胎儿肾后段左下腔静脉畸形的产前超声诊断及预后分析

Preatal ultrasound diagnosis and prognosis of fetal posterior renal segment left inferior vena cava malformation

目的总结胎儿肾后段左下腔静脉畸形的产前超声图像特征并进行临床预后分析。方法回顾性分析接受产前超声检查的27637名孕妇的临床资料,总结超声检查发现的胎儿肾后段左下腔静脉畸形病例的超声图像特征及临床预后情况。结果27637名孕妇,产前超声检查共诊断胎儿肾后段左下腔静脉畸形12例(0.4%)。超声图像显示,胎儿肾门下方的下腔静脉在腹主动脉的左侧,在肾门斜向跨越腹主动脉的前方,肾门上下腔静脉走行于腹主动脉右前侧,经肝脏最后回流至右心房。12例肾后段左下腔静脉畸形胎儿,均未合并其他系统结构畸形,其中10例进行了产前诊断,染色体和基因芯片检查均未发现异常,2例未进行产前诊断。放弃胎儿引产1例,足月分娩11例,其中9例经产后新生儿超声检查确诊,2例产后未经进一步的检查;足月分娩的11例产后随访均诉新生儿一般状况良好。结论胎儿肾后段左下腔静脉畸形有典型产前超声表现,对孕妇开展胎儿肾后段左下腔静脉畸形产前超声筛查非常必要,以改善新生儿预后。

Objective To summarize the prenatal ultrasonographic features of fetal posterior renal segment left inferior vena cava malformation and to analyze the clinical prognosis.Methods the clinical data of 27637 pregnant women who received prenatal ultrasonography were analyzed retrospectively,and the ultrasonic image features and clinical prognosis of fetal posterior renal segment left inferior vena cava malformations were summarized.Results Among 27637 pregnant women,12 cases(0.4%o)of fetal posterior renal segment left inferior vena cava malformations were diagnosed by prenatal ultrasonography.Ultrasound images showed that the inferior vena cava below the fetal renal hilum was on the left side of the abdominal aorta,in front of the renal hilum diagonal across the abdominal aorta,and the superior inferior vena cava of the renal hilum ran in front of the right side of the abdominal aorta,and finally returned to the right new chamber through the liver.None of the 12 fetuses with posterior renal segment left inferior vena cava malformations were complicated with other structural malformations.10 of them received prenatal diagnosis,but no abnormalities were found by chromosome and gene chip examination,and 2 cases did not receive prenatal diagnosis.1 case gave up fetal labor induction,1l cases delivered to term.Among them,9 cases were confirmed by postpartum ultrasound examination,and 2 cases did not undergo further postpartum examination.All the 11 cases of full-term delivery reported that the newborns were in good condition.Conclusion The left inferior vena cava malformation of the posterior segment of fetal kidney has typical prenatal ultrasonography.It is very necessary for pregnant women to carry out prenatal ultrasonography screening for the left inferior vena cava malformation of the posterior segment of fetal kidney to improve the prognosis of newborns.