右肺缺如的产前超声诊断研究

目的探讨产前右肺缺如的超声声像图特征，以提高对肺缺如的认识及产前诊断率。方法回顾性分析3例产前超声诊断并经引产或产后随访证实的右肺缺如的胎儿声像图特征。结果本次3个病例中1例咨询后予以引产；1例合并心脏严重畸形，临床考虑预后不良，予以引产；1例出生后患儿情况不佳，家属最终放弃治疗。本次3例病例图像超声上共同点：（1）患者胸腔体积明显缩小，未见正常肺组织回声。（2）心脏向患侧移位明显或旋转，紧贴胸壁。（3）肺动脉分叉处仅见一条动脉及动脉导管发出，主动脉弓上未见多余血管发出。（4）左心房内仅探及正常肺侧静脉汇入，并且血管迅速进入肺门处，患侧处左心房房顶处未见肺静脉开口，左心房较正常孕周内径偏小。（5）主支气管分叉切面仅见左侧或右侧支气管。结论产前超声检查可以在孕中晚期对疑似右肺缺如的胎儿明确诊断，从而为终止妊娠或继续妊娠的胎儿出生后治疗提供可靠的依据。

Oblective To explore the ultra sonographic features of the absence of lung in the prenatal in order to improve the understanding and the prenatal diagnosis rate of the absence of lung. Methods Retrospective analysis was performed in 3 cases considered as the absence of right lung using ultrasonic diagnosis and then confirmed by autopsy or postpartum follow-up. Results In these 3 cases ： the 1st case was induced by consultation; the 2nd case was induced due to severe cardiac malformations and the possible chnical poor prognosis; the 3rd cases was not well after birth, and then the family members finally gave up therapy. There were common ultra sonographic features in these 3 cases including： （ 1 ） significantly reduced pleural volume and the lack of normal lung tissue echo. （ 2 ） The heart has significant displacement or rotation to ipsilateral direction or close to the chest wall. （ 3 ） Only one artery and artery ductus could be found at pulmonary artery crotch, and there was no vessel found in Aortic arch. （ 4 ） In the left atrium, only the normal pulmonary side vein was detected and the blood vessels quickly entered the pulmonary hilum. There was no pulmonary vein opening at the top of left atrium in the affected side, and diameter of the left atrial was smaller than normal pregnancy. （ 5 ） The main bronchus bifurcation section were only obeserved in left or right bronchus. Conclusion Prenatal ultrasonography can make a clear diagnosis of the second or third trimester fetuses that was suspected the absent of right lung. It can provide the evidence of the terminal pregnancy or postnatal treatment if the family chose continues pregnant.