临床病理解剖检查在先天畸形胎儿及死胎病因诊断中的意义

Diagnostic Value of Clinical Pathological Anatomical Examination on Causes of Congenital Fetal Malformation and Death

【目的】探讨临床病理解剖检查在妊娠结局不良胎儿病因诊断中的意义。【方法】由临床医学和临床病理医师分别对203例异常妊娠胎儿进行临床诊断与临床病理学诊断,对比其诊断结果的差异。【结果】①胎儿畸形的诊断:临床诊断检出率34.5%(70/203例),神经系统畸形(17例)、多发畸形及泌尿系统畸形(各11例)、腹裂畸形及胎儿胸腹水(各5例)等占前三位;临床病理诊断检出率48.3%(98/203例),多发畸形(33例)、神经系统畸形(17例)、泌尿系统畸形(11例)占前三位。临床病理诊断的检出率明显高于临床诊断(P<0.01),尤其对多发畸形的诊断优势最明显。②死胎原因诊断:临床诊断死胎病因者为35%(41/117例),母体疾病(16例)、宫内缺氧(14例)、宫内感染(4例)和胎儿畸形(4例)等占前三位;原因不明者为64.9%(76/117例);临床病理诊断死胎病因者为80.3%(94/117例),胎儿畸形(28例)、宫内缺氧(26例)、宫内感染(20例)等占前三位;原因不明者为19.6%(23/117例)。临床病理诊断对死胎病因的检出率明显高于临床诊断(P<0.01)。【结论】临床病理检查是提高胎儿畸形检出率及明确死胎病因的有效手段,与临床诊断联合应用,诊断价值更大。

[Objective] To investigate the diagnostic value of clinical pathological anatomical examination on causes of fetus with adverse outcomes. [Methods] The clinical and pathological diagnosis of 203 cases of abnormal pregnant fetus were made separately by clinical doctors and the pathology experts, and the difference between two diagnostic results was compared. [Results] ① Diagnosis on congenital fetus： Of 34.5% （70/203） cases with congenital malformation scanned out by clinical diagnosis, the top three malformations were nervous system malformations in 17 cases, multiple defect or urinary system malformation in 22 cases, gastroschisis malformation, pleural fluid or ascites in each 5 cases. Meantime, about 48.3% （98/203）cases with congenital fetus malformation were picked out by clinical pathological diagnosis, which were ranked into 33 cases with multiple defects, 17 cases with nervous system malformation, and 11 cases with urinary system malformation. The rate of diagnosis on congenital fetus malformation by clinical and pathological method was remarkably higher than that of diagnosis only by clinical method, especially on fetus with multiple defect （ P 〈0.01 ）. ② Diagnosis on causes of fetal death： About 35 % （41/117） cases with fetal death whose death cause was found by clinical diagnosis, including to maternal disease in 16 cases, intrauterine anoxia in 14 cases, intrauterine infection in 4 cases, congenital fetal malformation and umbilical cord abnormality in each 3 cases. The causes of about 64.9%（76/117） cases with fetal death remained unknown. However, there were about 80.4%（94/117） cases with fetal death whose causes were found by clinical and pathological methods, including congenital fetal malformation in 28 cases, intrauterine anoxia in 26 cases, intrauterine infection in 20 cases. The cause of about 19.6%（23/117） cases with fetal death was unknown. The rate of diagnosis on the causes of fetal death by clinical pathological method was remarkable difference to that by clinical method（ P〈0.01）. [Conclusion] Clinical pathological anatomical examination is a useful tool to diagnosis of congenital fetal malformation and causes of fetal death. Clinical pathological method combining with clinical method may have more diagnostic value.