经产前超声诊断先天性畸形的外科干预

Surgical Intervention in Congenital Malformation Diagnosed by Prenatal Ultrasound

目的探讨先天性畸形产前超声诊断与小儿外科干预措施的价值。方法总结我院近3年收治25例先天性畸形的超声检查与临床资料。畸形包括消化道9例(36%),泌尿系7例(28%),腹壁4例(16%)和其它系统5例(20%)。结果本组25例中24例经手术或产后超声证实了产前诊断,特异性为96%。1例终止妊娠;16例经手术(急诊手术11例)治疗的患儿中13例治愈,2例因合并其他畸形家长放弃治疗,1例死亡;药物注射治愈胸壁淋巴管瘤1例;7例泌尿系畸形均在随诊观察中。结论超声检查是诊断宫内先天性畸形的首选和重要手段。我国先天性畸形产前诊断的水平及范围还很不平衡,本组诊断水平较高与地域有关。多数畸形适于早期手术治疗,而大部分泌尿系畸形需随诊观察。小儿外科医师应积极参与先天性畸形的产前诊断和围产期管理,使患儿得到及时、妥当的治疗,可进一步提高先天性畸形的诊治水平。

Objective To evaluate the prenatal ultrasound diagnosis and surgical intervention of congenital malformation. Methods 25 cases of congenital malformation were treated in our hospital in the last three years. The malformations were including the digestive tract 9(36%),urological 7(28%) systems,abdominal wall 4(16%) and other 5(20%). Results Out of the 25 cases,24 prenatal diagnosis were confirmed by operation and/or ultrasound after birth. The specificity was 96%. Abortion in 1 case. In the 16 cases were operated including 11 cases emergent operation, 13 cases recovered. 2 cases treatment were refused by parents because of the combined malformation, 1 case died. 1 case of lymphangioma of chest wall was successfully cured by injection of medication,and 7 cases of urological problem are all in observation. Conclusions ①Ultrasound is the first and important choice method of the prenatal diagnosis in the congenital malformation. ② The level and the diseases of prenatal diagnosis by ultrasound is different. The rather high diagnostic level of this group is related to capital region,where have medical superiority.③ Most malformations can be cured early by surgery. Many of the urological malformations need observation after birth. ④ More active intervention is necessary for pediatric surgeons in the prenatal ultrasound diagnosis and the perinatal management(method of delivery, plan and the perinata management (method of delivery, plan of treatment and counsel with parents ) for the improvement of the diagnosis and treatment in the congenital malformation.