71例胎儿永存左上腔静脉的产前超声诊断及临床分析

Prenatal ultrasound diagnosis and clinical analysis of persistent left superior vena cava in 71 cases of fetuses

目的评价产前超声诊断胎儿永存左上腔静脉(PLSVC)的临床价值。方法回顾性分析2013年9月5日至2015年3月27日24128例胎儿中孕期系统筛查出的71例PLSVC的超声表现,对其声像图进行分析,总结其合并心内外异常情况及妊娠结局。结果所有病例超声表现:3V或3VT切面均见肺动脉左侧血管横断面影像,即"四血管"征。34例诊断为单纯性PLSVC,其中1例合并染色体异常,均足月出生。15例同时合并心内及心外畸形,13例单纯合并心血管畸形,8例单纯合并心外畸形;此36例中1例合并染色体异常,9例根据胎儿父母意愿选择引产,3例胎死宫内引产,3例早产,1例失访,20例足月出生。71例PLSVC的胎儿中误诊1例,该患儿出生后经超声及手术证实为部分型肺静脉异位引流。结论产前超声能够准确诊断PLSVC,单纯PLSVC者,预后良好,当发现PLSVC时应注意检查有无合并心内畸形。

Objective To evaluate the clinical value of prenatal ultrasound diagnosis of fetal persistent left superior vena cava（ PLSVC）. Methods A retrospective analysis was conducted on 24128 cases of singleton pregnancies with second trimester from September,2013 to March,2015. there were 71 cases detected to be PLSVC through ultrasonography findings. And we analyze the ultrasonographic summary,and the conditions of cardiovascular and extra-cardiovascular adnormalities,and the final results of fetuses. Results Ultrasound findings of all the cases showed that there was a vascular cross-sectional imaging in the left side of the pulmonary artery at 3V or 3VT view,which called the＂four vessel＂sign. There are 34 cases of simple PLSVC,and 1case with chromosome abnoermality in them,and 15 cases of PLSVC with both Cardiovascular and extra-cardiovascular abnormalities,and 13 cases of PLSVC simply with Cardiovascular abnormalities; and 8 cases of PLSVC simply with extra-cardiovascular abnormalities. and only 1 cases of all PLSVC are with chromosome abnoermalities. In all of them,55 cases were term birth,which included all the simple one and 20 cases of non-simple one. And 9 cases of all were selected to be odinoeia by their parents,3 cases were odinoeia because of death in uterus,3 cases were premature birth,1case was loss to follow-up. In 71 cases of PLSVC,1 cases were misdiagnosed,and the children were diagnosed as partial anomalous pulmonary venous drainage after birth. Conclusion PLSVC can be diagnosed accurately by prenatal ultrasonography. And simply PLSVC usually has a good prognosis when PLSVC were found,we must pay attention to that whether cardiovascular abnormalities existed or not.