产前超声检查诊断胎儿颅脑积液的临床研究

Clinical study on fetal encephalic fluid

目的探讨产前超声检查诊断胎儿颅脑积液的变化及其临床意义。方法对2004年7月至2005年6月在我院就诊的妊娠20周以上的8426例孕妇行常规产前超声检查,发现胎儿颅脑积液超过5 mm 者纳入研究对象。对纳入研究的孕妇每2周1次行动态超声检查胎儿颅脑积液变化和其他异常情况,直至足月分娩,记录围产儿结局并定期随访。结果 8426例孕妇中,共有150例胎儿发生颅脑积液,发生率为1.8%。其中单侧侧脑室前角或后角积液72例,颅后窝积液46例,2个以上脑室积液32例。发现颅脑积液的最早孕周为17周(2例,外院转入),最迟为40周(1例),平均为(26±5)周。胎儿颅脑积液主要发生在孕29～32周[63例,42.0%(63/150)],胎儿颅脑积液量最多也发生在孕29～32周[70例,46.7%(70/150)]。孕期胎儿颅脑积液自行消退111例(74.0%,111/150),积液开始消退的孕周为29～40周,平均(36±2)周,以孕29～32周和33～36周为消退最多的两个时段。颅脑积液最大积液量<10 mm 者26例,10～14 mm者78例,≥15 mm 46例,其不良围产结局发生率分别是3.8%(1/26),10.2%(8/78)和67.4%(31/46);2个以上脑室积液者不良围产结局的发生率为60.0%。结论胎儿颅脑积液主要发生在孕29～32周,同时也是积液量高峰时期。积液量≥15 mm,或2个以上脑室积液者,其不良围产结局的发生率高,应引起高度重视。对单部位胎儿颅脑积液、积液量<15 mm 者可进行定期随访与观察。

Objective To discuss the clinical significance of fetal encephalic accumulated fluid revealed by prenatal ultrasonography. Methods Prenatal ultrasonography was performed on 8426 women at more than 20 weeks＇ gestation. Totally 150 women with fetal encephalic accumulated fluid more than 5 mm were included in this study. The changes of fetal encephalic accumulated fluid and the associated anomalies were observed regularly every 2 weeks until delivery. The live infants were followed up regularly. Results The incidence of fetal encephalic fluid was 1.8%, including 72 cases with fluid in the fetal anterior or posterior cornu of unilateral ventricle,46 cases with accumulated fluid in fetal posterior fossa, 32 cases with fluid in more than 2 sites. Generally, the accumulated fluid in fetal encephalus was first diagnosed at 17 -40 gestational weeks, with a median of （26 ± 5） weeks. Most of them were found between 29 - 32 gestational weeks（63 cases,42. 0% ）,and the maximum amount of accumulated fluid was also found between 29 -32 weeks（70 cases, 46.7% ）. Spontaneous regression of intracrauial fluid could be seen in 111 fetuses （74. 0% ）. The period of fluid regression ranged from 29 to 40 weeks of gestation, of which the average gestational week was （36 ± 2） weeks. Additionally, the most frequent period of regression was in the first two thirds of the three trimesters of pregnancy. The incidence of defected infants was 3. 8%, 10. 2% and 67.4%, respectively, when the amount of accumulated fluid was less than 10 mm,10 - 14 mm and more than 15 mm. And the accumulated fluid in more than 2 sites was also a risk factor of defected fetuses, with an incidence of 60. 0%. Conclusions Most cases could be diagnosed between 29 - 32 gestational weeks, and the maximum amount of accumulated fluid is also observed in this period. The more fluid in fetal encephalus,the more sites the fluid distributed in,the more defected fetuses or infants would be observed. So in cases of more than 15 mm of fluid, or accumulated fluid in more than 2 sites, anomalies should be observed extremely carefully.