“三步节段法”产前超声诊断胎儿内脏异位综合征

Three-step segmental approach for prenatal ultrasonography in diagnosis of fetal heterotaxy syndrome

目的探讨产前超声"三步节段法"对诊断胎儿内脏异位综合征的临床价值。方法在40 884胎产前超声检查中采用"三步节段法",胎龄14～38周,平均(27.4±6.5)周;孕妇年龄20～33岁,平均(23.6±4.3)岁。11胎诊断为内脏异位综合征,将其产前超声表现与引产后解剖学所见进行对比分析。结果 11胎内脏异位综合征胎儿中,左异构3胎,右异构8胎;10胎引产后经尸体解剖证实。内脏异位综合征的主要产前超声表现包括内脏心脏异位,下腔静脉离断伴奇静脉异位引流或下腔静脉紧靠腹主动脉和心脏畸形。结论产前超声是诊断胎儿内脏异位综合征有效可行的方法。采用产前超声"三步节段法"全面有序扫查获得主要超声征象可减少漏诊。

Objective To explore the clinical value of fetal ultrasonography in prenatal diagnosis of heterotaxy syndrome.Methods Three-step segmental approach prenatal ultrasound was performed in 40 884 fetuses.The maternal age ranged 20—33（mean 23.6±4.3） years,and the gestational age was 14—38（mean 27.4±6.5） weeks.Eleven fetuses were diagnosed as heterotaxy syndrome,their ultrasonographic manifestations were comparatively analyzed with postpartum autopsy findings.Results Of 11 fetuses,there were 8 fetuses with right isomerism（RI） and 3 fetuses with left isomerism（LI）.Ten fetuses of heterotaxy syndrome were confirmed by postpartum autopsy after induced abortion.Important ultrasonographic markers of heterotaxy syndrome included viscero-cardiac heterotaxy,interruption of inferior vena cava with azygous continuation or juxtaposition of inferior vena cava and abdominal aorta,as well as cardiac malformations.Conclusion Prenatal ultrasound in diagnosis of heterotaxy syndrome is feasible.Three-step segmental approach prenatal ultrasound can obtain comprehensively and orderly important ultrasonic signs of heterotaxy syndrome,therefore reducing misdiagnosis.