99例胎儿先天性肺囊腺瘤畸形的超声特征及随访结果分析

The analysis of ultrasonic features and follow-up outcome in 99 cases with fetal congenital cystic adenomatoid malformations

目的探讨胎儿先天性肺囊腺瘤畸形（congenital cystic adenomatoid malformations, CCAM）的超声特征和预后。方法回顾性分析本院产前诊断的99例CCAM的超声资料、妊娠结局及随访结果。结果 （1） 99例CCAM患者中,大囊泡型49例,微囊泡型50例,合并水肿胎儿3例,成功随访58例（58.6%）,其中活产40例（69.0%）,3例活产儿出生后有并发症,包括2例肺炎和1例支气管炎伴咳嗽;8例活产儿生后行手术治疗,手术均成功;（2） 99例CCAM患者中,27例行多次超声检查,获得139次囊腺瘤容积比值（cystic volume ratio,CVR）的平均值为0.71±0.85,其中妊娠25-29周平均CVR（0.76±0.54）明显大于妊娠≥30周（0.31±0.23）（P 〈0.05）。（3）多次超声检查的27例患者中,85.2%（23/27）的CVR随孕周下降,初次CVR〈0.4组、0.4≤初次CVR〈0.8组及初次CVR≥0.8组的CVR分别下降0.8%、20.5%和60.3%。结论胎儿CCAM多数预后良好,CVR于妊娠20-30周呈现高值,但多数CVR随孕周呈下降趋势,且妊娠30周后CVR下降明显,初次CVR越大,下降幅度越大,初次CVR预测胎儿预后的价值有限。

Objective To investigate the ultrasonic features and prognosis of fetal congenital cystic adenomatoid malformations（CCAM）. Methods The features of ultrasound, pregnancy outcome and follow-up result of fetal CCAM in 99 cases detected by prenatal ultrasound were analyzed retrospectively. Results（1） Among the 99 CCAM patients, there were 49 cases of macrocystic type, 50 cases of microvesicular type, and 3 cases of hydrops. There were 58 cases（58.6%） with successful postnatal followed-up, including 40 live births（69.0%）. 3 cases presented syndrome including two cases of pneumonia and one case of bronchitis and cough. All the 8 live babies were operated successfully after birth.（2） A total of 139 cystic volume ratio（CVR） values were available in 99 cases with 27 cases receiving multiple ultrasound examination, with the mean CVR of 0.71±0.85. The mean CVR between 25 and 29 gestational weeks（0.76±0.54） was significantly greater than that at 30 weeks or more（0.31±0.23）（P〈0.05）.（3） Of the 27 cases with multiple CVR values, 85.2%（23/27） of the CVR decreased with gestational week. The CVR of 6 cases with the initial CVR 0.4 declined by 0.8%; The CVR of 12 cases with the initial CVR ≥ 0.4 and 0.8 declined by 20.5%; The CVR of 9 cases with the initial CVR ≥ 0.8 declined by 60.3%. Conclusions Most of fetal CCAM had a good prognosis. CVR present a peak at 20 to 30 weeks＇ gestation, most CVR showed a downward trend with gestational week, and CVR decreased significantly after 30 weeks of gestation. The larger the initial CVR, the larger the CVR will decline. The value of the initial CVR to predict the fetal outcome is limited.