产前超声四腔心切面与三血管气管切面筛查胎儿食管闭锁价值的研究

Value of four chamber view and three-vessel-trachea view in screening esophageal atresia in prenatal ultrasound

目的:评估四腔心切面及三血管气管切面观察胎儿食管筛查食管闭锁(EA)的价值。方法:对425例孕21-25周行系统胎儿超声检查的胎儿获取四腔心切面(胸骨旁四腔心切面)、三血管气管切面的同时观察食管回声,排除EA造成的食管中断。四腔心切面及三血管气管切面均显示食管横断面回声为EA低风险胎儿;四腔心切面或三血管气管切面不显示食管横断面回声或上述两个切面均不显示为EA高风险胎儿,需进一步获取食管矢状切面及冠状切面进一步证实。结果:四腔心切面及三血管气管切面均能显示食管回声396例(93.1%,396/425),为EA低风险胎儿。余29例(6.8%,29/425)为EA高风险胎儿,其中27例通过食管矢状切面及冠状切面显示食管不断延长的条带状回声。2例食管连续性中断为EA。EA2例三血管气管切面均不显示食管回声。漏诊EA0例。利用四腔心切面及三血管气管切面显示食管筛查EA的灵敏度100%(2/2),特异度93.6%(396/423),阳性预测值6.9%(2/29),阴性预测值100%(396/396)。结论:四腔心切面及三血管气管切面显示食管可有效筛查胎儿EA。

Objective: To evaluate the value of four chamber view(4 C) and three-vessel-trachea view(3 VT) in screening fetal esophageal atresia in prenatal ultrasound. Methods: Prenatal ultrasound was prospectively performed in 425 consecutive fetuses between 21 and 25 weeks for detection of esophageal atresia. A complete anatomical survey was performed. We searched for esophagus on satisfactory 4 C and 3 VT view. Fetuses whose esophagus could be showed on 4 C and 3 VT were at low risk of esophageal atresia. Fetuses whose esophagus couldn’t be showed on either 4 C or 3 VT or both were at high risk of esophageal atresia. More views such as saggital and coronary view of esophagus could be needed to get more information.Results: Esophagus could be viewed on both 4 C and 3 VT in 396 cases(93.1%, 396/425). These were at low risk of esophageal atresia. The remaining 29 cases(6.8%, 29/425) were at high risk of esophageal atresia. Out of them, 27 cases were confirmed to be normal as continuous parallel echogenic lines was found on saggital views or coronary views. During the screening, 2 cases of esophageal atresia were found. Their esophaguses couldn’t be shown on 3 VT. Neither of esophageal atresia cases was misdiagnosed in this group. The sensitivity, specificity, positive predictive value and negative predictive value were 100%(2/2), 93.6%(396/423), 6.9%(2/29) and 100%(396/396) respectively of 4 C and 3 VT for the screening of the fetal esophageal atresia. Conclusions: It is effective to screen fetal esophageal atresia with 4 C and 3 VT.