产前超声在左侧先天性膈疝的诊断价值

Diagnostic Value of Prenatal Ultrasound in Left Congenital Diaphragmatic Hernia

目的探讨产前超声在左侧先天性膈疝(CDH)的诊断价值。方法选取2016年8月~2019年8月我院产前超声诊断为胎儿左侧CDH的70例超声影像资料,分析其声像图特征、超声表现及预后情况。结果 70例左侧CDH胎儿,灰阶声像图表现为胸腔内实性或囊实性占位、纵膈移位、肺发育不良、腹围缩小、膈肌回声缺损、胸腔积液,59例胸腔内可见胃泡,11例胃泡仍位于腹腔内;54例膈肌显示不完整,可见胸腔内包块经过膈肌的缺损与腹部相通,其余16例因孕周偏小和胎儿体位原因,膈肌显示不佳。70例诊断为胎儿左侧CDH的产妇,38例选择引产,足月妊娠26例,早产6例。32例分娩后的胎儿中,24例经手术后存活,3例手术后死亡,5例未经手术即死亡,总死亡率为25%(8/32);出生后LHR≤1.0的CDH患儿死亡率为71.43%,高于LHR 1.0~1.4和≥1.4的患儿的16.67%和7.69%,差异有统计学意义(P<0.05);出生后O/E LHR≤35%的CDH患儿死亡率为85.71%,高于O/E LHR 35%~45%、45%~65%和≥65%患儿的16.67%、10.00%和0,差异有统计学意义(P<0.05)。结论产前超声可用于诊断CDH,并可评估健侧肺发育情况及胎儿预后。

Objective To investigate the diagnostic value of prenatal ultrasound in left congenital diaphragmatic hernia(CDH).Methods From August 2016 to August 2019, 70 cases of ultrasound image data of fetal left-sided CDH diagnosed by prenatal ultrasound in our hospital were selected, and analyze its sonogram characteristics, ultrasound performance and prognosis.Results 70 cases of left-sided CDH fetus, grayscale sonogram showed solid chest or cystic solid space occupying, mediastinal displacement, lung dysplasia, abdominal circumference reduction, diaphragmatic echo defect,pleural effusion, 59 cases of intrapleural Gastric vesicles can be seen, 11 cases are still located in the abdominal cavity;54 cases of diaphragm muscles are incomplete, and the mass in the chest cavity can be seen to communicate with the abdomen through the diaphragm defect. The remaining16 cases have poor diaphragm performance due to small gestation and fetal position. 70 cases of maternal diagnosis of CDH on the left side of the fetus, 38 cases of induced labor, 26 cases of full-term pregnancy, 6 cases of premature delivery. Of the 32 fetuses after delivery, 24 survived after surgery, 3 died after surgery, and 5 died without surgery,with a total mortality rate of 25%(8/32);children with CDH with LHR ≤1.0 after birth mortality rate was 71.43%, higher than 16.67% and 7.69% of children with LHR 1.0 ~ 1.4 and ≥1.4, the difference was statistically significant(P<0.05);The mortality rate of CDH children with O/E LHR≤35% after birth is 85.71%, which is higher than 16.67%, 10.00% and 0 of O/E LHR 35%~ 45%, 45%~65% and≥65% children,the difference was statistically significant(P<0.05).Conclusion Prenatal ultrasound can be used to diagnose CDH, and can assess the development of the healthy lung and the prognosis of the fetus.