二维及三维超声在胎儿唇腭裂产前诊断中的应用

Application of two- and three-dimensional ultrasound in diagnosis of fetal cleft lip with or without cleft palate

目的总结胎儿唇裂及唇腭裂二维超声及三维超声声像图特征。方法应用二维超声及三维超声多种成像模式重建法对10268例胎儿行产前唇腭部超声筛查,并与引产或产后检查结果进行对照分析,总结胎儿唇腭裂超声声像图特征。结果 10268例胎儿经引产(9例)或胎儿自然分娩后(1例单胎,1例双胎)检查证实产前二维超声正确诊断唇腭裂畸形9例,三维超声正确诊断唇腭裂畸形10例。其中二维超声漏诊1例唇腭裂,三维超声诊断为Ⅲ度唇腭裂;二维及三维超声均漏诊1例Ⅰ度唇裂:二维超声无异常表现,三维超声表面成像模式显示胎儿唇红处可疑回声缺失,误诊为胎儿人中,胎儿自然分娩后证实新生儿为Ⅰ度唇裂。11例唇腭裂胎儿产前超声声像图表现:(1)单纯唇裂3例,超声声像图示一侧或双侧上唇部连续性中断,回声缺失;(2)唇腭裂合并牙槽突裂7例,腭部连续性中断,回声缺失。(3)三维超声表面成像及断层成像(TUI)模式可直观、立体显示胎儿唇裂类型,诊断唇裂3例,唇腭裂7例;骨骼成像及TUI模式显示牙槽突至鼻切迹处的上颌体不连续回声图像,旋转X轴连贯显示硬腭的连续性中断。(4)唇腭裂合并其他畸形3例,其中唇腭裂合并足外翻和眼距宽1例、心脏畸形1例,手畸形1例。结论建立在二维超声基础上的三维超声重建丰富了二维超声影像信息,二维及三维超声联合检查可提高唇裂及唇腭裂产前超声诊断准确性,减少漏误诊。

Objective To summarize the features of fetal cleft lip with or without cleft palate with two-dimensional( 2D) and three-dimensional( 3D) ultrasonography scanning. Methods Retrospective analysis of three planes of verticality of two-dimensional ultrasonography and reconstruction of three-dimensional ultrasonography of 10 268 cases of fetal lip and palate were examined in our hospital,and sonographic characteristics of fetal cleft lip and palate examination results were compared with the postpartum diagnosis or pregnancy termination. Results Nine cases of fetal cleft lip with or without cleft palate were diagnosed by 2D ultrasound while 10 cases of fetal cleft lip with or without cleft palate were diagnosed by 3D ultrasound in 10 268 cases; 8 cases were unilateral,2 cases were bilateral( 3 cases of cleft lip,Ⅱ degree,7 cases of cleft lip with cleft palate,Ⅲ degree) . One case of Ⅲ degree cleft lip with cleft palate,cleft palate was misdiagnosed by 2D ultrasound; 1 case of Ⅰdegree cleft lip was misdiagnosed by 2D ultrasound,3D ultrasound surface mode displayed suspicious vermilion echo loss,misdiagnosed as normal fetal,cleft lip was diagnosed in newborn,which was validated by postpartum observation( 9 cases after the induction of labor and 2 cases of postpartum) . Ultrasonography manifestations of eleven cases of cleft lip with or without palate: ( 1) Two- dimensional ultrasonographic features: 3 cases of cleft lip,simple or bilateral upper lip discontinuity,echo loss; 7 cases of cleft lip and palate,alveolar process discontinuity,echo loss. ( 2 ) Three-dimensional ultrasonographic features: Surface imaging and TUI model were intuitive,stereoscopic imaging displayed cleft lip type; bone imaging and TUI mode displayed the body of maxilla from alveolar to nasal incisures discontinuity,echo loss,the X axis rotation coherence showed discontinuity of the palate in 3 cases of cleft lip and 7 cases of cleft lip and palate. ( 3) Three cases of cleft lip and palate combined with other organ malformations( 1 cases of wide distance between the eyes and strephexopodia; 1 cases of cardiac malformation; 1 cases of hand deformities) . Conclusion Three-dimensional ultrasound reconstruction based on two-dimensional ultrasound,it enriches the two-dimensional ultrasound imaging information,application of two and three-dimensional ultrasound in the diagnosis of fetal cleft lip with or without cleft palate can improve the diagnostic accuracy and reduce missed diagnosis or misdiagnosis.