胎儿肝门部囊性占位的超声表现及临床预后研究

Prenatal ultrasound diagnosis and clinical outcomes of fetal hepatohilar cystic occupying lesions

目的分析胎儿肝门部囊性占位的超声表现,总结临床预后.方法2008年1月至2017年12月于中山大学附属第一医院行产前系统超声检查显示肝门部囊性占位的病例,根据囊肿最大径和形态分为4组,≥30mm且多角为组1,≥30mm非多角为组2,<30mm且多角为组3,<30mm非多角为组4,追踪各组病例预后情况.结果共47例胎儿纳入研究,其中38例胎儿出生,9例引产(仅1例有病理结果),追踪到妊娠结局共39例,其中先天性胆管扩张症27例(69.2%,27/39),囊肿消退5例(12.8%,5/39),胆道闭锁3例(7.8%,3/39),肠系膜囊肿2例(5.1%,2/39),畸胎瘤和双胆囊各1例(2.6%,1/39).组3病例数最多,共22例,其中先天性胆管扩张症15例,胆道闭锁3例,囊肿消退3例,双胆囊1例,与其他组比较差异无统计学意义(均P>0.05).结论胎儿肝门部囊性占位半数以上为先天性胆管扩张症,预后较好;少数病例囊肿可于出生后吸收;7.8%的病例为胆道闭锁,预后差,产前临床咨询时需谨慎.

Objective To explore the prenatal ultrasound diagnosis and postnatal clinical outcomes of fetuses with hepatohilar cystic occupying lesions. Methods This was a retrospective study that included all fetuses found to have hepatohilar cystic occupying lesions diagnosed by ultrasound in the First Affiliated Hospital of Sun Yat-sen University between January 2008 and December 2017. According to the morphology of the cyst and max diameter, the cases were divided into four groups. Cases with polygonal cysts and max diameter over 30 mm were assigned to group 1, non-polygonal cysts and max diameter over 30 mm to group 2, polygonal cysts and max diameter under 30 mm to group 3, non-polygonal cysts and max diameter under 30 mm to group 4. The birth status, ultrasound review image, surgical treatment and pathological findings were tracked to analyze the prognosis of these fetuses. Results Among 47 cases of fetal hepatohilar cystic occupying lesions, 38 fetuses were born and 9 were terminated with only 1 case taking pathological examination. There were 39 cases with pregnancy outcomes. Twenty-seven cases (69.2%, 27/39) were diagnosed as congenital biliary dilatation (CBD), 5 cases (12.8%, 5/39) were found cysts resolved in postnatal ultrasound examinations. Biliary atresia was diagnosed in 3 cases (7.8%, 3/39) by operation;Mesenteric cysts (5.1%, 2/39) were diagnosed in 2 cases by ultrasound. One (2.6%, 1/39) was diagnosed as double-gallbladder by ultrasound. 1(2.6%, 1/39) was diagnosed as teratoma by operation. Most cases were in the group 3, but there was no significant difference compared with other groups (all P>0.05). Conclusions More than half of hepatohilar cystic occupying lesions diagnosed in prenatal ultrasound are proved to be CBD with good prognosis. The cysts in few cases can be resolved after born. 7.8% of cases are biliary atresia with poor prognosis, which give messages to prenatal clinical consultation.