胎儿脐膨出和腹裂的发生情况及胎儿结局比较

Comparison of incidence and fetus outcome between fetus exompholos and fetus gastroschisis

目的探讨并比较当前胎儿脐膨出和腹裂的发生情况及胎儿结局比较。方法对北京市海淀区妇幼保健院2005年1月1日至2008年12月31日期间20例诊断为胎儿脐膨出和腹裂的孕妇的临床资料进行回顾性分析。结果 (1)8例胎儿脐膨出,孕妇平均年龄32.60岁,12例胎儿腹裂,孕妇平均年龄29.4岁;胎儿脐膨出孕妇平均孕次2.2次,胎儿腹裂孕妇平均孕次3次,仅1例胎儿腹裂孕妇有1次自然流产史,其它无不良孕产史记录。在性别方面无差异,脐膨出发生率为1.8/万(8/44094),胎儿腹裂的发生率为2.7/万(12/44094)。(2)4例脐膨出伴发其它结构异常(50%),3例伴有心脏畸形,2例腹裂伴发其它结构异常(16.7%);1例脐膨出胎儿染色体检查异常(12.5%),无腹裂胎儿染色体检查异常。(3)脐膨出首次发现孕周为12～31周,腹裂首次发现孕周为14～37周,脐膨出产前B超诊断率100%,腹裂的诊断率为75%。3例诊断胎儿脐膨出时为死胎(37.5%),其中1例为围产儿死亡(12.5%),18例孕妇选择引产终止妊娠。结论脐膨出常伴有其他先天畸形及染色体异常,围产儿死亡率高。近年来胎儿腹裂的发生率高于脐膨出,由于腹裂胎儿预后好于脐膨出胎儿,应加强脐膨出与腹裂之间的B超鉴别诊断,从而降低围产儿死亡率。

Objective：To study the incidence and fetus outcome of fetus exompholos and fetus gastroschisis. Methods：Retrospective analysis the clinical data of fetus exompholos and fetus gastroschisis which were diagnosed from Jan,1,2005～Dec,31,2008 in Beijing Haidian District Maternal and Children Health Hospital. Results：The pregnant women average age of fetus exompholos and fetus gastroschisis are respectively 32.6 and 29.4 years old,the average gravidity are 2.2 and 3 times. Only 1woman of fetus gastroschisis has nature abortive history and no fetus gender difference.The incidence are respectively 0.018% and 0.027%,multiple malformations are respectively 4 cases （ 50%） （include 3 heart malformation） and 2 cases （ 16.7%）. 1case chromosome of fetus exompholos is abnormal. The diagnosed gestation are respectively 12～31 and 14～37 weeks. The prenatal diagnosis are respectively 100% and 75%. 3 fetus exompholos are stillbirth. The perinatal mortality of both are same （12.5%）. 18 women determine pregnancy by artificial labor. Conclusion：The incidence of fetus gastroschisis has been increasing in the recent years. To distinguish the fetus exompholos and the fetus gastroschisis by ultrasound screening is important as the prognosis of the latter is much better than the former. It can also decrease the perinatal motality.