二维联合四维超声检查对胎儿先天性心脏畸形的诊断价值

Clinical Value of Two-dimensional Combined with Four-dimensional Ultrasound in Prenatal Di- agnosis of Fetus Congenital Heart Malformation

【目的】探讨二维联合四维超声检查在先天性心脏畸形胎儿产前诊断中的临床价值。【方法】随机选取2011年9月至2015年9月在本院接收产前检查的中晚期孕妇4642例，产前首先采用二维超声对孕妇进行全面的检查，然后对二维超声疑有畸形的胎儿联合四维超声再次检查，通过分析比较由二维超声和二维联合四维超声两种检查方法对诊断胎儿畸形的准确率差异，来判断两种方法的临床价值。【结果】通过随访发现，4681个胎儿中有89个胎儿患有先天性心脏畸形，发生率为1．9％。89个胎儿畸形中，通过二维超声检查出患有先天性心脏畸形的胎儿共70例，其中，漏诊或误诊16例；而采用二维联合四维超声检查出患有先天性心脏畸形的胎儿共78例，漏诊或误诊11例。二维超声联合四维超声检查方法诊断准确率显著高于二雏超声（P〈0．05）。【结论】超声检查是产前诊断胎儿先天性心脏畸形的有效方法，四维超声检查可以作为二维超声的有益补充。两种超声联合检查，能够显著提升诊断胎儿先天性心脏畸形的准确率，同时有效减少漏诊和误诊的发生率。

[ObjectivelTo explore the clinical value of two-dimensional combined with four-dimensional ul- trasound in prenatal diagnosis of fetus congenital heart malformation. [Methods]From September 2011 to September 2015 ,4642 cases of the middle and late pregnant women who received prenatal examination were randomly selected from in our hospital. Prenatal examination of pregnant women was performed by two-dimensional ultrasound at first, then, the fetuses with suspected malformation under two-dimensional ultrasound were examined by four-dimensional ultrasonography again. By analyzing and comparing the two methods of two-dimensional ultrasound and two-dimensional combined with four-dimensional ultrasound, the clinical value of the two methods was determined by the different accuracy of fetal malformation diagnosis. [Results]By follow-up, congenital heart malformations were found in 89 fetuses out of 4681 fetuses, the incidence rate was 1.9%. In 89 fetal malformations, 70 fetuses with congenital heart malformations were examined by two-dimensional ultrasound. Among them, 16 cases were missed or misdiagnosed; a total of 78 fetuses with congenital heart malformations were examined by two-dimensional ultrasound combined with four-dimensional ultra- sound, and Ⅱ cases were missed or misdiagnosed. The diagnostic accuracy of two-dimensional ultrasound combined with four-dimensional ultrasonography was significantly higher than that of two-dimensional ultra-sound （ P 〈0.05）.[Conclusion]Ultrasonography is an effective method for prenatal diagnosis of fetal congenital heart malformations. Four dimensional ultrasonography can be a useful supplement to two-dimensional ultrasound. Combination of two kinds of ultrasound examination can significantly improve the accuracy of diagnosis of fetal congenital heart malformations, and effectively reduce the incidence of misdiagnosis and leakage.