产前超声诊断单脐动脉与胎儿异常的关系分析

Analysis of relationship between single umbilical artery diagnosed by prenatal ultrasonography and fetal malformation

目的探讨产前超声诊断单脐动脉(single umbilical artery,SUA)与合并胎儿畸形类型的价值。方法回顾性分析不同孕周产前超声检查发现的143例SUA胎儿超声表现,确定脐动脉缺失侧别,分析左右侧脐动脉缺失合并胎儿畸形、染色体异常等情况。结果143例SUA中左侧脐动脉缺失83例(58.0%),右侧脐动脉缺失60例(42.0%),差异无统计学意义(P>0.05);孕20周及之前检出6例(4.2%,6/143),其余137例均在孕20周之后检出(95.8%,137/143);单纯性SUA 121例(84.6%),合并胎儿畸形22例(15.4%),其中左侧脐动脉缺失10例(45.5%),右侧脐动脉缺失12例(54.5%),左侧与右侧脐动脉缺失合并胎儿畸形差异无统计学意义(χ^2=1.692,ν=1,P>0.05);合并心血管系统畸形最多(7.7%,11/143),其次是消化系统畸形(6.3%,9/143);接受染色体检查共23例,发现18-三体和13-三体各1例,均为右侧脐动脉缺失,且均合并多种畸形。结论左右侧脐动脉缺失均可合并胎儿畸形异常,经产前超声检查能较准确诊断SUA及合并胎儿畸形。

Objective To evaluate the value of prenatal ultrasound in the diagnosis of single umbilical artery(SUA) and fetal malformation. Methods The characteristics of the prenatal ultrasound findings of 143 fetuses with SUA in different gestational weeks were retrospectively analyzed, and the missing side of SUA were checked. Different types of SUA combined with fetal malformation were analyzed as well as chromosomal abnormalities and so on. Results For 143 fetuses with SUA, there were 83 cases (58.0%) with absent left umbilical artery and 60 cases (42.0%) with absent right umbilical artery, there was no statistical difference between the two groups(P>0.05). Six cases (4.2%, 6/143) were detected at and before 20 weeks of gestation, and the rest 137 cases were detected after 20 weeks(95.8%, 137/143). There were 121 cases (84.6%) of isolated SUA, 22 cases(15.4%) were complicated with other malformations, including 10 cases (45.5%) with absent left umbilical artery and 12 cases (54.5%) with absent right umbilical artery. There was no statistical difference between left and right umbilical artery deletion combined with fetal malformation(χ^2=1.692,ν=1, P>0.05). There were 11 cases(7.7%, 11/143) with cardiovascular malformation and nine cases(6.3%, 9/143) with digestive system malformation. Chromosome examination was performed in 23 cases. One case of trisomy 18-trisomy and 1 case of trisomy 13-trisomy were found to be with missing right umbilical artery and all of them were complicated with multiple deformities. Conclusions The absence of left and right umbilical artery can be combined with abnormal fetal malformation. Prenatal ultrasonography can accurately diagnose SUA and fetal malformation.