目的 探讨胎儿腹部囊肿的超声影像学特征和围产结局.方法 2011年10月1日至201 3年10月31日,广东省妇幼保健院行产前胎儿系统超声检查发现胎儿腹部囊肿210例.产前对胎儿进行全面系统的超声检查,发现胎儿腹部囊肿时,观察其发生部位、形态、大小、内部回声、血流情况以及与周边邻近脏器的关系,并结合临床和遗传学情况进行评估,继续妊娠者每3～4周定期复查,直至分娩.如果囊肿巨大(直径＞4cm),或性质不明,或病情有进展,必要时进行囊肿穿刺.分娩后新生儿进行超声检查,必要时CT检查.有手术指征者建议手术治疗;非手术者每2～6个月进行随访.分析胎儿腹部囊肿的解剖部位、性质、超声特征、临床情况及预后. 结果 210例胎儿腹部囊肿中,肝胆来源20例(l0％,20/210),其中肝囊肿10例,胆总管囊肿7例,胆道闭锁2例,肝脏错构瘤l例.消化道来源51例(24％,51/210),其中胎粪性腹膜炎9例,十二指肠梗阻15例,小肠梗阻10例,肛门闭锁7例,结肠梗阻3例,巨大肠系膜囊肿2例,肠重复畸形5例.肾脏和肾上腺区域来源42例(20％,42/210),其中肾囊肿19例,膈肌下隔离肺5例,神经母细胞瘤3例,肾上腺畸胎瘤1例,肾母细胞瘤l例,多囊性肾发育不良13例.泌尿系统梗阻55例(26％,55/210),其中肾积水34例,输尿管扩张16例,巨膀胱症5例.生殖系统来源42例(20％,42/210),均为女性胎儿的卵巢囊肿.210例胎儿腹部囊肿中,以卵巢囊肿最多,其次为肾积水、肾囊肿、输尿管扩张及十二指肠梗阻.22例(10％,22/210)产前行囊肿穿刺抽液,未出现流产等合并症.共8例行引产及尸检,结果与超声诊断相符,其中2例十二指肠梗阻及1例肛门闭锁均合并21-三体,1例巨膀胱症合并18-三体,另外1例胆道闭锁、1例神经母细胞瘤、2例巨膀胱症因孕妇主动要求而引产.202例(96％,202/210)继续妊娠至出生;除l例十二指肠闭锁生后死亡外,其余201例生后存活.生后手术治疗138例(69％,138/201),无手术死亡. 结论 产前超声检查可发现胎儿腹部囊肿,对预测与评估胎儿发育、妊娠结局、生后治疗有重要作用,可为临床处理及治疗提供参考.
目的 探討胎兒腹部囊腫的超聲影像學特徵和圍產結跼.方法 2011年10月1日至201 3年10月31日,廣東省婦幼保健院行產前胎兒繫統超聲檢查髮現胎兒腹部囊腫210例.產前對胎兒進行全麵繫統的超聲檢查,髮現胎兒腹部囊腫時,觀察其髮生部位、形態、大小、內部迴聲、血流情況以及與週邊鄰近髒器的關繫,併結閤臨床和遺傳學情況進行評估,繼續妊娠者每3～4週定期複查,直至分娩.如果囊腫巨大(直徑＞4cm),或性質不明,或病情有進展,必要時進行囊腫穿刺.分娩後新生兒進行超聲檢查,必要時CT檢查.有手術指徵者建議手術治療;非手術者每2～6箇月進行隨訪.分析胎兒腹部囊腫的解剖部位、性質、超聲特徵、臨床情況及預後. 結果 210例胎兒腹部囊腫中,肝膽來源20例(l0％,20/210),其中肝囊腫10例,膽總管囊腫7例,膽道閉鎖2例,肝髒錯構瘤l例.消化道來源51例(24％,51/210),其中胎糞性腹膜炎9例,十二指腸梗阻15例,小腸梗阻10例,肛門閉鎖7例,結腸梗阻3例,巨大腸繫膜囊腫2例,腸重複畸形5例.腎髒和腎上腺區域來源42例(20％,42/210),其中腎囊腫19例,膈肌下隔離肺5例,神經母細胞瘤3例,腎上腺畸胎瘤1例,腎母細胞瘤l例,多囊性腎髮育不良13例.泌尿繫統梗阻55例(26％,55/210),其中腎積水34例,輸尿管擴張16例,巨膀胱癥5例.生殖繫統來源42例(20％,42/210),均為女性胎兒的卵巢囊腫.210例胎兒腹部囊腫中,以卵巢囊腫最多,其次為腎積水、腎囊腫、輸尿管擴張及十二指腸梗阻.22例(10％,22/210)產前行囊腫穿刺抽液,未齣現流產等閤併癥.共8例行引產及尸檢,結果與超聲診斷相符,其中2例十二指腸梗阻及1例肛門閉鎖均閤併21-三體,1例巨膀胱癥閤併18-三體,另外1例膽道閉鎖、1例神經母細胞瘤、2例巨膀胱癥因孕婦主動要求而引產.202例(96％,202/210)繼續妊娠至齣生;除l例十二指腸閉鎖生後死亡外,其餘201例生後存活.生後手術治療138例(69％,138/201),無手術死亡. 結論 產前超聲檢查可髮現胎兒腹部囊腫,對預測與評估胎兒髮育、妊娠結跼、生後治療有重要作用,可為臨床處理及治療提供參攷.
목적 탐토태인복부낭종적초성영상학특정화위산결국.방법 2011년10월1일지201 3년10월31일,광동성부유보건원행산전태인계통초성검사발현태인복부낭종210례.산전대태인진행전면계통적초성검사,발현태인복부낭종시,관찰기발생부위、형태、대소、내부회성、혈류정황이급여주변린근장기적관계,병결합림상화유전학정황진행평고,계속임신자매3～4주정기복사,직지분면.여과낭종거대(직경＞4cm),혹성질불명,혹병정유진전,필요시진행낭종천자.분면후신생인진행초성검사,필요시CT검사.유수술지정자건의수술치료;비수술자매2～6개월진행수방.분석태인복부낭종적해부부위、성질、초성특정、림상정황급예후. 결과 210례태인복부낭종중,간담래원20례(l0％,20/210),기중간낭종10례,담총관낭종7례,담도폐쇄2례,간장착구류l례.소화도래원51례(24％,51/210),기중태분성복막염9례,십이지장경조15례,소장경조10례,항문폐쇄7례,결장경조3례,거대장계막낭종2례,장중복기형5례.신장화신상선구역래원42례(20％,42/210),기중신낭종19례,격기하격리폐5례,신경모세포류3례,신상선기태류1례,신모세포류l례,다낭성신발육불량13례.비뇨계통경조55례(26％,55/210),기중신적수34례,수뇨관확장16례,거방광증5례.생식계통래원42례(20％,42/210),균위녀성태인적란소낭종.210례태인복부낭종중,이란소낭종최다,기차위신적수、신낭종、수뇨관확장급십이지장경조.22례(10％,22/210)산전행낭종천자추액,미출현유산등합병증.공8례행인산급시검,결과여초성진단상부,기중2례십이지장경조급1례항문폐쇄균합병21-삼체,1례거방광증합병18-삼체,령외1례담도폐쇄、1례신경모세포류、2례거방광증인잉부주동요구이인산.202례(96％,202/210)계속임신지출생;제l례십이지장폐쇄생후사망외,기여201례생후존활.생후수술치료138례(69％,138/201),무수술사망. 결론 산전초성검사가발현태인복부낭종,대예측여평고태인발육、임신결국、생후치료유중요작용,가위림상처리급치료제공삼고.
Objective To investigate the ultrasonographic features and the perinatal outcome of fetal abdominal cyst.Methods From October 1,2011 to October 31,2013,210 cases of fetal abdominal cyst were detected by fetal ultrasound examination in Guangdong Women and Children Hospital.Systemic fetal ultrasonic examination was performed and the location,shape,size,internal echo,blood flow and adjacent organs and theire relationship with the abdominal cyst were observed.Then all cases were evaluated in consideration of clinical and genetic condition.Those who decided to continue the pregnancy should be monitored once every three to four weeks until delivery.If the cyst was huge (diameter ＞ 4 cm),of unknown nature,or became worse,cyst puncture would be offered.After born,the newborns were examined by ultrasound,and CT scan when needed.Surgery were recommended if there was any indication,and those who did not need surgery were followed up for every two to six months.The location,nature,ultrasonic features,clinical status and prognosis of fetal abdominal cyst were analyzed.Results Among the 210 cases of fetal abdominal cyst,20 (10％) were originated from liver and gallbladder,including ten with hepatic cyst,seven with choledochal cyst,two with biliary atresia,one with liver hamartoma.51(24％) cases were of gastrointestinal origin,including nine cases of meconium peritonitis,15 with duodenal obstruction,ten with small bowel obstruction,seven with imperforate anus,three with colon obstruction,two with huge mesenteric cyst and five with duplication of the intestine.42 (20％) cases were originated from kidney or adrenal area,including 19 with fetal renal cyst,five with isolated lungs under the diaphragm,three with neuroblastoma,one with adrenal teratoma,one with Wilms tumor and 13 with multicystic dysplasia kidney.There were 55 (26％) cases with urinary tract obstruction,including 34 with hydronephrosis,16 with ureterectasia and five with megabladder syndrome.There were 42 (20％) cases originated from reproductive system,and all were ovarian cysts in female fetuses.Among the 210 cases,the most common type observed were ovarian cysts,followed by hydronephrosis,renal cysts,ureterectasia and duodenal obstruction.Totally,22 cases (10％,22/210) received prenatal cyst puncture and drainage and no abortion or other complications were reported.Induced abortion was conducted in eight cases and autopsy reports were consistent with the ultrasonic diagnosis,including two of duodenal obstruction and one of imperforate anus (the three cases were all complicated with trisomy 21) and one of megabladder syndrome associated with trisomy 18.One case of biliary atresia,one of neuroblastoma,and two of megabladder syndrome were terminated upon maternal requirement.Totally,202 pregnancies (96％,202/210) were continued to delivery among which 201 babies survived except for one died after birth due to duodenal atresia.After birth operations were offered for 138 babies (69％,138/201) and no dead case was reported due to the operation.Conclusions Fetal abdominal cyst could be detected through prenatal ultrasound scan which is very important in predicting and evaluating pregnancy outcome,fetal development and afterbirth treatment and could provide valuable reference for clinical management and treatment.
