胎儿肠扭转及肠套叠的产前超声诊断及漏误诊分析

Prenatal ultrasound diagnosis of fetal intestinal volvulus and intussusception and misdiagnosis analysis

目的探讨胎儿肠扭转及肠套叠的产前超声图像特征,并对漏误诊进行分析。方法总结2017年6月至2018年12月期间在我院经产前超声诊断和(或)生后证实的11例肠扭转及肠套叠的产前二维及三维声像图特征并随访其预后。结果11例胎儿中有8例肠扭转,3例肠套叠。8例肠扭转中产前超声正确诊断6例,漏诊2例:正确诊断的6例中有3例二维声像图上出现了典型的"漩涡征",1例呈"咖啡豆征",6例三维声像图均显示肠管呈"盘绕征"。3例肠套叠中均出现了"面包圈征",其中1例宫内肠管自动复位。11例胎儿中1例引产;1例尚在妊娠中;9例出生并经手术证实,1例术后死亡。结论肠扭转及肠套叠有其特征性声像图表现,当出现短期内胎儿肠管扩张伴胎粪性腹膜炎时需考虑这两种急腹症的存在,但当其伴有肠管坏死时,二维声像图的典型征象会缺失,三维成像可辅助诊断。

Objective To investigate the characteristics of prenatal ultrasound sonography of fetal intestinal volvulus and intussusception, and analyze the misdiagnosis. Methods The prenatal two-dimensional and three-dimensional sonographic features of 11 patients with volvulus and intussusception confirmed by prenatal ultrasound and/or postnatal confirmation from June 2017 to December 2018 were summarized and the prognosis were followed up. Results Of the 11 fetuses, 8 had intestinal volvulus and 3 had intussusception. Of the 8 cases of intestinal volvulus, 6 cases were correctly diagnosed by prenatal ultrasound, and 2 cases were missed. Among the 6 cases diagnosed correctly, 3 cases showed a typical " vortex sign" on the two-dimensional sonogram. One case showed " coffee beans" sign, and 6 cases of three-dimensional sonograms showed that the intestines were " coiled"." Bread ring" sign appeared in 3 cases of intussusception, and 1 case of intrauterine intestine was automatically reset. One of the 11 fetuses was induced to give birth, 1 was still in pregnancy;9 cases were born and confirmed by surgery, 1 case died after operation. Conclusions Intestinal volvulus and intussusception have their characteristic sonographic features.When there is a short-term fetal bowel dilatation with meconium peritonitis, the existence of these two acute abdomen should be considered, but when it is accompanied by intestinal necrosis, typical signs of two-dimensional sonograms are missing, and three-dimensional imaging aids in diagnosis.