产前超声诊断胎儿循环通道异常的临床价值

The clinical value of prenatal ultrasound in diagnosis of abnormal fetal circulation channels

目的探讨产前超声诊断胎儿循环通道(FCC)异常的临床价值。方法回顾性分析2016年1月至2017年6月在北京妇产医院产前超声检查并随访至妊娠结局的FCC[静脉导管(DV)、卵圆孔(FO)、动脉导管(DA)]异常病例共131例,总结其超声表现及妊娠结局。结果 131例FCC异常中,有46例DV异常,其中DV缺如6例,内径细窄2例,血流异常38例;合并异常有NT增厚、胎儿颈部水囊瘤、胎儿全身水肿等。有53例FO异常,包括FO内径异常45例,卵圆瓣异常6例,血流异常2例;合并异常有永存左上腔静脉、右心发育不良、心内膜垫缺损等。有32例DA异常,包括DA缺如5例、形态异常12例、走形异常3例、血流异常12例;合并异常有大动脉转位、肺动脉闭锁、右位主动脉弓等。131例FCC异常胎儿中,胎儿总存活率为49.6%,DV、FO、DA异常在各通道病例中存活率分别为13.0%,92.5%,56.3%。结论产前超声监测FCC具有非常实用的临床价值,通过观察FCC内径、走形、血流方向及频谱改变,为临床咨询、评价预后提供更多有价值的参考依据。

Objective To investigate the clinical value of prenatal ultrasound in diagnosis of abnormalities in fetal circulation channels （FCC）. Methods A retrospective study was conducted among 131 cases with abnormal FCC [ including venous catheter （DV） , foramen ovale （FO） , patent ductus arteriosus （DA）] detected by prenatal ultrasound examination from January 2016 to June 2017 in Beijing Obstetrics and Gynecology Hospital. All cases have been followed up to the outcome of pregnancy. Results Among 131 patients with abnormal FCC, 46 cases had abnormal DV, 53 cases of FO abnormalities, 32 patients with abnormal DA. For cases with abnormal DV, 6 of them were DV agenesis, 2 cases were with narrow diameter and 38 cases were with abnormal blood flow; other complicated abnormality included NT thickening, fetal neck cystic hygroma and fetal hydrops. For cases of FO abnormalities, 45 of them were with abnormal internal diameter of FO, 6 cases were with abnormal oval valves, 2 cases were with abnormal blood flow, other complicated abnormality included abnormal left ventricular vein, hypoplastic right heart and endocardial cushion defect. For cases with abnormal DA, 5 of them were DA ageuesis, 12 cases were with abnormal structure, 3 cases were with abnormal contorts, 12 cases were with abnormal blood flow; other complicated abnormality included transposition of great arteries, pulmonary atresia, right aortic arch with abnormal. The overall fetal survival rate was 49.6% , and the abnormal survival rates of DV, FO and DA were 13.0%, 92.5%, 56.3%, respectively. Conclusion It is useful for prenatal ultrasound monitoring of FCC in clinical practice. To observe the diameter, shape, flow direction and spectrum of fetal FCC, valuable references to clinical consultation and prognosis evaluation could be provided.