胎儿肠管增宽的超声影像特征及其与新生儿预后的相关性

Ultrasound imaging features of fetal intestine widening and its correlation with neonatal prognosis

目的观察胎儿肠管增宽的超声影像特征并分析其与新生儿预后的相关性。方法抽取2016年1月至2019年3月驻马店市中心医院接收的产前筛查孕妇8243例,采用彩色多普勒超声产前检查,检查出肠管增宽的胎儿98例,排除失访和无生产记录18例,入选肠管增宽胎儿80例,观察胎儿肠管增宽超声影像特征,测定肠管最宽内径,诊断胎儿肠管增宽的部位,告知孕妇新生儿可能的预后情况,决定引产的孕妇,于引产前进行羊膜腔穿刺,采集脐带血进行染色体核型分析,并对引产胎儿进行剖检,验证超声影像诊断;决定继续妊娠的孕妇,分娩时取脐带血进行染色体核型分析,并记录产后新生儿的排便情况,正常排便为预后良好,非正常排便的为预后不良,预后不良新生儿进行钡餐造影与腹部X线检查,判断是否有肠梗阻,并进行肠梗阻分型。结果胎儿肠管增宽发生率为1.19%;80例肠管增宽的胎儿中,十二指肠肠管增宽13例(16.25%),空回肠肠管增宽31例(38.75%),结肠肠管增宽36例(45.00%);空回肠肠管增宽与结肠肠管增宽的胎儿羊水过多、染色体异常、引产与胎儿死亡的比例低于十二指肠肠管增宽的胎儿(P<0.05);69例继续妊娠孕妇中,新生儿预后良好23例(33.33%),新生儿预后不良46例(66.67%),46例新生儿预后不良中十二指肠闭锁6例,结肠闭锁8例,小肠畸形24例,直肠肛门闭锁7例,先天性巨结肠1例。结论胎儿肠管增宽与新生儿消化道畸形密切相关,对选择继续妊娠的孕妇,应定期检查,根据胎儿肠道增宽部位,增宽程度,羊水过多与染色体异常情况,综合判断新生儿肠梗阻的情况。

Objective To observe ultrasound imaging features of fetal intestinal widening,and analyze its correlation with neonatal prognosis.Methods A total of 8243 pregnant women who underwent prenatal screening and were admitted to the Zhumadian Central Hospital during the period from January 2016 to March 2019 were enrolled.Prenatal examination with color Doppler ultrasound,there were 98 cases with intestinal widening.After excluding the 18 cases with follow-up loss and without production records,80 cases with with intestinal widening were enrolled.Ultrasound imaging features of fetal intestine widening were observed.The widest inner diameter of intestine was measured.The locations of fetal intestinal widening were diagnosed.The possible prognosis of neonates was informed to pregnant women.For pregnant women who decided to induce labor,amniocentesis was performed before induction of labor.The umbilical cord blood was collected for karyotype analysis.The necropsy was performed for induced fetus.The ultrasound imaging diagnosis was verified.For pregnant woman who decided to continue pregnancy,umbilical cord blood was collected at delivery for karyotype analysis.The neonatal defecation after delivery was recorded.Normal defecation was defined as good prognosis,while abnormal defecation as poor prognosis.For neonates with poor prognosis,barium radiography and abdominal X-rays were applied to determine presence or absence of intestinal obstruction.The intestinal obstruction typing was conducted.Results The incidence of fetal intestinal widening was 1.19%.In 80 fetus with intestinal widening,there were 13 cases(16.25%)with duodenum widening,31 cases(38.75%)with jejuno-ileum widening,and 36 cases(45.00%)with colon widening.The proportions of fetus with polyhydramnios,chromosomal abnormalities,induction of labor and death in fetus with jejuno-ileum widening and colon widening were significantly lower than those with duodenum widening(P<0.05).Among 69 pregnant women who continued pregnancy,there were 23 cases(33.33%)with good neonatal prognosis,46 cases(66.67%)with poor neonatal prognosis.Among 46 cases with poor neonatal prognosis,there were 6 cases with duodenal atresia,8 cases with colonic atresia,24 cases with small intestinal malformation,7 cases with rectal anal atresia,and 1 case with congenital megacolon.Conclusions Fetal intestinal widening is closely related to neonatal digestive tract malformation.For pregnant women who choose to continue pregnancy,they should be checked regularly.According to widening locations and degree,polyhydramnios and chromosomal abnormalities,the neonatal intestine obstruction should be comprehensively judged.