胎儿胆管扩张症的超声特征

Ultrasonic Features of Fetal Biliary Dilatation

【目的】探讨胎儿胆管扩张症(biliary dilatation,BD)的超声特征。【方法】回顾性分析2018年3月至2020年8月在本院行产前超声筛查提示胎儿BD,分析其超声特征,比较出生前后囊性肿块的变化,追踪其预后情况。【结果】孕妇年龄19〜35(27.7±4.2)岁,第一次发现囊性肿块的平均孕周为18.1〜33.6(25.2±3.4)周。产前诊断胎儿BD病例22例,其中女性胎儿17例(77.3%),男性胎儿5例(22.7%)。产后超声符合率为81.8%(18/22);误诊率为18.2%(4/22),其中囊肿型胆道闭锁1例,肝囊肿2例,囊肿消退1例。囊性肿块多位于第一肝门区及胆囊周边,扫查胆囊区未见明显充盈胆囊声像病例3例,其余19例病例胆囊形态正常;囊性肿块形态欠规则13例,形态规则9例,所有病例均边界清晰;其中肿块内可见强光点漂浮的病例为2例,其余内透声可;22例病例中仅1例可见肝内胆管扩张;可见囊性肿块与肝内胆管相通的病例21例,1例病例未见与肝内胆管相通的管道。除误诊的4例,其余病例囊性肿块随着孕周延长而增大。【结论】胎儿ED产前超声诊断率较高,早期筛查明确诊断可改善预后。

【Objective】To analyze the sonographic findings of fetal biliary dilatation to predict clinical prognosis.【Methods】We retrospectively studied the prenatal ultrasound screening of fetal biliary dilation(BD)from March 2018 to August 2020 in our hospital.The ultrasonic characteristics of BD and changes of cystic mass before and after birth were analyzed to track the prognosis.【Results】Pregnant women were 19 to 35(27.7±4.2)years old and the average gestational age for prenatal cystic mass to be discovered at the first time was 18.1 to 33.6(25.2±3.4)weeks.There were 22 fetal BD cases diagnosed prenatally,including 17 female fetuses(77.3%)and 5 male fetuses(22.7%).The coincidence rate of postpartum ultrasound was 81.8%(18/22)and the misdiagnosis rate was 18.2%(4/22),including I case of cystic biliary atresia,2 cases of liver cyst,and I case of cyst regression.Cystic masses were mostly located in the first hepatic hilar area and the periphery of the gallbladder.There were 3 cases of gallbladder ultrasound imaging without obvious filling in the gallbladder area;while the other 19 cases had normal gallbladder morphology.There were 13 cases of cystic masses showing irregular shape and 9 cases were regular in shape.All the cases showed clear boundaries.There were 2 cases with.floating bright spots in the mass,and the rest showed normal ultrasound internally.In the 22 cases,only I case of intra-hepatic bile duct dilation was seen and 21 cases of cystic mass were linked to intrahepatic bile duct are visible.Except for the 4 misdiagnosed cases,the cystic masses in the remaining cases increased with the prolonged gestational age.【Conclusions】Prenatal ultrasound screening is a good way to make diagnosis for fetal bile duct dilatation,which can improve the prognosis.