CAJ | 학술논문

目的总结中孕期胎儿唇裂及唇腭裂的超声声像图特征.方法2009年1月至2012年12月以规范化二维口唇冠状切面和上牙槽突冠状切面作为常规超声筛查切面对60007例中孕期(孕20~24周)胎儿行颜面部超声筛查,并与引产及产后检查结果进行对照分析.结果产前超声于60007例中孕期胎儿中检出唇裂及唇腭裂畸形214例,检出率为0.36%(214/60007);超声未发现胎儿唇腭部异常59793例(99.64%,59793/60007).214例胎儿唇裂及唇腭裂超声声像图表现:(1)单纯唇裂36例,超声显示上唇回声中断但未达鼻根部,上牙槽突未见连续中断;(2)唇腭裂178例,超声显示上唇连续中断达鼻根部伴鼻变形,同时伴上牙槽突中断、排列不齐或上腭回声中断;三维超声成像能直观显示唇裂及唇腭裂程度.214例唇裂和唇腭裂胎儿产后随访到170例(79.44%,170/214),失访44例(20.56%,44/214);随访结果显示:(1)因胎儿唇裂(其中单纯唇裂24例)及唇腭裂(130例)孕妇选择于孕28周前引产154例(71.96%,154/214);引产胎儿颜面部检查证实均有不同程度的唇裂;(2)唇裂或唇腭裂不合并其他系统异常的胎儿足月分娩16例,1例产前诊断唇裂,足月分娩后检查为唇裂合并腭裂;3例产前诊断唇腭裂,足月分娩后检查仅为唇裂,12例出生后检查与产前超声诊断相符合.(3)60007例中孕期胎儿产前超声未发现唇腭部异常59793例,足月分娩后检查发现超声漏诊1例Ⅰ度唇裂;2例新生儿颜面部检查发现胎儿期唇裂和唇腭裂宫内自愈.超声检查后共随访到胎儿妊娠结局171例,与引产或产后检查结果对照显示,产前超声诊断唇裂及唇腭裂的符合率为99.42%(170/171),漏诊率为0.58%(1/171).结论中孕期超声筛查重视胎儿唇腭部检查,二维与三维多切面扫查及规范化留存超声图像可增加更多诊断信息,提高胎儿唇腭裂检出率,降低漏诊率.
목적총결중잉기태인진렬급진악렬적초성성상도특정.방법2009년1월지2012년12월이규범화이유구진관상절면화상아조돌관상절면작위상규초성사사절면대60007례중잉기(잉20~24주)태인행안면부초성사사,병여인산급산후검사결과진행대조분석.결과산전초성우60007례중잉기태인중검출진렬급진악렬기형214례,검출솔위0.36%(214/60007);초성미발현태인진악부이상59793례(99.64%,59793/60007).214례태인진렬급진악렬초성성상도표현:(1)단순진렬36례,초성현시상진회성중단단미체비근부,상아조돌미견련속중단;(2)진악렬178례,초성현시상진련속중단체비근부반비변형,동시반상아조돌중단、배렬불제혹상악회성중단;삼유초성성상능직관현시진렬급진악렬정도.214례진렬화진악렬태인산후수방도170례(79.44%,170/214),실방44례(20.56%,44/214);수방결과현시:(1)인태인진렬(기중단순진렬24례)급진악렬(130례)잉부선택우잉28주전인산154례(71.96%,154/214);인산태인안면부검사증실균유불동정도적진렬;(2)진렬혹진악렬불합병기타계통이상적태인족월분면16례,1례산전진단진렬,족월분면후검사위진렬합병악렬;3례산전진단진악렬,족월분면후검사부위진렬,12례출생후검사여산전초성진단상부합.(3)60007례중잉기태인산전초성미발현진악부이상59793례,족월분면후검사발현초성루진1례Ⅰ도진렬;2례신생인안면부검사발현태인기진렬화진악렬궁내자유.초성검사후공수방도태인임신결국171례,여인산혹산후검사결과대조현시,산전초성진단진렬급진악렬적부합솔위99.42%(170/171),루진솔위0.58%(1/171).결론중잉기초성사사중시태인진악부검사,이유여삼유다절면소사급규범화류존초성도상가증가경다진단신식,제고태인진악렬검출솔,강저루진솔.
Objective To summarize the ultrasonographic feathers of cleft lips (CL) with or without cleft palates (CL/P) in mid-gestation.Methods From 2009 Jan.to 2012 Dec.,60 007 fetal faces in mid-gestation (20-24 pregnancy weeks) were screened.The two dimensional coronal planes of lips and alveolar ridges of maxillas were standardized as the regular CL/P screening planes.The examination results of fetus after abortion or birth were golden criterion.Results Ultrasonography detected 214 fetuses with CL/P (0.36%, 214/60 007).CL without CP were detected in 36 fetuses.In ultrasonography,an anechoic region in the upper lip extended to the nares.The alveolar ridges of the maxillas were normal .CL with CP were detected in 178 fetuses.In ultrasonography,an anechoic region in the upper lip extended to the nares with disturbed nose and a gap in the maxilla and palate.CL/P was better displayed in three-dimensional ultrasonogram.One hundred and seventy fetuses (79.44%,170/214) were followed up till abortion or birth and 44 fetuses (20.56%, 44/214) lost follow up.One hundred and fifty-four fetuses (71.96%,154/214) were aborted before 28 pregnancy weeks because of CL (24 cases) and CL with CP (130 cases).CL with varying degree of symptoms were confirmed.Sixteen fetuses with CL/P without other system involved had full-term birth (one CL with CP case was diagnosed as CL by ultrasonography ,three CL cases were diagnosed as CL with CP by ultrasonography,12 cases were diagnosed accurately by ultrasonography ).One case of I degree CL which was confirmed after birth was not detected by ultrasonography .Two cases of CL with CP were found self-healed in uterus.Totally 171 cases were followed up.The diagnosis accordance rate of ultrasonography was 99.42%(170/171) and the rate of missed diagnosis was 0.58% (1/171).Conclusions The examination of fetal lip and palate in mid-gestation by ultrasonography should be emphasized .Two-dimensional and three-dimensional multiplanes screening and standardized restored ultrasound images can provide additional information for diagnosis,enhance the detection rate of CL/P and decrease the rate of missed diagnosis .