胎儿脉管性疾病的超声特征与预后分析

Ultrasonographic features and prognosis of fetal vascular anomalies

目的探讨胎儿脉管性疾病的超声特征并进行预后分析。方法回顾性分析2013年6月至2018年8月长沙市妇幼保健院诊断为脉管性疾病的31例胎儿,超声仔细观察病灶的部位、大小、形态、内部回声及血流分布,追踪随访,分析预后。结果31例胎儿中,10例经引产后尸体解剖证实,21例经产后局部观察外观或手术与病理证实。其中静脉畸形肢体肥大综合征(KTS)4例(包括Parkes-Weber综合征1例),血管瘤3例,原发性先天性淋巴水肿1例,淋巴管瘤23例。31例病灶均与超声定位诊断吻合,其中头颈部9例,躯干部15例,上肢1例,下肢6例。3例胎儿病灶内有动静脉瘘血流频谱,28例胎儿病灶内无明显血流信号。结论产前超声检查及随访对胎儿脉管性疾病的诊断、预后判断具有重要作用。胎儿脉管性疾病的预后与病变的部位、大小、对周围组织的影响以及病灶内血液的分流量密切相关。

Objective To investigate the ultrasonographic features and prognosis of fetal vascular anomalies.Methods Thirty-one fetuses with vascular anomalies diagnosed from June 2013 to August 2018 in Changsha Hospital for Maternal and Child Health Care were retrospectively analyzed.The location,size,shape,internal echo and blood flow distribution of the lesions were observed by ultrasound carefully,and the prognosis was followed up and analyzed.Results Among the 31 cases of fetal vascular anomalies,10 cases were comfirmed by autopsy after induced labor,and 21 cases were confirmed by postpartum local observation or surgery and pathology.Among them,there were 4 cases of Klippel-Trenaunay syndrome(including 1 case of Parkes-Weber syndrome),3 cases of hemangioma,1 case of primary congenital lymphedema and 23 cases of lymphangioma.Thirty-one cases showed lesions coincident with ultrasound localization and diagnosis,including 9 cases of head and neck lesions,15 cases of trunk lesions,1 case of upper limb lesion and 6 cases of lower limb lesions.The blood flow spectra of arteriovenous fistulas were found in 3 cases of fetal lesions and no obvious blood flow signals were found in 28 cases of fetal lesions.Conclusions Prenatal ultrasound examination and follow-up play an important role in the diagnosis and prognostic prediction of fetal vascular diseases.The prognosis of fetal vascular diseases is closely related to the location,size,effect on the surrounding tissue and shunt volume of the lesion.