产前超声诊断胎儿肝内门静脉-肝静脉瘘的临床价值

Clinical Value of Prenatal Ultrasound in Diagnosing Fetal Intrahepatic Portal Vein-Hepatic Vein Fistula

目的 探讨胎儿肝内门静脉-肝静脉瘘诊断中产前超声的临床价值,为临床诊治提供参考。方法回顾性分析2017年2月-2022年2月襄阳紫荆妇产医院收治的50例经二维超声诊断为肝内门静脉-肝静脉瘘胎儿的临床资料,均接受二维超声检查、彩色多普勒超声检查等产前超声检查,以临床检查为金标准。分析彩色多普勒超声检查结果、预后。结果 44例阳性胎儿中,在分流类型方面,左内支与中肝静脉、左外支与左肝静脉、左外下支与中肝静脉及左内支与中肝静脉吻合比率高于左肝及中肝多处吻合;在合并异常情况方面,双肾盂增宽与胎儿生长受限占比比较,差异无统计学意义(P>0.05);在产后闭合时间方面,3个月与6个月比较,经统计学的计算发现,差异无统计学意义(P>0.05)。50例患者中,临床确诊阳性44例,阴性6例;41例的阳性,9例的阴性为彩色多普勒超声的检查结果。以临床确诊为金标准,彩色多普超声检查的灵敏性为90.91%(40/44),特异性为83.33%(5/6),准确性为90.00%(45/50),阳性预测值为97.56%(40/41),阴性预测值为55.56%(5/9)。结论 胎儿肝内门静脉-肝静脉瘘诊断中产前彩色多普勒超声检查的临床价值较二维超声检查稍高,值得推广。

Objective To explore clinical value of prenatal ultrasound in diagnosis of fetal intrahepatic portal vein-hepatic venous fistula,and provide reference for clinical diagnosis and treatment.Methods The paper reveiwed and analyzed clinical data of 50 fetuses diagnosed with intrahepatic portal vein hepatic venous fistula by two-dimensional ultrasound admitted to Xiangyang Bauhinia Obstetrics and Gynecology Hospital from February 2017 to February 2022,treated with prenatal ultrasound examinations including two-dimensional ultrasound and color Doppler ultrasound.With gold standard of clinical examination,examination result and prognosis of color Doppler ultrasound examination was analyzed.Results Among 44 positive fetuses,in terms of shunt types,anastomosis rates of left internal branch to middle hepatic vein,left external branch to left hepatic vein,left lower external branch to middle hepatic vein,and left internal branch to middle hepatic vein was higher than multiple anastomosis sites in left liver and middle liver.In terms of merging abnormal situations,there was no statistically significant difference in proportion of double renal pelvis widening and fetal growth restriction(P>0.05).In terms of postpartum closure time,there was no statistically significant difference between 3 months and 6 months after statistical calculation(P>0.05).Among the 50 patients,44 were clinically confirmed positive and 6 cases were negative,41 cases were positive,and 9 negative cases were results of color Doppler ultrasound examination.With of gold standard clinical diagnosis,sensitivity of color Doppler ultrasound examination was 90.91%(40/44),specificity was 83.33%(5/6),accuracy was 90.00%(45/50),positive predictive value was 97.56%(40/41),and negative predictive value was 55.56%(5/9).Conclusion Prenatal color Doppler ultrasound can achieve slightly higher clinical value in diagnosis of fetal intrahepatic portal vein-hepatic vein fistula than twodimensional ultrasound,which is worthy of promotion.