消化道梗阻的产前超声诊断及围产期结局

Diagnosis of digestive tract obstruction of prenatal ultrasound and perinatal outcome

目的探讨先天性消化道梗阻产前超声声像图特征,回顾性分析其围产期结局。方法收集产前超声诊断为消化道梗阻胎儿的完整资料,与产后新生儿特殊检查及手术结果或引产后尸体解剖及病理检查结果相比较,分析总结其产前超声声像图特征,并对其羊水或脐血染色体检测结果进行分析,新生儿随访至出生后1个月,追踪其围产期结局。结果本组70 278例胎儿中超声拟诊87例消化道梗阻胎儿(2例结肠一过性扩张误诊为结肠梗阻,产后腹部平片未见异常),消化道梗阻检出率为0.1%(85/70 278);漏诊1例乙状结肠闭锁(产后手术证实),超声诊断消化道梗阻的诊断符合率为98.8%(85/86)。86例消化道梗阻胎儿伴发染色体异常21例,染色体异常发生率为24.4%(21/86),其中包括5例食管狭窄或闭锁,8例十二指肠狭窄或闭锁,4例小肠狭窄或闭锁,3例结肠狭窄或闭锁,1例肛门闭锁。62例单一消化道梗阻伴发染色体异常7例,染色体异常发生率为11.3%(7/62),24例消化道梗阻合并其他结构畸形伴发染色体异常14例,染色体异常发生率为58.3%(14/24),二者比较,差异有统计学意义(U=20.7,P<0.005)。结论消化道不同部分梗阻具有其特殊超声声像图表现,围产期结局与梗阻部位以及是否合并其他畸形有关;消化道梗阻胎儿染色体异常发生率较高,合并其他结构畸形时染色体异常发生率显著高于单一消化道梗阻胎儿。

Objective To explore the ultrasonic feature of congenital digestive tract obstruction prenatal ultrasound, and to retrospectively analyse the perinatal outcome. Methods To collect the complete data of prenatal diagnosis for fetal digestive tract obstruction. Compared with postpartum neonatal special examination and operation results or the corpse and anatomical and pathological examination results after induction, to analyse the prenatal ultrasonographic characteristics. And amniotic fluid or blood chromosome examination results were analyzed. The newborns were followed up for 1 month after birth, tracking the perinatal outcome. Results Totally 87 fetuses （misdiagnosis 2 cases colon ＇atresia with transient dilatation of colon） among 70 278 fetuses（including 1 389 transregional fetuses, 70 278 pregnant women） were considered with digestive tract obstruction, the accidence was 0.1% （85/70 278）. 1 case was Missed diagnose with sigrnoid colon atresia（postpartum operation confirmed）, so the conformity rate was 98.8% （85/86）. 21 cases among 86 cases associated with fetal chromosome abnormality, so the rate of which was 24.4% （21/86）, including 5 cases esophageal stenosis or atresia, 8 cases duodenal stenosis or atresia, 4 cases intestinal stenosis or atresia, 3 cases colonic stricture or atresia and 1 case anal atresia. 62 cases single digestive tract obstruction associated with chromosome abnormality in 7 cases, so the rate of which was 11.3% （7/62）, 24 cases digestive tract obstruction complicated with other malformations associated with chromosome abnormality in 14 cases, so the rate of which was 58.3% （14/24）, a comparison of the two, the difference had statistical significance （U=20.7, P〈0.005）. Conclusion Different parts of digestive tract obstruction has its special ultrasonographic manifestations. Perinatal outcome associated with obstruction position and whether combination of other deformity. Digestive tract obstruction fetal associated with higher chromosomal abnormalities, the rate of digestive tract obstruction fetal combined with other structural malformations associated with chromosomal abnormalities was significant higher than the fetal digestive tract obstruction single.