胎儿先天性肺腺瘤样囊肿的超声诊断与临床预后

Ultrasonographic diagnosis and clinical prognosis of fetal congenital cystic adenomatoid malformation of the lung

目的探讨胎儿先天性肺腺瘤样囊肿(CCAM)的超声表现,预测CCAM胎儿的预后与转归情况。方法应用二维超声于胎儿胸腔多切面扫查,观察肺部肿块发生的位置、形态、大小;随访CCAM的大小、声像图变化及是否出现合并症。结果产前诊断19胎CCAM,13胎引产后病理证实,1胎出生后死亡,5胎于36周前肺部肿块消失。肺部病灶声像图变化特点:Ⅰ型囊性肿块逐渐缩小,直至消失;Ⅱ型囊性部分渐渐变小,数目减少,强回声部分逐渐变浅变淡直至与正常肺组织回声相同;Ⅲ型实质性肿块由强回声逐渐变浅变淡直至与正常肺组织回声近似,或由Ⅲ型逐渐演变为Ⅱ型然后随孕周增加恢复为正常肺组织回声。随访中10胎(10/19,52.63%)CCAM随孕周增加而增大,出现心脏、纵隔移位、胸腹腔积液和(或)胎儿水肿等并发症。结论超声检查是诊断胎儿CCAM的可靠方法;可从超声观察角度预测CCAM胎儿的预后与转归;胎儿纵隔、心脏移位、胸腔积液、胎儿水肿或合并其他发育异常是终止妊娠的指征。

Objective To explore the diagnostic value of ultrasonography of fetal congenital cystic adenomatoid malformation of the lung （CCAM）, and to predict the prognosis according to ultrasonographic findings. Methods The chest of 19 fetus with CCAM was multi-sectionally scanned with two-dimensional ultrasonography. The position, appearance and size of mass were observed, and complications were continuously followed. Results CCAM was pathologically confirmed in 13 fetus after induced abortion. One neonatal died, while CCAM in other 5 fetus disappeared before 36 weeks. The mass of type Ⅰ CCAM became smaller and smaller, and eventually disappeared. The echo-free spaces in type Ⅱ became smaller and fewer, and the strong echo weakened to the same level as normal lung. For type Ⅲ, the echo of solid mass weakened to the same level as normal lung, or transformed to type Ⅱ gradually, and finally recovered to normal echo of lung as the gestational age increased. During follow up, there were 10 fetus （10/19, 52. 63%） that lung adenoma cyst increased with the gestational age increased, and the heart, mediastinal shifted, pleural effusion, and （or） fetal edema were observed. Conclusion Ultrasound examination is a reliable method for the diagnosis of CCAM, and enable to predict the prognosis of the affected fetuses. If heart and mediustinum displacement, pleural effusion, hydrops fetal or other abnormalities exist, it＇s necessary to terminate the pregnancy.