胎儿下腔静脉离断的超声诊断分析

Analysis on Ultrasound Diagnosis of Interruption of Inferior Vena Cava in Fetus

[目的]探讨产前超声诊断胎儿下腔静脉离断的价值。[方法]对2007年3月至2012年12月在本院产前超声系统筛查201069例孕妇，诊断胎儿下腔静脉离断34例的声像图特征及漏诊原因进行分析。[结果]胎儿下腔静脉离断诊断率为0．17‰，34例中内脏异位综合征11例（其中左侧异构9例，右侧异构2例），完全性内脏反位2例；合并心脏畸形18例（房室间隔缺损4例，法洛四联症3例，永存动脉干3例，左上腔静脉3例，右室双出口1例，房室间隔缺损＋肺静脉异位引流1例，法洛四联症＋左上腔静脉1例，永存动脉干＋肺静脉异位引流1例，右室双出口＋肺静脉异位引流1例）；漏诊3例，2例在孕23、24周筛查时漏诊，孕32周复查时检出；1例出生后诊断，随访至今5年余，患儿生长发育正常，无异常临床表现。[结论]上下腔静脉长轴切面、胸腹部斜冠状切面、四腔心切面及上腹部横切面是筛查胎儿下腔静脉离断的重要切面，对产前超声诊断胎儿下腔静脉离断具有重要的临床价值。

[Objective]To explore the value of prenatal ultrasound diagnosis of interruption of inferior vena cava .[Methods] A total of 201069 pregnant women in our hospital from March 2007 to Dec .2012 were screened by prenatal ultrasonic system .The characteristics of sonogram and the causes of the missed diagnosis of 34 fetuses diagnosed as interruption of inferior vena cava were analyzed .[Results]The diagnostic rate of in-terruption of inferior vena cava in fetuses was 0 .17% .Among 34 patients ,11 patients were heterotaxy syn-drome（9 left isomerism and 2 right isomerism） ,and 2 patients were complete situs inversus viscerum ,and 18 patients were combined with cardiac deformity （4 atrioventricular septal defect ,3 tetralogy of fallot ,3 persis-tent truncus arteriosus ,3 persistent left superior vena cava ,1 double outlet right ventricle ,1 complete atrio-ventricular septal defect and anomalous pulmonary venous connection ,1 tetralogy of fallot and persistent left superior vena cava ,1 persistent truncus arteriosus and anomalous pulmonary venous connection ,1 double out-let right ventricle and anomalous pulmonary venous connection） ,and 3 patients were undetected in which 2 pa-tients were undetected at 23~24 weeks but detected at 32 weeks ,and 1 patient was diagnosed after birth . During the follow up for 5 years ,the growth and development of patients were normal without abnormal clini-cal manifestations .[Conclusion] The upper and inferior vena cava long axis view ,thoracic-abdominal oblique coronary view ,four-chamber view and upper abdominal transverse view are vital for the diagnosis of interrup-tion of inferior vena cava in fetus .Prenatal ultrasound diagnosis of interruption of inferior vena cava is of im-portant value in clinical practice .