胎儿肺囊性腺瘤样病变37例临床分析

Clinical analysis of 37 cases fetal congenital cystic adenomatoid malformation of the lung

目的:探讨胎儿肺囊性腺瘤样病变的诊断及预后。方法:近10年常规及系统超声产前筛查发现胎儿肺囊性腺瘤样病变37例,发现病灶后彩色多普勒探查内部血供情况,同时观察并记录有无胎儿水肿及浆膜腔积液等,建议孕妇48 h内行MRI检查,2～4周后复查超声,产后新生儿可行CT检查。结果:胎儿肺单个囊性病灶11例,多囊性病灶26例;左肺20例,右肺17例;超声发现囊性混合回声病灶6例;合并胸水2例,腹水及皮下水肿5例,唇裂1例,羊水过多8例,羊水过少1例;孕妇及家属要求引产14例,自然流产1例,16例随访病灶稳定、变小或消失,新生儿结局良好,6例失访。结论:产前超声及MRI检查可以发现胎儿肺部囊性腺瘤样病变并监测其变化,能够评估胎儿肺部囊性腺瘤样病变的预后。

Objective： To evaluate the diagnosis and outcome features of congenital cystic adenomatoid malformation of lung.Methods： 37 cases of congenital cystic adenomatoid malformation were founded during the last 10 years by fetal screening.Blood supply of the lesion,fetus hydrops and other extra-lung anomalies should be evaluated by color Doppler flow image when cystic lesions were detected.The fetus with cystic lesions in lung at the first time scanning should be monitored by ultrasound in every four weeks,six of them received magnetic resonance imaging（MRI） examination within 48 hours after ultrasound.Ultrasonography should be run back for two or four weeks.CT was used in neonate to diagnosis congenital cystic lung disease.Results： 11 cases with single cystic lesion,26 cases were multiple.Left lung was implicated in 20 cases,right lung was implicated in 17 cases.6 cases with cystic-solid mixture lesions,2 cases with hydrothorax,5 cases with ascites and edema,1 case with harelip,8 cases with polyhydramnios,1 case with oligohydramnios were founded by ultrasound.Lesions in 16 cases were smaller,disappeared,or remained stable in size with gestational age developing,who had normal neonate,14 cases were on induced labor,1 case was on spontaneous abortion,6 cases were lost to follow-up.Conclusion： Prenatal ultrasonography and MRI are very useful in detecting and monitoring cystic lesions of the fetal lung,evaluating features of congenital cystic adenomatoid malformation.