产前超声诊断胎儿先天性肺囊性腺瘤样畸形

Prenatal Ultrasound in Diagnosis of Fetal Congenital Cystic Adenomatoid Malformation of the Lung

目的先天性肺囊性腺瘤样畸形(CCAM)是一种良性非肿瘤性的异常肺组织,严重者可致胎儿围生期死亡。本文探讨胎儿CCAM的产前超声表现及预后,为评估临床转归提供依据。资料与方法回顾性分析产前超声诊断的25胎CCAM的声像图特征,与引产或分娩结果进行对照,并随访妊娠结局。结果 25胎均经产前超声诊断为CCAM,24胎经引产或分娩后确诊。24胎均为单侧肺发病,其中左肺11胎,右肺13胎;CCAM Ⅰ型2胎,Ⅱ型13胎,Ⅲ型9胎;合并腹水5胎,胸腔积液2胎,胎儿水肿1胎,羊水过多7胎。妊娠结局:11胎为活产,其中2胎病变自行消失,5胎病变于产前自发性减小,3胎病变无明显变化,1胎出生后9 d因呼吸衰竭死亡。其余13胎为引产。结论产前超声能够较准确地诊断胎儿CCAM,并能够明确其病变类型、范围及并发症,对预测妊娠结局具有重要意义。

Purpose Fetal congenital cystic adenomatoid malformation of the lung（CCAM） is benign tumor-like lesion. Severe cases can cause fetal death in the perinatal period. This article discusses the prenatal sonographic findings and prognosis of fetal CCAM to provide the basis for evaluation of clinical outcome. Materials and Methods The ultrasonographic features of twenty-five fetuses with CCAM were retrospectively analyzed and compared with examination results after birth or induced abortion. Results For 25 fetuses with CCAM, 24 were confirmed by postpartum or induced pathological findings. 1 fetus had pulmonary sequestration. The lesions were all located in one lobe of the lung, including 11 in the left lung and 13 fetuses in the right lung. There were 2 type Ⅰ CCAM, 13 type Ⅱ, and 9 type Ⅲ. Ascites was found in 5 fetuses, hydrothorax in 2 fetuses, fetal hydrops in 1 fetus and 7 fetuses with polyhydramnios. Pregnancy outcomes included 11 live births, of which 2 lesions resolved, 5 lesions became smaller, 3 lesions had no obvious changes and 1 fetus died of respiratory failure nine days after birth. 13 pregnancies were terminated. Conclusion Prenatal ultrasound can accurately diagnose the fetal CCAM and depict its lesion type, range and complications, thus is valuable in predicting pregnancy outcome.