产前诊断胎儿“双泡征”的处理及其预后

Perinatal outcomes of fetuses prenatally diagnosed with double bubble sign

目的探讨产前超声显示腹部“双泡征”胎儿的围产结局及影响其预后的因素。方法2000年1月1日至2013年12月31日，57例孕妇于上海交通大学医学院附属新华医院产前超声检查诊断胎儿“双泡征”，回顾性分析这些胎儿的病历资料及围产结局。新生儿存活≥42d者（38例）作为存活组，新生儿存活不足42d者（11例）作为死亡组。采用t检验、x^2检验、Fisher精确概率法及Logistic回归模型分析预后不良的影响因素。结果（1）产前超声诊断“双泡征”胎儿羊水过多发生率为88％（50／57），胎死宫内发生率为4％（2／57），合并畸形发生率为23％（13／57）。8例引产终止妊娠，其余49例活产分娩。49例活产新生儿中10例放弃治疗，另外39例接受手术治疗，1例术后死亡，其余38例存活≥42d。生后42d总体存活率为67％（38／57），手术存活率为97％（38／39）。（2）死亡组新生儿的出生胎龄和出生体重分别为（35．8±3．0）周和（2229±567）g，均小于存活组新生儿[分别为（38．1±1．9）周和（2830±558）g，t值分别为2．859和3．136，P值均〈0．011。死亡组新生儿产前诊断合并畸形发生率及生后诊断染色体异常发生率均为3／11，均高于存活组新生儿[均为3％（1／38），P值均〈0．05]。（3）“双泡征”胎儿合并FGR时，合并畸形的风险较高（OR=9．893，95％CI：1．758～55．661，P=0．009）。结论“双泡征”胎儿发生早产、低出生体重、合并畸形和染色体异常者预后不良。

Objective To determine the perinatal outcomes and its risk factors of fetuses prenatally diagnosed with the double bubble sign on ultrasound scanning. Methods The clinical data of 57 cases of fetal double bubble sign which was prenatally diagnosed by ultrasound in Xin Hua Hospital from January 1, 2000 to December 31, 2013 were retrospectively analyzed. The neonates survived not less than 42 days were as surviving group, and who survived lower than 42 days were as dead group. The t test, Z2 test and Logistic regression were used for statistical analysis of the data. Results Of 57 fetuses with the double bubble sign, the incidence of polyhydramnios, intrauterine fetal death and associated anomalies was 88% （ 50/57 ） , 4% （ 2/57 ） and 23% （ 13/57 ） , respectively. Induced labor to terminate the pregnancy was occurred in eight cases, the other 49 cases had live births but ten neonates abandoned therapy.Thirty-nine live babies accepted surgical treatment with one dead, and the other 38 neonates survived not less than 42 days.The overall 42-day survival rate was 67% （ 38/57 ） and the surgical survival rate was 97% （ 38/39 ） . Compared with surviving neonates, the neonates who died had lower gestational age [ （ 35.8±3.0 ） vs （ 38.1± 1.9 ） weeks, t=-2.859, P〈0.01] and birth weight [ （ 2 229± 567 ） vs （ 2 830±558 ） g, t=3.136, P〈0.01], and a higher incidence of prenatally diagnosed structural anomalies [3/11 vs 3% （ 1/38 ）, P〈0.05] and karyotype anomalies detected after birth [3/11 vs 3% （ 1/38 ）, P〈0.05]. Logistic regression analysis showed that the fetuses with the double bubble sign and fetal growth restriction had a higher risk of complications （ 0R=9.893, 95%CI： 1.758-55.661, P=0.009 ） . Conclusions Fetuses with double bubble sign have adverse outcome if they complicating preterm delivery, low birth weight, prenatally diagnosed structural anomalies and karyotype anomalies.