胎儿先天性胆总管囊肿产前超声诊断与预后结局

Prenatal Ultrasound Diagnosis and Prognosis of Fetal Congenital Choledochal Cyst

目的探讨胎儿先天性胆总管囊肿(congenital choledchal cyst,CCC)的产前超声表现及预后情况。方法回顾性分析郑州大学第三附属医院2019年5月—2022年5月产前超声疑诊为CCC的产前超声图像、临床资料及预后结局,同时选择孕周年龄相符的正常胎儿作为对照组,比较两者宫内生长情况。结果①共纳入产前超声提示为CCC 56例,其中12例引产,44例继续妊娠。产后确诊CCC 38例:26例手术治疗,12例保守观察;产后证实误诊6例:肝囊肿3例,先天性胆道闭锁2例,皱褶胆囊1例。②产前超声均表现为肝门部无回声,透声佳,周边可及伴行的门静脉,46例与胆管或胆囊相通,6例囊肿产后透声变差,内可及絮状偏高回声。2例伴发其他超声异常,1例脐疝,1例三尖瓣反流。③首诊孕周15~33(23.30±3.18)周,首诊平均径5~42(13.19±6.53)mm,84.21%(32/38)囊肿平均径随孕周增大而增大。④共26例患儿行手术根治治疗,手术时间为产后0~660(150.38±211.99)d,术后预后良好。⑤CCC患儿与正常胎儿的宫内生长径线比较,差异无统计学意义(P>0.05)。结论先天性胆总管囊肿可在产前通过超声有效检出,不影响患儿宫内生长发育,术后转归良好,产前咨询时应谨慎建议终止妊娠。

Objective To investigate the prenatal ultrasound manifestations and prognosis of fetal congenital choledochal cyst(CCC).Methods Prenatal ultrasound images,clinical data and prognostic outcomes of 56 pregnant women suspected of CCC by prenatal ultrasound were retrospectively analyzed,while normal foetuses matching the gestational week were selected as a control group,and their intrauterine growth was compared.Results①A total of 56 cases with CCC suggested by prenatal ultrasound were included,of which 12 were induced and 44 continued.Postnatal diagnosis of CCC was confirmed in 38 cases:26 cases were treated surgically and 12 cases were observed conservatively.Postnatal confirmation of misdiagnosis was made in 6 cases:3 cases of hepatic cysts,2 cases of congenital biliary atresia,and 1 case of folded gallbladder.②Prenatal ultrasound showed anechoic portals with good translucency and peripheral access to the accompanying portal vein.46 cases showed communication with the bile ducts or gallbladder,6 cysts showed postnatal deterioration in translucency and flocculent hyperechoicity.2 cases were associated with other ultrasonographic abnormalities,1 case of umbilical hernia,and 1 case of tricuspid regurgitation.③The first week of gestation was 15-33(23.30±3.18)week,the first mean diameter was 5-42(13.19±6.53)mm,and 84.21%(32/38)of the mean cyst diameter increased with the week of gestation.④26 cases were treated surgically with a mean time of operation of 0-660(150.38±211.99)days after delivery,and the postoperative prognosis was good.⑤There was no statistically significant difference between the growth and development of CCC children and normal fetuses(P>0.05).Conclusion Congenital choledochal cysts can be effectively detected prenatally by ultrasound,which does not affect the intrauterine growth and development of the child with good postoperative regression,and termination of pregnancy should be cautiously recommended at the time of prenatal counselling.