胎儿胆囊异常的产前超声诊断及意义

Diagnosis and clinical evaluation of gallbladder anomalies by prenatal ultrasound screening

目的探讨胎儿胆囊异常产前超声图像特征及胆囊异常的临床意义。方法对2004年1月至2011年3月中孕期来我院行系统超声检查诊断为胆囊异常的520例胎儿随访至出生后1个月至1年,并将胎儿出生后随访结果与产前超声图像特征、染色体检查结果及临床结局进行总结分析。结果 (1)520例产前超声显示胆囊异常胎儿中胆囊增大123例,胆囊不显示393例,胆囊内异常回声4例。其中4例行胎儿染色体检查,3例染色体检查结果正常,1例合并心脏严重畸形胎儿染色体检查结果为18-三体。(2)产后发现8例胆道闭锁,其中5例在产前超声表现为胎儿胆囊不显示,1例胆囊明显增大,2例胆囊正常。(3)胆囊内异常回声4例,其中3例产前超声复查或产后超声检查胆囊内异常回声消失,1例出生后10个月未复查,但无任何临床表现。结论产前超声诊断胆道闭锁较困难。胆道闭锁产前超声可表现为胆囊不显示、胆囊增大,也可表现为胆囊正常。孤立性胎儿胆囊增大和孤立性胎儿胆囊不显示不增加非整倍体的风险,合并其他结构异常时是否建议行胎儿染色体检查视合并畸形而定。胆囊内异常回声预后良好,可于产前或产后自然消失。

Objective To study the diagnosis and clinical evaluation of gallbladder anomalies by prenatal ultrasound screening.Methods Retrospectively analyse the prenatal ultrasonographic features,clinical management and outcomes of 520 fetuses with gallbladder anomalies were performed detailed antenatal ultrasound examination from January 2004 to March 2011.All fetuses were followed up ranging from 1 month to 1 year.Comparative analysis among the outcome of followed-up and prenatal diagnosis,clinical management was carried out.Results A total of 520 fetuses with gallbladder ultasonographic anomalies were detected,including 123 cases with cholecystomegaly,393 cases with non-visualized fetal gallbladder and 4 cases with echogenic materials in fetal gallbladder.Only 4 cases were performed fetal karyotype analysis.Three of four were normal and the rest one was trisomy 18.Eight fetuses with biliary atresia were diagnosed postnatally.In prenatal scanning,5 of 8 had non-visualized fetal gallbladder,one had cholecystomegaly,and 2 had normal gallbladder.Four cases with echogenic material in fetal gallbladder,but three of them disappeared antenatally or postnatally.The rest one hasn＇t been performed ultrasonography after birth and the baby was asymptomatic during the time of following up to 10 months.Conclusions It is difficult to diagnose biliary atresia prenatally.Babies with biliary atresia may demonstrated as non-visualized gallbladder or cholecystomegaly or a normal gallbladder.Isolated non-visualized gallbladder or cholecystomegaly does not seem to increase the risk of biliary atresia.Amniocentesis should be preformed when gallbladder anomaly associated with other serious abnormalities.Fetuses with echogenic materials in gallbladder have a benign prognosis,as it maybe naturally disappear antenatally or postnatally.