胎儿先天性胆总管囊肿产前超声诊断价值及出生后随访分析

Value of prenatal ultrasound diagnostic and analysis of postnatal follow-up of fetal congenital choledochal cyst

目的:通过分析胎儿先天性胆总管囊肿的产前超声声像图特征及出生后随访结果,探讨胎儿先天性胆总管囊肿的产前超声诊断价值。方法:回顾性分析2018年1月—2020年1月在浙江大学医学院附属妇产科医院进行产前超声检查并确诊胎儿为先天性胆总管的34例孕妇的产前超声声像图以及出生后患儿的随访资料,最终将产前诊断结果与手术后病理进行对比,总结产前超声图像特点,分析产前超声诊断价值及出生后预后情况。结果:34例胎儿中,5例选择引产(14.7%),继续妊娠至分娩29例(85.3%)。3例于36周+行剖宫产分娩,26例妊娠至足月后分娩。25例患儿出生后复查超声检查提示先天性胆总管囊肿,均接受手术治疗,手术时间均在出生后的3个月内,手术病理结果证实为先天性胆总管囊肿。余4例中2例出生后腹部超声提示为肝囊肿,1例腹部超声及MRI提示正常,1例出生后诊断为胆道闭锁。产前产后的诊断符合率为73.5%(25/34),误诊率11.8%(4/34)。胎儿胆总管囊肿的超声图像特征表现为右上腹肝门部或胆囊旁的囊肿,囊壁薄,与胆囊和/或其周围肝内胆管相通,彩色多普勒显示囊肿内无血流信号。结论:先天性胆总管囊肿可通过产前超声发现,为非致死性先天畸形,可通过手术治疗,出生后及时地进行手术治疗,预后多理想,故产前咨询时不宜盲目建议终止妊娠。

Objective Through analyzing the prenatal ultrasonographic features,and postnatal follow-up results of fetal congenital choledochal cyst,to explore the diagnostic value of prenatal ultrasound for fetal congenital choledochal cyst.Methods The prenatal ultrasound images of 34 pregnant women who underwent prenatal ultrasound examination in Women’s Hospital of School of Medicine of Zhejiang University and were diagnosed with fetuses with congenital choledochal cyst from January 2018 to January 2020 and follow-up data of child after birth were analyzed retrospectively.Finally,The results of prenatal diagnosis and postoperative pathology were compared,and prenatal ultrasound image features,analysis value of prenatal ultrasound diagnosis and prognosis outcome of postnatal were summarized.Results Among the 34 cases,5 cases were chose to induce labor(14.7%),29 cases were chose continuing pregnancy to delivery(85.3%).3 cases were delivered by caesarean section at 36 weeks+,and 26 cases were delivered after pregnancy to term.25 cases of children with congenital choledochal cyst were diagnosed by ultrasonography after birth.All received surgical treatment,and the operation time was within 3 months after birth,and pathological results of surgical confirmed congenital choledochal cyst.Among the remaining 4 cases,2 cases were diagnosed as liver cysts by abdominal ultrasound after birth,1 case was normal by abdominal ultrasound and MRI,and 1 case was diagnosed as biliary atresia after birth.The prenatal diagnosis rate was 73.5%(25/34),and the misdiagnosis rate was 11.8%(4/34).Ultrasound image features of fetal choledochal cysts were cysts in the right upper quadrant hepatic hilum or adjacent to the gallbladder,with thin cyst walls that communicate with the gallbladder and/or its surrounding intrahepatic bile ducts.Color Doppler flow imaging showed no blood flow in the cyst.Conclusion Congenital choledochal cysts can be found by prenatal ultrasound.Congenital choledochal cysts was non-fatal congenital malformations and can be treated by surgery.Surgical treatment seasonable which has a good prognosis after birth.Therefore,there is no need to recommend termination of pregnancy during prenatal consultation.