胎儿肺部肿瘤超声诊断与临床意义

Prenatal diagnosis of fetal lung masses by ultrasonography and its clinical significance

目的分析胎儿肺部肿瘤超声声像图特征及临床预后。方法对2011年6月1日至2013年5月31日南京医科大学附属苏州医院产前超声检查发现肺部肿瘤的38例胎儿均随访至产后或引产后,与出生后CT或引产后尸检结果对照,分析胎儿肺部肿瘤产前超声声像图特征。结果 38例肺肿瘤胎儿中产前超声显示20例为肺囊腺瘤,其中Ⅰ型4例,声像图表现为多囊样无回声区;Ⅱ型7例,声像图表现为混合性回声;Ⅲ型9例,声像图表现为增强回声。超声检查后孕妇选择终止妊娠2例,引产胎儿尸检证实均为肺囊腺瘤;6例临床随访过程中胎儿肺部肿瘤消失;11例胎儿顺产后CT检查证实为肺囊腺瘤;1例超声检查后失访。其余18例产前超声显示为隔离肺,肿瘤呈楔形高回声,边界清,彩色多普勒血流成像显示为体循环血供;超声检查后15例胎儿顺产,9例临床随访过程中隔离肺消失,6例产后CT检查证实为隔离肺,3例超声检查后失访。与产后和引产后检查结果对照,34例临床病理资料完整的肺肿瘤胎儿中产前超声正确诊断肺囊腺瘤19例(19/19),隔离肺15例(15/15)。结论胎儿肺部疾病产前超声可表现为各种类型的肺部肿瘤图像,早期正确诊断对胎儿预后和临床处理有重要指导意义。

Objective To analyze the ultrasonographic features of fetal lung masses and their clinical prognosis. Methods There were total 38 fetuses with lung masses detected by prenatal ultrasonography in Suzhou Hospital Affiliated to Nanjing Medical University during June 1st 2011 to May 31st2013. They were followed up to birth or induction of labor. Prenatal ultrasonographic features were analyzed by comparing to the CT examinations after birth or autopsy. Results Among 38 fetuses, there were 20 fetuses with cystic adenomatoid malformation（CAM） and 18 with pulmonary sequestration（PS） diagnosed by prenatal ultrasonography, and most of them were confirmed by CT after birth or autopsy. Their ultrasonogrphic characteristics and outcome were as followings.（1） Among 20 fetuses with CAM, there were 4 cases of CAM type Ⅰ, and their ultrasonography showed polycystic anechoic areas. Ultrasonography showed mixed echoic areas in 7 cases of type Ⅱ, and hyperechoic areas in 9 cases of type Ⅲ. After prenatal ultrasonography, 2 cases chose termination of pregnancy and were confirmed by autopsy. Lung masses in 6 cases disappeared gradually during follow up. Eleven cases were confirmed as CAM by CT after birth. However 1 case was missed follow-up.（2） Ultrasonography showed well-defined wedge-shaped hyper echo in 18 cases of PS, and color Doppler flow imaging（CDFI） showed that their blood supply were all from systemic circulation. Among 15 cases who underwent natural labor, masses in 9 cases disappeared during follow-up, and 6 cases were confirmed by CT after birth. The other 3 cases were missed. Conclusions Fetal lung masses have different ultrasonographic characteristics. Early and exact diagnosis has great significance for fetal prognosis and clinical management.