产前超声诊断胎儿颅后窝积液的临床意义

Study on clinical significance of fetal posterior fossa fluid

目的 探讨产前超声诊断胎儿颅后窝积液的临床意义。方法 对 2 0 0 0年 1月至 2 0 0 1年 1月在我院就诊的妊娠 2 0周以上的 5 40 0例孕妇行常规产前超声检查 ,发现胎儿颅后窝积液超过5mm者纳入研究对象 ,共 1 1 0例。每 2～ 3周动态观察这 1 1 0例胎儿颅后窝积液的变化及其他异常情况 ,直至足月分娩 ,并对新生儿行出生后随访。结果 胎儿颅后窝积液的发生率为 2 0 % ,首次发现颅后窝积液的孕周最早为 2 2周 ,最迟为 41周 ,平均 (31± 4)周 ;颅后窝积液以妊娠 2 9～ 32周最多见(42例 ,占 38 2 % ) ,积液量最多也在孕 2 9～ 32周 (39例 ,占 35 5 % ) ;颅后窝积液量 6～ 2 6mm ,平均(1 1± 3)mm ,其中 1 0～ 1 4mm者最多 (79例 ,占 71 8% ) ;颅后窝积液在 <1 0mm ,1 0～ 1 4mm和≥ 1 5mm3种情况时 ,其不良围产儿的发生率分别为 4 0 %、7 6 %和 83 3 %。结论 (1 )胎儿颅后窝积液于孕2 9～ 32周最易发现 ,且积液量最多。 (2 )积液量越多 ,不良围产儿的发生率越高。建议对胎儿颅后窝积液量大于 1 0mm者严密随访 ,凡大于 1 5mm者 ,胎儿异常的可能性大 ,需引起高度重视。

Objective To discuss the clinical significance of accumulated fluid in fetal posterior fossa Methods Prenatal ultrasonography examination was performed on 5 400 woman at more than 20 weeks gestation, 110 women with fetus accumulated fluid in the posterior fossa more than 5mm were included in this study The changes of accumulated fluid in fetal posterior fossa and the associated intracranial and extracranial anomalies were observed regularly every 2 or 3 weeks until delivery The infants were also followed up Results The incidence of the fetal posterior fossa fluid was 2 0% Generally, the accumulated fluid in fetal posterior fossa was diagnosed at first time at 22～41 gestation weeks, median was (31±4) weeks Most of them were be found between 29～32 weeks (42 cases, 38 2%), and the maximum amount of accumulated fluid in fetal posterior fossa was also in 29～ 32 gestation weeks (39 cases, 35 5%) The amount of accumulated fluid was from 6 mm to 26 mm, mean (11± 3) mm, mostly between 10～14 mm (79 cases, 71 8%) The incidence of defected infants was 4 0%, 7 6% and 83 3% respectively, when the posterior fossa fluid was less than 10 mm, 10～14 mm and more than 15 mm Conclusion Most of cases could be diagnosed between 29～32 weeks gestation The more fluid in the posterior fossa found, the more defected fetal or infant would be observed In cases of more than 10 mm, especially more than 15 mm,anomales should be observed carefully