胎儿肠旋转不良伴中肠扭转超声诊断研究

Ultrasonographic diagnosis of intestinal malrotation with midgut volvulus in fetus

目的探讨胎儿肠旋转不良伴中肠扭转超声声像图特征。方法对2014年1月至2016年5月在首都医科大学附属北京妇产医院产前超声诊断的5例肠旋转不良伴中肠扭转胎儿超声表现及临床结局进行分析。结果 5例胎儿肠旋转不良伴中肠扭转产前均依据特异性超声征象＂漩涡征＂正确诊断;间接和非特异性的超声征象包括＂咖啡豆征＂3例、假性囊肿3例、腹腔积液5例。5例胎儿产科处理及随访结果显示2例肠旋转不良伴中肠扭转行剖宫产紧急终止妊娠,转入小儿外科手术,手术证实产前诊断正确,患儿术后均恢复良好。3例胎儿肠旋转不良伴中肠扭转继发胎粪性腹膜炎,自然分娩后患儿转小儿外科行剖腹探查术,证实产前诊断正确,患儿并发肠闭锁,分别切除60-90 cm闭锁回肠,术后出现短肠综合征症状。结论胎儿肠旋转不良伴中肠扭转有典型声像图特征,即＂漩涡征＂,超声可作为该病产前诊断首选的检查方法。产前超声诊断肠旋转不良伴中肠扭转对产科处理和胎儿出生后手术治疗有重要指导作用。

Objective To discuss the prenatal ultrasound manifestations of intestinalmalrotation with midgut volvulus. Methods An analysis of prenatal ultrasound findings and postnatal features was performed on five cases of fetuses with intestinal malrotation with midgut volvulus that were identified by ultrasonography at Beijing Obstetrics and Gynecology Hospital, in the period of January 2014 to May 2016. Results The 5 fetuses with intestinal malrotation with midgut volvulus were diagnosed based on the typical ？whirlpoolsign？ in ultrasonography. Indirect and non-specificultrasonographic signs included ？coffee bean sign？, pseudocysts and ascites. Obstetric management and follow-up results： 2 cases emergency caesarian section were performed, infantstransferred to pediatric surgery, the intraoperative findings confirmed the prenatal diagnosis, postoperative the infants made an uneventful recovery. Another 3 cases suggesting the presence of meconium peritonitis, fetus born via a spontaneous vaginal delivery, the intraoperative findings confirmed the prenatal diagnosis, concurrent intestinal atresia,resectionof about 60 to 90 cm of atresia ileum, postoperative the infants showed symptoms of shortbowel syndrome. Conclusions Fetuses with intestinal malrotation with midgut volvulushad characteristic ？whirlpool sign？ in ultrasonography.Ultrasonography may be used as the first choice for prenatal diagnosis of this disease. Prenatal diagnosis of intestinal malrotation with midgut volvulus can provide guidance for clinical obstetrical management and postnatal treatment.