先天性脐膨出:产前MRI表现与出生后闭合方式

Congenital omphalocele:Fetal MRI manifestations and postpartum closure type

目的 观察先天性脐膨出(CO)胎儿MRI表现与出生后闭合方式的关系。方法 回顾性分析10例CO,根据出生后治疗方案分为一期组(n=5,一期手术缝合)及保守组(n=5,囊膜悬吊保守治疗);基于胎儿MRI测量腹壁缺损直径(DD)、膨出物体积(OV)及脏腹失调比(OV/APV),以Bland-Altman图评价观察者间测量结果的一致性,比较组间基本资料及MRI指标差异。结果 2组患儿接受MR检查时胎龄、出生胎龄及体质量差异均无统计学意义(P均>0.05);保守组出生后初次住院时间长于一期组(P<0.05)。10例CO胎儿MRI均见腹内结构由腹壁缺损处向外膨出,其内可含多种结构,脐带由此插入。胎儿期MRI显示,一期组5例中,肝脏及肠管膨出各3例,胃及胆囊膨出各1例;保守组5例均见肝脏膨出,4例肠管膨出,胃及胆囊膨出各3例,脾脏膨出2例。Bland-Altman图示基于胎儿MRI测量DD、OV及OV/APV结果的观察者间一致性较好,一期组OV/APV小于保守组(P<0.05),而组间DD及OV差异无统计学意义(P均>0.05)。结论 CO胎儿MRI表现为腹内结构由腹壁缺损处向外膨出,其内可含多种结构;无肝脏膨出或OV/APV较小提示出生后可行一期手术治疗,对脾脏、胃脏或胆囊膨出,尤其脾脏膨出者则宜采用保守治疗。

Objective To observe the relationships of fetal MRI manifestations and postpartum closure type of congenital omphalocele(CO). Methods Data of 10 newborns with CO were retrospectively analyzed. The newborns were divided into one-stage group(n=5, one-stage surgical suture) and conservative group(n=5, conservative treatment with capsular suspension) according to the postnatal treatment plan. The defect diameter(DD) of abdominal wall, omphalocele volume(OV) and viscero-abdominal disproportion ratio(OV/APV) on fetal MRI were measured. The intra-observer consistencies of the above indicators were evaluated using Bland-Altman plot. The basic data of newborns and fetal MRI indicators were compared between groups. Results There was no significant difference of the gestational age(MR examination), birth gestational age nor birth weight between groups(all P>0.05). The duration of initial hospitalization after birth in conservative group was longer than that in first-stage group(P<0.05). Fetal MRI showed omphalocele presenting as outward bulge at the site of abdominal wall defect, which might included hepatocele, splenocele, gastrocele, gallocele and enterocele, and umbilical cord inserted at the same site. In first-stage group, fetal MRI showed hepatocele and enterocele in 3 cases, gastrocele and gallocele each in 1 case. In conservative group, all 5 cases were found with hepatocele, while 4 with enterocele, 3 with gastrocele and 3 with gallocele, 2 with splenocele. Bland-Altman plot showed that the measured results of DD, OV and OV/APV of CO on fetal MRI had good intra-observer consistencies. OV/APV of the first stage group was lower than that of the conservative group(P<0.05). There was no significant difference of DD and OV on fetal MRI between groups(both P>0.05). Conclusion Fetal MRI of CO manifested as outward bulge at the defect of abdominal wall with various internal structures. No liver eviscerated and small OV/APV indicated primarily closure could be performed after birth, while splenocele, gastrocele and gallocele should be treated conservatively, especially splenocele.