孕早期二维超声三切面法在胎儿腭裂筛查中的应用价值研究

Study on application value of three section method of two dimensional ultrasound in screening for fetal cleft palate during early pregnancy

目的研究孕早期(孕11~13^(+)6周)二维超声三切面法在胎儿腭裂筛查中的应用价值。方法20000例产妇,以筛查手段不同分为对照组(9600例)和观察组(10400例)。对照组行颈项透明层(NT)扫描(孕早期)^(+)三级超声检查(孕中期),观察组行NT扫描(孕早期)^(+)二维超声三切面法筛查(孕早期)^(+)三级超声检查(孕中期)。比较两组产前检查效能;比较观察组不同孕周(13~13^(+)6周、12~12^(+)6周、11~11^(+)6周)三切面有效显示率;分析观察组腭裂类型、妊娠结局。结果观察组产前检出22例唇腭裂,出生后确诊24例,漏诊率为8.33%(2/24),准确率为99.98%(10398/10400),特异度为100.00%(10376/10376),灵敏度为91.67%(22/24),阳性预测值为100.00%(22/22),阴性预测值为99.98%(10376/10378)。对照组产前检出14例唇腭裂,出生后确诊22例,漏诊率为36.36%(8/22),准确率为99.92%(9592/9600),特异度为100.00%(9578/9578),灵敏度为63.64%(14/22),阳性预测值为100.00%(14/14),阴性预测值为99.92%(9578/9586)。观察组漏诊率低于对照组,灵敏度、阴性预测值高于对照组(P<0.05)。观察组不同孕周三切面有效显示率分别为94.88%、94.09%、93.30%,比较差异无统计学意义(P>0.05)。观察组产前检出14例胎儿伴其他严重畸形,家属、孕妇选择引产;8例胎儿为单侧唇腭裂,足月顺产。结论孕早期(孕11~13^(+)6周)二维超声三切面法在胎儿腭裂筛查中的应用价值较高,具有可行性。

Objective To study the application value of three section method of two dimensional ultrasound in screening for fetal cleft palate during early pregnancy(11-13^(+)6 weeks of gestation).Methods 20000 postpartum women were divided into a control group(9600 cases)and an observation group(10400 cases)based on different examination methods.The control group received nuchal translucency(NT)(early pregnancy)scanning^(+)levelⅢultrasound examination(mid pregnancy),while the observation group received NT(early pregnancy)scanning^(+)three section method of two dimensional ultrasound(early pregnancy)^(+)levelⅢultrasound examination(mid pregnancy).The efficacy of prenatal examination was compared between the two groups.The effective display rate of three sections in different gestational weeks(13-13^(+)6 weeks,12-12^(+)6 weeks,11-11^(+)6 weeks of gestation)was compared.The cleft palate types and pregnancy outcome were analyzed in the observation group.Results In the observation group,22 cases of cleft lip and palate were detected prenatally,and 24 cases were confirmed after birth,with a missed diagnosis rate of 8.33%(2/24),an accuracy rate of 99.98%(10398/10400),a specificity of 100.00%(10376/10376),a sensitivity of 91.67%(22/24),a positive predictive value of 100.00%(22/22)and a negative predictive value of 99.98%(10376/10378).In the control group,14 cases of cleft lip and palate were detected prenatally and 22 cases were diagnosed after birth,with a missed diagnosis rate of 36.36%(8/22),an accuracy of 99.92%(9592/9600),a specificity of 100.00%(9578/9578),a sensitivity of 63.64%(14/22),a positive predictive value of 100.00%(14/14)and a negative predictive value of 99.92%(9578/9586).The rate of missed diagnosis in the observation group was lower than that in the control group,and the sensitivity and negative predictive value were higher than those in the control group(P<0.05).The effective display rates of three sections at different gestational weeks in the observation group were 94.88%,94.09%,and 93.30%,and the difference was not statistically significant in comparison(P>0.05).In the observation group,14 cases of fetuses with other serious malformations were detected prenatally,and the families and pregnant women chose to induce labor;8 cases of fetuses with unilateral cleft lip and palate were delivered at full term.Conclusion Three section method of two dimensional ultrasound in early pregnancy(11-13^(+)6 weeks of gestation)is of high value and feasible for screening fetal cleft palate.