产前超声诊断胎儿先天性肺囊腺瘤畸形的临床价值

Clinical value of prenatal ultrasound in diagnosis of congenital cystic adenomatoid malformation of the lung

目的探讨产前超声对胎儿先天性肺囊腺瘤样畸形(CCAM)的诊断价值及临床意义。方法回顾性分析2012年3月~2017年5月在我院行常规产前超声检查的孕妇共12518例,其中产前超声怀疑的18例胎儿CCAM的超声图像特征及临床资料,继续妊娠者,动态观察肿块的变化,并随访至产后半年,引产者与病检结果对照。结果产前超声诊断的18例CCAM均为单胎妊娠,正确诊断15例,诊断准确率约83%,其中Ⅰ型5例,Ⅱ型7例,Ⅲ型3例;误诊3例,其中两例为膈疝,为完全误诊,1例为CCAM合并隔离肺,为部分误诊。发生于左侧者15例,右侧者3例;超声检出孕周为20~31周;1例合并无脑儿;18例引产6例,分娩12例;继续妊娠的胎儿中肿块随孕周增大而缩小或至消失者3例,持续存在9例。结论胎儿CCAM具有较典型的超声图像特征,超声可动态观察肿块的发展变化过程,有助于产前正确诊断及预后评估与处理。因此产前超声可成为胎儿CCAM的首选及有效的影像学检查方法 。

Objective To investigate the diagnostic value and clinical significance of prenatal ultrasound of congenital cystic adenomatoid malformation(CCAM)of the Lung.Methods It was a retrospective study.Among all the 12518 pregnant women examined in liangxiang teaching hospital of capital medical university from March 2012 to May 2017,a total of 18 fetuses were suspected to CCAM by prenatal ultrasound.In continued pregnancy cases,dynamic observation of changes in the tumor was made and followed-up to postpartum.In the induced abortion cases,pathological and ultrasonic characteristics were compared.Results All the 18 cases of ultrasonic suspected CCAM were single fetal pregnancy,15 cases were correctly diagnosed,the diagnosis accuracy was about 83%,including 5 cases of type I,7 cases of type II and 3 cases of type III.Three cases were misdiagnosed,two of which were completely misdiagnosed as diaphragmatic hernia,and one was partly misdiagnosed for CCAM combined with isolated pulmonary.15 cases occurred in the left side while 3 in the right side;The ultrasound was made in the gestational age of 20~31 weeks;One case was a no-brainer;12 cases continued pregnancies while 6 cases terminated.In the fetus that continued pregnancy,the tumor was narrowed or disappeared in 3 cases,while nine cases continued.Conclusion Fetal CCAM has more typical ultrasonic characteristics,Ultrasound can dynamically observe the development of lumps and ultrasound is helpful for prenatal diagnosis,prognosis evaluation and management.In conclusion,prenatal ultrasound can be the preferred and effective imaging method for fetal CCAM.