早孕期胎儿腹壁缺损的超声诊断

Ultrasound diagnosis of fetal abdominal wall defects in the first trimester

目的探讨早孕期胎儿腹壁缺损的超声图像特征及临床诊断价值。方法收集2019年1月至2021年12月湖北省妇幼保健院早孕期产前超声诊断和引产后病理证实的胎儿腹壁缺损病例77例,对其超声声像图与生后病理检查进行对比分析。结果77例早孕期腹壁缺损胎儿中,脐膨出47例,超声表现为胎儿脐部见腹腔器官向外膨出,外有包膜覆盖,脐带附于包块的顶端;腹裂19例,超声表现为胎儿脐部见腹腔器官向外膨出,漂浮于羊水中,无包膜覆盖,腹壁缺损多位于脐部右侧;体蒂异常7例,超声主要特征为腹壁(或胸腹壁)缺损伴器官外翻、脊柱侧弯、肢体畸形、脐带短;羊膜带综合征3例,主要超声特征为羊水中可见漂浮的光带黏附于胎儿,并出现与光带相关的肢体、腹壁等截断畸形;泄殖腔畸形1例,超声主要特征是脐膨出、脊柱侧弯、膀胱显示不清。2例脐膨出漏诊。本组早孕期腹壁缺损超声诊断率为97.4%(75/77)。结论早孕期胎儿腹壁缺损超声声像图表现看似简单,均为向外膨出的包块,但腹壁缺损可能为包含多器官畸形的疾病,早孕期超声具有较高的诊断价值。

Objective To investigate the ultrasound image characteristics and their clinical diagnostic value in fetal abdominal wall defects in early pregnancy.Methods A total of 77 cases of fetal abdominal wall defects diagnosed by prenatal ultrasound and confirmed by postnatal pathological examination at Hubei Maternal and Child Health Hospital from January 2019 to December 2021 were collected.A comparative analysis was conducted between the ultrasound images and postnatal pathological examination results.Results Among the 77 cases of fetal abdominal wall defects in early pregnancy included,47 were diagnosed with omphalocele.Ultrasound revealed the protrusion of fetal abdominal organs from the umbilical region,covered by a membrane,with the umbilical cord attached to the top of the mass.There were 19 cases of gastroschisis,where ultrasound showed fetal abdominal organs in the amniotic fluid without a covering membrane,and the majority of abdominal wall defects were located on the right side of the umbilical region.Additionally,there were 7 cases of body stalk anomaly,characterized by abdominal(or thoracoabdominal)wall defects accompanied by major abdominal wall defect and mass,scoliosis,limb deformity,and short umbilical cord.Furthermore,3 cases of amniotic band syndrome were identified,displaying a floating band adhering to the fetus in the amniotic fluid,with associated limb deformity and abdominal wall defect.One case of cloacal exstrophy was observed,showing omphalocele,scoliosis,and non-visualization of the bladder.Two cases of omphalocele were missed.The ultrasonic diagnostic rate of fetal abdominal wall defects in this group of patients was 97.4%(75/77).Conclusion The ultrasound images of fetal abdominal wall defects in the first trimester seem simple,appearing as abdominal wall defect and mass.However,these defects may involve multiple organ malformations.First trimester ultrasound has high diagnostic value in detecting these abnormalities.