先天性肺囊腺瘤样畸形的产前超声诊断及预后判断

The effect of prenatal ultrasonography in diagnosis and prognosis of congenital cyst adenomatous malformation

目的总结先天性肺囊腺瘤样畸形(CCAM)的产前超声图像特点,并判断其预后。方法选取我院行产前超声诊断的CCAM胎儿46例,根据其囊肿大小进行分型。回顾性分析并比较各类型CCAM的产前超声图像特点、胸廓指标,以及有无合并纵隔移位、羊水过多、胎儿水肿或积液及其他畸形,随访体积变化及预后。结果46例CCAM胎儿,根据其囊肿大小分为大囊型(Ⅰ型)9例、中囊型(Ⅱ型)22例和微囊型(Ⅲ型)15例。①产前超声表现:病变位于单侧43例,双侧3例。Ⅰ型、Ⅱ型、Ⅲ型的CCAM体积比逐渐增大,肺体积与胸廓体积比值逐渐变小,差异均有统计学意义(均P<0.05),而肿块体积、胸廓横径、胸廓前后径、胸廓面积、胸围、肺体积及胸廓体积间比较差异均无统计学意义。②合并症:Ⅲ型合并羊水过多、胎儿水肿或积液最多,Ⅰ型最少,差异有统计学意义(P<0.05),而在有无纵隔移位、合并其他畸形及随访体积变小方面比较差异均无统计学意义。③预后:不同分型CCAM在妊娠结局上,Ⅲ型预后最差(P<0.05),而在产后干预上差异无统计学意义,合并胎儿水肿预后差。结论CCAM具有典型的产前超声特征,不同类型CCAM的囊肿大小、CCAM体积比、肺体积与胸廓体积比值及合并症均有所差异;产前超声可根据其分型及合并症判断预后,其中Ⅲ型预后较Ⅰ型、Ⅱ型差。

Objective To summarize the prenatal ultrasonography characteristics of congenital cystic adenomatoid malformation(CCAM)and determine its prognosis.Methods Forty-six fetuses with prenatally diagnosed CCAM using ultrasound were selected and classified according to the size of their cysts.The prenatal ultrasonographic features,thoracic indicators,whether complicated with mediastinal shifts,polyhydramnios,fetal edema or hydrops and other malformations were analyzed and compared,and follow-up volume changes and prognosis.Results Forty-six CCAM fetuses were divided into 9 cases of large capsule type(typeⅠ),22 cases of medium capsule type(typeⅡ)and 15 cases of microcapsule type(typeⅢ)according to the size of their cysts.①Prenatal ultrasonography characteristics of CCAM:lesions were located in unilateral thorax in 43 cases and bilateral thorax in 3 cases.The CCAM volume ratio(CVR)was gradually increased but lung volume to thoracic volume ratio was gradually decreased in three CCAM types,the difference was statistically significant(all P<0.05),while there were no significant differences in mass volume,thoracic transverse diameter,anteroposterior diameter,chest area,chest circumference,lung volume and thoracic volume.②Complications of CCAM:the presence or absence of polyhydramnios,fetal edema and hydrops were different among different types,typeⅢwas the most,and typeⅠwas the least(P<0.05),while there were no statistically significant differences in mediastinal shift,other malformations and decreased mass size at follow-up.③Prognosis of CCAM:the pregnancy outcomes were different in different types,typeⅢwas the worst(P<0.05),while there were no statistically significant differences in postpartum intervention.The prognosis of fetuses complicated with edema was poor.Conclusion Prenatal ultrasonography characteristics of CCAM is typical.The classification of CCAM is related to the size of cyst,CVR,lung volume to thoracic volume ratio and complications.Prenatal ultrasound can evaluate the prognosis according to the types and complications,typeⅢis worse than typeⅠand typeⅡ.