超声诊断胎儿畸形的处理及预后分析

Management and outcomes of fetal abnormality diagnosed by prenatal ultrasound

目的探讨产前超声诊断的不同种类胎儿畸形的处理和预后分析。方法总结124例产前超声检查时诊断的畸形胎儿的处理和追踪结果。结果（1）124例畸形胎儿中76例选择引产，其中有7例为染色体异常（2例13-三体，1例21-三体，1例45XO，3例18-三体）。（2）48例非致死性畸形在知情同意前提下选择继续妊娠。1例12指肠闭锁胎儿发生胎死宫内，1例重度膈疝胎儿生后当天死亡。18例胎儿生后手术治疗，16例健康存活，2例术后死亡。28例生后动态观察追踪，8例泌尿系统异常恢复正常；6例尚在观察中；3例卵巢囊肿生后2个月消失且健康存活；5例轻度脑室扩张者2例生后追踪未见异常，2例发展为少见的异常综合征，1例尚在追踪观察中；5例先心病患儿3例新生儿期死亡，2例等待手术；1例胸腹腔积液胎儿生后追踪至2年完全健康。结论非致死性胎儿畸形和异常在知情同意的前提下与儿科合作，针对异常情况可以通过手术或密切观察得到良好的结局。

Objective To investigate the management options and prognosis of fetal abnormalities diagnosed by prenatal ultrasound. Methods The outcomes of 124 cases with fetal abnormality diagnosed by ultrasound prenatally were studied and followed up. Results Among the 124 fetuses, 76 were induced, in which 7 with chromosomal abnormality. The rest 48 fetuses were delivered with informed consent. Eighteen newborns underwent surgery in Pediatrics and 16 recovered. But 2 died after operation. One baby with severe diaphram hernia died after birth. Twenty-eight newborns were followed up after birth and 8 were found with urinary system abnormallty and 3 with ovarlan cyst, but all recovered completely. Ventricular dilatation diminished in 2 cases with mild lateral ventriculomegaly. Another two babies with ventricular dilatation were diagnosed as other problems in Peadiatics. Conclusion Many non-lethal abnormal fetuses without chromosomal abnormality may recover after birth and some abnormalities can involute with time.