二维超声横切面观察唇裂胎儿硬腭的研究

Study on two-dimensional ultrasound cross-sectional method on observing hard palate of cleft lip fetus

目的:探讨二维超声横切面法判断唇裂胎儿硬腭裂及唇腭裂分型的准确性。方法:收集在我院产检或外院转诊至我院诊断或疑诊为胎儿唇裂的病例190例,所有患者均经出生或引产后证实。产前超声在诊断胎儿唇裂的基础上,使用横切面法观察胎儿牙槽突及继发硬腭是否中断,与出生后结果对照,统计横切面法诊断牙槽突裂、继发硬腭裂及唇腭裂分型的准确性。同时观察合并畸形并统计不同程度唇腭裂合并畸形的差异。结果:产前超声共诊断147例胎儿牙槽突裂,误诊2例,诊断43例未见牙槽突裂,漏诊2例,产前超声诊断牙槽突裂的敏感性为98.6%,特异性为95.3%。产前超声诊断107例胎儿有继发硬腭裂,误诊2例,诊断83例胎儿没有继发硬腭裂,漏诊1例,产前超声诊断继发硬腭裂的敏感性为99.1%,特异性为97.6%。190例唇裂胎儿合并牙槽突裂及继发硬腭裂的分型情况,产前超声误诊7例,误诊率为3.7%。唇裂合并完全性腭裂胎儿合并其他畸形的发生率高于唇裂合并牙槽突裂及单纯唇裂的胎儿,差异均有统计学意义(P<0.05)。结论:二维超声横切面法应用于唇裂胎儿腭裂严重程度的评估及腭裂分型中有较高的准确性,有利于产前临床预后咨询。

Objective:To investigate the accuracy of the two-dimensional ultrasound cross-sectional method in judging the classification of cleft lip fetus with hard cleft palate and cleft lip and palate.Methods:A total of 190 cases of fetal cleft lip diagnosed or suspected were collected from our hospital’s prenatal examination or referral to our hospital.All the cases were confirmed by birth or induced labor.On the basis of prenatal ultrasound diagnosis of fetal cleft lip,the transverse section method was used to observe whether the fetal alveolar process and secondary hard palate were interrupted,and the accuracy of the classification of alveolar process cleft,secondary hard cleft palate,and cleft lip.The palate diagnosed by the transverse section method was calculated and compared with the results after birth.At the same time,the combined deformities were observed and the differences of different degrees of cleft lip and palate combined deformities were counted.Results:One hunderd and forty-seven cases of fetal alveolar cleft were diagnosed by prenatal ultrasound,2 cases were misdiagnosed,43 cases were diagnosed as no alveolar cleft,and 2 cases were missed diagnosis.The sensitivity and specificity of prenatal ultrasound in diagnosing alveolar cleft were 98.6%and 95.3%,respectively.Prenatal ultrasound diagnosed 107 fetuses with secondary hard cleft palate,2 misdiagnosed,83 fetuses without secondary hard cleft palate and 1 missed diagnosis.The sensitivity and specificity of prenatal ultrasound in diagnosing secondary hard cleft palate were 99.1%and 97.6%,respectively.Of 190 cleft lip fetuses complicated with the alveolar process and secondary hard cleft palate,7 were misdiagnosed by prenatal ultrasound,with a misdiagnosis rate of 3.7%.The incidence rate of cleft lip complicated with complete cleft palate complicated with other malformations was higher than that of cleft lip complicated with alveolar cleft and simple cleft lip,and the difference was statistically significant(P<0.05).Conclusion:The two-dimensional transverse section method has high accuracy in evaluating the severity of cleft palate in cleft lip fetus and cleft palate classification,which is conducive to prenatal clinical prognosis consultation.