胎儿肾上腺区肿物的超声表现及结局

Study on the ultrasonographic features and outcomes of suprarenal masses in the fetus

目的探讨超声对胎儿肾上腺区肿物的诊断及临床处理意义。方法对2014年1月至2016年6月在首都医科大学附属北京妇产医院进行超声检查并诊断为肾上腺区肿物的17例胎儿产前超声表现、产后随访结果及其临床结局进行分析。结果 17例胎儿肾上腺区肿物中左侧8例,右侧7例,双侧2例,共19个肿物;初次检查肿物长径1.2-6.5 cm,平均（2.8±1.4）cm;初次检查时4个肿物内部回声为囊性（单房2个,多房2个）,11个肿物为囊实性,4个肿物为实性（高回声2个,低回声2个）;7个肿物内部有点状或条状血流信号。3例胎儿产前复查超声,2例肿物体积稍增大,1例明显增大,其中2例内部回声无明显变化,1例内部回声从单房囊性变为囊实性。17例中4例孕妇选择终止妊娠;继续妊娠的13例中8例在足月产前超声或出生后超声检查显示肿物消失,临床考虑肾上腺出血;余5例中3例在出生后接受手术治疗并证实为肾上腺神经母细胞瘤,2例临床考虑肾上腺神经母细胞瘤行动态观察,随诊过程中肿物逐渐变小或消失。结论肾上腺出血及肾上腺神经母细胞瘤超声表现有一定特点,产前超声检查对于明确诊断和肿物的临床处理均有较重要意义。

Objectives To investigate the significance of antenatal ultrasonography on the diagnosis of suprarenal masses and the effect on the postnatal strategy. Methods Analyzed the antenatal ultrasonographic manifestations and followed up the outcomes of 17 cases with suprarenal masses diagnosed in Beijing Obstetrics and Gynecology Hospital from January 2014 to June 2016. Results Among 17 cases of fetal suprarenal masses, 19 lesions were located on the left side in 8 cases, on the right side in 7 cases, bilaterally in 2 cases; the initial sizes of lesions were 1.2-6.5 cm, with the mean of 2.8±1.4 cm; the original ultrasonographic manifestations were cystic in 4 lesions, cystic-solid in 11 lesions, solid in 4 lesions; internal blood flow was detected in 7 lesions; antenatal follow-up results were available in 3 cases, which showed slightly increased lesion size in 2 cases and remarkably increased size in 1 case, and the internal echoes of lesions was persistently cystic-solid or solid in 2 cases, while in 1 case, the cystic echo turned into cystic-solid. Among 17 cases, 4 cases terminated the pregnancy selectively. In 13 cases which continued the pregnancy, 8 cases were diagnosed as adrenal hemorrhage and the lesions disappeared on the postnatal ultrasound examinations, while 5 cases were neuroblastoma, 3 received surgery postnatally and 2 were followed up conservatively and the lesions decreased in size or completely disappeared. Conclusions Adrenal bleeding and neuroblastoma have certain characteristics on antenatal ultrasound.Antenatal ultrasound has important role in the definite diagnosis and the establishment of treatment strategy of the suprarenal masses.