规范产前超声检查诊断胎儿手缺失的价值

Value of standard prenatal ultrasound diagnosis for absent fetal hand

目的探讨连续顺序追踪超声法在产前胎儿手缺失筛查中的应用价值。方法采用连续顺序追踪超声法(SCSA)对51720例孕妇分4个阶段(孕11～14周、18～24周、25～32周、33～40周)进行规范化产前超声检查,以18～24周、25～32周作为常规检查肢体的两个重要时期。每一孕周超声筛查时均逐一观察胎儿四肢肢体形态、结构、姿势、运动情况,重点观察有无胎手、胎手形态、姿势。结果 51720例孕妇中胎儿肢体异常62例,共9种畸形,其中前臂缺失1例,双侧股骨不等长2例,下肢小腿缺如2例,手缺失7例,肢体姿势异常8例,桡骨缺如9例,足内翻10例,四肢短小畸形11例,多(少、并)指﹑趾12例;其中21例合并其他系统异常(神经系统、泌尿系统及心脏等)。产前超声检出肢体异常51例(82.26%,51/62),漏诊11例肢体异常(17.74%,11/62)。7例手缺失胎儿仅2例合并其他系统畸形(双侧多囊肾1例,右侧脑室稍宽12mm1例),出生(1例)或引产(6例)后证实产前超声诊断7例手缺失均与产后诊断符合(7/7)。结论分阶段、规范化连续顺序追踪超声检查是有效提高胎儿手缺失检出率的重要影像学方法。

Objective To evaluate the efficacy of standardized prenatal ultrasound screening used in diagnosis of absent fetal hand. Methods A total of 51 720 pregnant women received the standardized ultrasound screening and color dopplor uhrasonography. The continuous sequence approach （SCSA） of ultrasound was used to observe the morphology posture, structure and movement of fetal limbs, especially the themorphology posture and the status of hands. The patients were screened in four stages （l 1 to 14 weeks, 18 to 24 weeks, 25 to 32 weeks, 33 to 40 weeks）. 18-24 weeks and 25-32 weeks were two important periods. Results Sixty-two cases were detected with fetal limb deformity, and they can be divided into nine kinds： 1 case of absent forearm, 2 cases of different length of bilateral femoral, 2 cases of absent leg, 7 cases of absent hand, 8 cases of pairs of limb posture abnormalities, 9 cases of radial deficiency, 10 cases of varus foot, 11 cases of short limbs deformity, and 12 cases of multiple fingers（toes）. 21 of the 62 cases were complicated with other malformations,which were confirmed by postnatal operation. 51 cases were detected with fetal limb deformity by prenatal ultrasound exzamination （82.26%, 51/62 ）, and 11 cases were missed （17.74%, 11/62）. Only 2 of 7 hand-absent cases combined with other malformations （1 bilateral tetal polyeystic kidney disease, 1 ventricle slightly wider 12 ram）. All 7 hand-absent cases were confirmed by postnatal examination（7/7）. Conclusion The standard prenatal ultrasound diagnosis for absent fetal hand is an important diagnostic imaging method.