胎儿肠扭转的产前超声诊断及临床预后探讨

Prenatal Ultrasound Diagnosis and Clinical Prognosis of Fetal Intestinal Volvulus

【目的】探讨胎儿肠扭转的产前超声特征及临床预后。【方法】回顾性分析2017年6月至2021年3月在广东省妇幼保健院超声科进行产前超声检查、超声提示肠扭转或产后证实肠扭转的17例胎儿的超声表现及临床资料,以肠管扩张合并漩涡征或血管螺旋征为诊断肠扭转的标准,并随访胎儿出生后手术病理或引产后尸体解剖结果,追踪其临床预后。【结果】17例孕妇年龄介于24~40岁,中位数29(26~33)岁;初次诊断肠扭转的孕周介于24~33周,中位数26(24~31)周。17例胎儿在妊娠过程中均出现肠管扩张,16例存在漩涡征,13例存在血管螺旋征,2例存在咖啡豆征。10例胎儿出生,7例引产(含2例胎死宫内者)。出生后9例接受手术证实肠扭转(其中7例伴有肠坏死),1例自愈无需治疗。2例引产儿尸体解剖证实肠扭转,另外5例引产后未进行尸体解剖。接受手术的患儿7例术后恢复良好,2例因肠管坏死严重术后短期内死亡。经手术或尸体解剖证实存在肠扭转的11例胎儿,在25次系统性产前超声检查中超声征象阳性率为:肠管扩张(22/25)、漩涡征(20/25)、血管螺旋征(15/25)、咖啡豆征(2/25)、腹腔积液(6/25)、腹部囊性包块(1/25)、羊水过多(6/25);手术或病理证实肠扭转坏死的7例胎儿,全部具有提示肠坏死或穿孔的相关的超声征象:腹水(5/7)、肠管结构模糊(1/7)、肠管血流信号减弱或消失(2/7)、肠管扩张程度减轻(1/7)、咖啡豆征(2/7)。【结论】胎儿先天性肠扭转有其特征性的声像图表现,产前超声对其诊断和监测具有重要应用价值,可为产前咨询及临床处理提供重要依据。

【Objective】To investigate the prenatal ultrasound manifestations of fetal intestinal volvulus,and to analyze the prognosis.【Methods】Prenatal ultrasound features of 17 pregnant women with fetal intestinal volvulus confirmed by surgery and pathology at Guangdong Women and Children Hospital from June 2017 to March 2021 were analyzed retrospectively and the prognosis were followed up.【Results】The ages of the subjects were 24 to 40 years old,with median age of 29(26~33)years old. Antepartum diagnosis found the gestational age was 24 to 33 weeks,with median gestational age of 26(24~31)weeks. Prenatal ultrasound found 17 cases had bowel obstruction,16 cases showed a typical"whirlpool sign",13 cases showed twisting of mesenteric vessels,2 cases showed coffee bean sign. Among the 17 cases,10 cases were delivered and 7 cases were induced(including 2 cases of intrauterine fetal death). Among 10 cases born,9 cases of intestinal volvulus were confirmed by surgery(7 cases were accompanied by intestinal necrosis),and 1 case of intestinal volvulus was healed spontaneously. Among the 7 cases of labor induction,autopsy in 2 cases confirmed intestinal volvulus,and the other 5 cases did not undergo autopsy. Among the 9 cases of intestinal volvulus,7 cases recovered well after operation,and 2 cases died within a short period of time due to severe intestinal necrosis. In the 25 ultrasound examinations,the ultrasonographic patterns of intestinal volvulus in the 11 cases confirmed by surgery and pathology were dilated small intestine(22 times), "whirlpool" signs(20 times),clockwise wrapping of branch vessels of the superior mesenteric vein and the superior mesenteric artery(15 times),and "coffee bean" sign(2 times),ascites(6 times),polyhydramnios(6 times),pseudocysts(once). All the 7 cases of intestinal necrosis appeared associated signs in the ultrasound examinations,including ascites(5 times),the ambiguous intestine structure(once),intestinal blood flow decreased or disappeared(twice),the intestinal dilatation decreased(once), "coffee bean" sign(twice).【Conclusions】Most fetal intestinal volvulus has characteristic sonographic features. Prenatal ultrasound has important application value in the diagnosis and monitoring of intestinal volvulus,which could provide important information for prenatal consultation and clinical treatment.