胎儿肺部病变产前超声表现与临床预后

Ultrasonographic diagnosis and clinical prognosis of fetal congenital diseases of the lung

目的探讨胎儿肺部病变超声声像图特征及临床预后与转归。方法对49例肺部病变胎儿的产前超声声像图特征及临床随访资料进行回顾性分析。结果 49例肺部病变胎儿产前超声表现及临床结局:(1)先天性肺囊腺瘤畸形21例(42.9%,21/49),超声表现为混合性回声内见多个大小不等的无回声区或增强回声团块。其中15例引产后病理证实为先天性肺囊腺瘤畸形,1例出生后新生儿死亡,5例于孕37周前肺部肿块消失。(2)隔离肺12例(24.5%,12/49),超声主要表现为胎儿胸腔内均质增强回声的楔形包块。其中3例引产后病理证实为隔离肺;3例于孕36周前肺部肿块消失;6例活产后经MRI或手术病理证实病灶仍存在。(3)先天性膈疝9例(18.4%,9/49),超声表现为胸腔内见腹腔脏器。其中7例引产(1例合并18-三体),1例出生后新生儿死亡,1例活产,产后手术存活。(4)胸腔积液5例(10.2%,5/49),超声表现为胸腔内无回声区,其中4例引产(分别合并有21-三体、胎儿水肿、Turner综合征、大量腹腔积液),1例于孕34周时胸腔积液消失。(5)肺缺如2例(4.1%,2/49),超声表现为肺叶缺失,其中左、右肺叶缺如各1例,均选择引产。结论超声检查是检出胎儿肺部病变的可靠方法,可从超声观察角度预测肺内病变胎儿的临床预后与转归;胎儿纵隔和心脏移位、胎儿水肿或合并染色体异常是终止妊娠的指征。

Objective To explore the diagnostic value of ultrasonography of fetal congenital disease of the lung,and to predict the prognosis according to ultrasonographic findings. Methods A total of 49 cases of fetal congenital disease of the lung were confirmed by odinopoeia or follow-up,and the data was retrospectively analyzed. Results Among the 49 fetuses of congenital lung disease,there were 21 cases （ 42. 9%,21/49） of congenital cystic adenomatoid malformation （ CCAM） ,12 cases （ 24. 5%,12/49） of pulmonary sequestration（ PS） ,9 cases （ 18. 4% ,9 /49） of congenital diaphragmatic hernia （ CDH） ,5 cases （ 10. 2%,5/49） of pleural effusion（ PE） ,and 2 cases （ 4. 1%,2/49） of pulmonary agenesis （ PA） . In ultrasonographic images,CCAM demonstrated mixed echoes with several different sizes of anechoic areas or enhanced echogenic masses in the fetal lung; PS demonstrated wedge-shaped mass of homogeneous enhanced echo in the fetal chest; CDH demonstrated the abdominal organs pushed into the chest cavity; PE demonstrated an echo-free zone in the intrathoracic; PA demonstrated the lobe missing. CCAM was pathologically confirmed in 15 fetuses after induced abortion,one neonatal died,but CCAM in other 5 fetuses disappeared before 37 weeks. PS was pathologically confirmed in 3 fetus after induced abortion,and was confirmed by MRI or pathologic examination in 6 live births,while PS in other 3 fetuses disappeared before 36 weeks. Among the 9 cases of CDH,7 fetuses were performed induced abortion（ one combined with Trisomy 18） ,one live birth was survived after post-natal surgery,and one neonatal died. 4 cases of the 5 PE fetuses were performed induced abortion（ combined with Trisomy 21,fetal hydrops,Turner＇s syndrome and peritoneal effusion respectively） ,while PE in the other one disappeared before 34 weeks. 2 cases of PA were performed induced abortion（ one without the left lung,and the other without the right lung） . Conclusions Ultrasound examination is a reliable method for the diagnosis of fetal congenital lung disease,and enable the prediction of clinical prognosis of the affected fetuses. If the fetus had heart and mediustinum displacement,hydrops or chromosomal abnormalities,termination should be considered.