三维超声对隔离肺胎儿肺发育情况的评估及随访应用

Evaluation and follow-up application of three-dimensional ultrasound on fetal lung development in pulmonary sequestration

目的利用三维超声虚拟器官计算机辅助分析(VOCAL)测量胎儿隔离肺体积,并计算肺头比(CVR)值,分析CVR值评估隔离肺胎儿预后的价值。方法收集108例中晚孕隔离肺胎儿的超声及临床资料,根据产前测量计算的CVR值分为CVR≥1.6组(48例)和CVR<1.6组(60例),对比两组胎儿胸腔积液发生率、心脏异常或畸形发生率、产后呼吸窘迫发生率及存活率。结果CVR≥1.6组合并胸腔积液32例(32/48,66.7%),心脏异常或畸形21例(21/48,43.8%),其中21例引产,余27例出生后出现呼吸窘迫者16例(16/48,33.3%),其中3例死亡,存活率50%(24/48);CVR<1.6组合并胸腔积液5例(5/60,8.3%),心脏异常5例(5/60,8.3%),娩出后有1例出现呼吸窘迫症状(1/60,1.7%),存活率100%(60/60)。两组胸腔积液发生率、心脏异常或畸形发生率、出生后呼吸窘迫发生率及存活率有显著差异,有统计学意义(P<0.01)。结论三维超声VOCAL技术可以准确地测量并计算CVR值,对指导产前咨询、随访并评估胎儿PS预后及临床治疗均有重要价值。

Objective To analyze the value of CVR value in evaluating the prognosis of fetus with pulmonary sequestration, the fetal pulmonary sequestration volume by three-dimensional ultrasound virtual organ computer-aided analysis(VOCAL) was measured, and the cystic adenomatoid malformation volume ratio(CVR) value was calculated. Methods The ultrasound and clinical data of 108 fetuses with pulmonary sequestration in the middle and late pregnancy were collected. And they were divided into CVR≥1.6 group(48 cases) and CVR<1.6 group(60 cases) according to the CVR value calculated by prenatal measurement. The incidence of fetal pleural effusion, the incidence of cardiac abnormalities or malformations, the incidence of postpartum respiratory distress and the survival rate were compared between the two groups. Results 32 cases combined with pleural effusion in CVR≥1.6 group(32/48, 66.7%), 21 cases were heart abnormality or deformity(21/48,43.8%), of which 21 cases induced labor, and 16 cases had respiratory distress after birth in the left 27 cases(16/48, 33.3%), of which 3 cases died, and the survival rate was 50%(24/48). 5 cases combined with pleural effusion in CVR<1.6 group(5/60,8.3%), and 5 cases were cardiac abnormalities(5/60, 8.3%), 1 case had respiratory distress symptoms after delivery(1/60,1.7%), and the survival rate was 100%(60/60). There were significant differences in the incidence of pleural effusion, heart abnormality or deformity, postnatal respiratory distress and survival rate between the two groups, all of which were statistically significant(P<0.01). Conclusion The three-dimensional ultrasound VOCAL technology can accurately measure and calculate the CVR value, which is of great value for guiding prenatal consultation, follow-up, and evaluation of the prognosis of fetal PS and clinical treatment.