胎儿先天性膈疝128例回顾分析

Fetal congenital diaphragmatic hernia 128 cases:A retrospective analysis

目的统计并分析胎儿先天性膈疝的转归及其影响因素。方法回顾性分析2015年1月至2019年12月西北妇女儿童医院产前检出膈疝的胎儿孕周、左右侧发病数量、肺头比、肝脏疝入病例数、合并畸形、是否娩出等情况。统计娩出后膈疝新生儿的合并畸形、孕周、出生体重、治疗方法及转归。结果36%的膈疝胎儿合并其他畸形,至少有55%(71/128)病例引产。肺头比<1.4的胎儿发现孕周早于≥1.4胎儿,合并畸形胎儿较非合并畸形胎儿发现孕周早,肝脏疝入胎儿发现孕周晚于肝脏未疝入胎儿。合并畸形与不合并畸形胎儿、肝脏疝入与肝脏未疝入2组胎儿肺头比大小差异无统计学意义。肝脏疝入胎儿容易合并其他畸形,左右侧发病合并畸形差异无统计学意义。娩出43例患儿,高危患儿7例,死亡4例。结论胎儿膈疝合并畸形的比例较高,孕期引产率高。单纯膈疝治愈率高。仅以肺头比大小、肝脏疝入与否评估胎儿预后需要继续完善。

Objective To analyze the outcome and its influencing factors of fetal congenital diaphragmatic hernia(FCHD).Methods To retrospectively analyze the data of fetal diaphragmatic hernia fetuses detected prenatal in Northwest Women and Children's Hospital from January 2015 to December 2019,including gestational age,number of left and right side,lung area to head circumference ratio(LHR),number of liver herniation cases,combined malformations and delivery.The combined malformations,gestational age,birth weight,treatment and outcome of neonates with diaphragmatic hernia after delivery were analyzed.Results 36%of FCHD had combined malformations,and at least 55%(71/128)cases were induced labor.The gestational age of the fetus with LHR<1.4 was earlier than those with LHR≥1.4.The gestational age of the fetus with combined malformations was earlier than those without combined malformations.The gestational age of the fetus with liver herniation is later than those without liver herniation.There was no statistically significant difference in LHR between fetuses with and without combined malformations,and fetuses with and without liver herniation,respectively.Liver herniation is more likely to be combined with other malformations in the fetus.There was no significant difference in the incidence of left and right sides with combined malformations.Of the 40 children delivered,there were seven at high risk and 4 cases of death.Conclusion Fetal diaphragmatic hernia has high proportion of combined malformations and high rate of induced labor.The cure rate of simple diaphragmatic hernia is high.The assess of fetal prognosis by the LHR and liver herniation should be further improved.