胎儿肺囊腺瘤畸形的产前超声诊断与分型

Prenatal diagnosis and typing of fetal cystic adenomatoid malformation of the lung by ultrasound

目的探讨胎儿肺囊腺瘤畸形(CAML)产前超声分型特征及临床价值。方法对41例产前超声诊断为肺囊腺瘤畸形胎儿的超声声像图表现进行回顾性分析并分型,41例均随访至引产或出生。结果 (1)肿瘤部位:41例胎儿肺囊腺瘤畸形发生在左侧22例,右侧15例,双侧4例。(2)产前超声分型诊断:Ⅰ型3例,Ⅱ型14例,Ⅲ型24例。(3)病理诊断:41例中32例引产,尸检病理诊断为肺囊腺瘤29例,3例隔离肺产前超声误诊为肺囊腺瘤Ⅲ型。(4)41例中9例随访至出生(3例肿块逐渐减小消失,6例出生后CT证实为肺囊腺瘤),产前超声分型与产后诊断均符合。(5)产前超声诊断胎儿肺囊腺瘤畸形与病理诊断和出生儿随访诊断符合率为92.7%(38/41),误诊率为7.3%(3/41)。结论胎儿肺囊腺瘤畸形产前超声诊断及分型诊断准确率高,是产前早期发现胎儿肺囊腺瘤畸形的首要检查方法,有重要的临床意义,但隔离肺易误诊为肺囊腺瘤Ⅲ型,应注意鉴别。

Objective To explore the clinical value and typing characteristic of prenatal ultrasonography for fetal cystic adenomatoid malformation of the lung（CAML）.Methods Ultrasonographic features and typing of fetal CAML in 41 cases detected by prenatal ultrasonography were analyzed retrospectively.All cases were followed up until to the induction of labor or birth.Results （1）Site of tumor： in the 41 cases,there were 22 cases on the left side,15 on the right side and 4 on bilateral.（2）Typing diagnosis of prenatal ultrasonography： three cases were CAML type Ⅰ,14 were type Ⅱ,and 24 cases were type Ⅲ.（3）Pathology diagnosis： thirty two cases were induced abortion.CAML was confirmed in 29 cases by autopsy and the classifications were consistent with the prenatal diagnosis of ultrasonography.Three pulmonary sequestration cases were prenatally misdiagnosed as CAML type Ⅲ by ultrasonography.（4）The other nine cases were followed up to birth.Three masses decreased gradually and then disappeared.Six newborns were confirmed as CAML by CT.Their typings were consistent with the postnatal diagnosis.（5）The diagnostic accuracy rate of prenatal ultrasonography for CAML was 92.7%（38/41）.Its misdiagnostic rate was 7.3%（3/41）.Conclusions Prenatal ultrasonography has a high accuracy rate for the diagnosis and classification of CAML and is the first choice to detect CAML early in pregnancy.It has an important clinical value.Pulmonary sequestration should be distinguished from CAML type Ⅲ because they tend to be confused.