胎儿唇腭部的产前超声研究

Study of ultrasonic imaging of fetal midface anatomy and prenatal diagnosis of cleft lip and palate

目的探讨与胎儿唇腭裂有关解剖结构显示的重要超声切面及先天性唇腭裂畸形的产前诊断。方法将13例颜面部正常的引产畸形胎儿标本置于水盆内,采用冠状切面、横切面、矢状切面、经口裂斜冠切面及经颏下三角斜冠状切面直接扫查。用相同的超声切面对1524例胎儿的颜面部进行扫查。胎儿唇腭裂的诊断采用敏感性、特异性、假阳性率和假阴性率进行评价。结果①离体胎儿标本:超声扫查显示与唇腭裂相关的重要解剖结构主要为胎儿鼻、上唇、上颌牙槽突、继发腭的融合线、硬腭及软腭。②宫内胎儿:冠状切面上胎儿鼻与上唇显示率为96%,横切面上上唇与上颌牙槽突显示率为95%,矢状切面上继发腭的融合线显示率为23%,经口裂斜冠状切面硬软腭显示率为66%,经颏下三角腭部显示率仅为5%。在该组病例中,胎儿唇腭裂31例,产前超声检出28例,敏感性为90.32%,特异性为99.93%,假阳性率为0.07%,假阴性率为9.68%。腭裂的产前超声检出敏感性为95.00%,特异性为99.93%,假阳性率为0.07%,假阴性率为5.00%。结论对于胎儿唇腭裂畸形的产前超声诊断,冠状切面、横切面及经口裂斜冠状切面是三个最重要的切面,而矢状切面及经颏下三角切面仅作为补充。

Objective To find out important ultrasonic section which can visualize fetal midface anatomy related to cleft lip and palate through experiment of in vitro specimens with ultrasound so as to make out a detailed prenatal diagnosis of fetal cleft lip and palate by using the important ultrasonic section. Methods Putting 13 cases induced malformed fetuses with normal face under the water in a basin and examining the midface structures directly in the coronal, sagittal, axial, transoralrima oblique coronal and transsubmental triangle oblique coronal planes with ultrasound. There were 1524 cases fetuses scanned in the same plane in attemp to identify the same anatomic landmarks identified in the fetal specimens. The value of cleft lip and palate diagnosis were evaluated with sensitivity, specificity, false positive rate and false negative rate. Results ①In vitro specimens the important anatomic structures related to cleft lip and palate were fetal nose, upper lip, alveolar ridge of the maxilla, the fusion line of the secondary palate, hard palate and soft palate. ②In utero fetuses, the visualized rate of fetal nose and upper lip achieved in the coronal plane was 96%. In the axial plane, the visualized rate of the upper lip and alveolar ridge of the maxilla was 95%. In the sagittal plane, the visualized rate of the fusion line of the secondary palate was 23%. And in the transoralrima oblique coronal plane, the visualized rate of the hard palate and soft palate was 66%. It was 5% in the transsubmental triangle oblique coronal plane. In this group,there were 31 cases of fetal cleft lip and palate, 28 cases were detected out by ultrasound prenatally. Its sensitivity was 90.32%, specificity 99.93% ,false positive rate 0.07%, false negative rate 9.68%. Meanwhile, the sensitivity of cleft palate detected before birth with ultrasound was 95.00%, specificity 99.93%, false positive rate 0.07%, false negative rate 5.00%. Conclusions Coronal, axial and transoralrima oblique coronal plane were the most three important sections in the prenatal ultrasonic diagnosis of fetal cleft lip and palate,but the sagittal and transsubmental triangle oblique coronal plane were only complemental ones.