형.소유병례산후영인15개월내행초성심동도、CT혹MRI검사관찰심장정황,인산병례행태인시체해부.채용x2검험비교조간태인RAA류형,시부합병심내화(혹)심외결구이상급임신결국적차이.결과 저위조산전진단태인RAA 15례,검출솔위0.11％(15/13 600),명현저우고위조태인RAA적검출솔(0.60％,30/5000),차이유통계학의의(x2=98.20,P＜0.01).산전초성대태인RAA적검출정학솔위96％(43/45).령외2례태인산전초성균진단위RAA병미주좌쇄골하동맥,생후1례학진위쌍주동맥궁,령1례학진위RAA병경상양분지、좌위도관.고위조태인발생RAA병경상양분지、합병심내화(혹)심외이상적비례분별위73％(22/30)、67％(20/30)화27％(8/30),고우저위조(분별위0/15、1/15화0/15),RAA병미주좌쇄골하동맥화15개월적생존솔분별위20％(6/30)화40％(12/30),저우저위조(분별위12/15화15/15),차이균유통계학의의(x2=30.000、25.200、28.000、7.700화15.610,P균＜0.05).결론 고위잉부발생태인RAA적비례원고우저위잉부,차이RAA병경상양분지다견,상합병심내화(혹)심외이상,예후불량.
Objective To investigate the clinical value of ultrasound diagnosis of fetal right aortic arch (RAA).Methods From March 5,2009 to September 2,2012,18 600 pregnant women in three hospitals in Foshan City,Guangdong Province,were divided as RAA high-risk group (n=5000) and low-risk group (n =13 600).During 18 to 42 gestational weeks,detailed ultrasound examinations of fetal aortic arch were done.All babies received echocardiography,CT or MRI within 15 months after birth to observe the cardiovascular condition,and aborted fetus was autopsied.RAA type,complicated structural abnormality and pregnancy outcomes between the two groups were compared with Chi-square test.Results Fifteen fetal RAA were diagnosed prenatally in the low-risk group,and the detection rate was 0.11％ (15/13 600),which was lower than that in the high-risk group (0.60％,30/5000)(x2=98.20,P＜0.01).The correct rate of prenatal ultrasound diagnosis of RAA was 96％ (43/45),while the other two cases were diagnosed as RAA with aberrant left subclavian artery and confirmed to be double aortic arch and RAA with mirror image after birth.In the high-risk group,the incidence of RAA with mirror image,cardiac and extra-cardiac malformation was 73％(22/30),67％(20/30) and 27％(8/30),respectively,which were higher than those in the low-risk group(0/15,1/15 and 0/15)(x2 =30.000,25.200 and 28.000,P＜0.01 respectively).The incidence of RAA with aberrant left subclavian artery and the 15-month survival rate of RAA infants in the high risk group was lower than those in the low-risk group [20％ (6/30) vs 12/15,40％ (12/30) vs 15/15] (x2=7.700 and 15.610,P＜0.05,respectively).Conclusions The incidence of fetal RAA is higher in the high-risk pregnant women than in the low-risk pregnant women,and babies often complicated with other malformations with poor prognosis.