产前超声在左侧先天性膈疝的诊断价值

姜书情 邱文倩 张超学

摘要：目的  探討产前超声在左侧先天性膈疝（CDH）的诊断价值。方法  选取2016年8月～2019年8月我院产前超声诊断为胎儿左侧CDH的70例超声影像资料，分析其声像图特征、超声表现及预后情况。结果  70例左侧CDH胎儿，灰阶声像图表现为胸腔内实性或囊实性占位、纵膈移位、肺发育不良、腹围缩小、膈肌回声缺损、胸腔积液，59例胸腔内可见胃泡，11例胃泡仍位于腹腔内;54例膈肌显示不完整，可见胸腔内包块经过膈肌的缺损与腹部相通，其余16例因孕周偏小和胎儿体位原因，膈肌显示不佳。70例诊断为胎儿左侧CDH的产妇，38例选择引产，足月妊娠26例，早产6例。32例分娩后的胎儿中，24例经手术后存活，3例手术后死亡，5例未经手术即死亡，总死亡率为25%（8/32）;出生后 LHR≤1.0的CDH患儿死亡率为71.43%，高于LHR 1.0～1.4和≥1.4的患儿的16.67%和7.69%，差异有统计学意义（P<0.05）;出生后O/E LHR≤35%的CDH患儿死亡率为85.71%，高于O/E LHR 35%～45%、45%～65%和≥65%患儿的16.67%、10.00%和0，差异有统计学意义（P<0.05）。结论  产前超声可用于诊断CDH，并可评估健侧肺发育情况及胎儿预后。

关键词：产前超声;先天性膈疝;彩色多普勒血流显像

中图分类号：R445.1                                 文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2020.09.053

文章编号：1006-1959（2020）09-0158-04

Diagnostic Value of Prenatal Ultrasound in Left Congenital Diaphragmatic Hernia

JIANG Shu-qing，QIU Wen-qian，ZHANG Chao-xue

（Department of Ultrasound，the First Affiliated Hospital of Anhui Medical University，Hefei 230022，Anhui，China）

Abstract：Objective  To investigate the diagnostic value of prenatal ultrasound in left congenital diaphragmatic hernia （CDH）.Methods  From August 2016 to August 2019， 70 cases of ultrasound image data of fetal left-sided CDH diagnosed by prenatal ultrasound in our hospital were selected， and analyze its sonogram characteristics， ultrasound performance and prognosis.Results  70 cases of left-sided CDH fetus， grayscale sonogram showed solid chest or cystic solid space occupying， mediastinal displacement， lung dysplasia， abdominal circumference reduction， diaphragmatic echo defect， pleural effusion， 59 cases of intrapleural Gastric vesicles can be seen， 11 cases are still located in the abdominal cavity; 54 cases of diaphragm muscles are incomplete， and the mass in the chest cavity can be seen to communicate with the abdomen through the diaphragm defect. The remaining 16 cases have poor diaphragm performance due to small gestation and fetal position. 70 cases of maternal diagnosis of CDH on the left side of the fetus， 38 cases of induced labor， 26 cases of full-term pregnancy， 6 cases of premature delivery. Of the 32 fetuses after delivery， 24 survived after surgery， 3 died after surgery， and 5 died without surgery，with a total mortality rate of 25%（8/32）;children with CDH with LHR≤1.0 after birth mortality rate was 71.43%， higher than 16.67% and 7.69% of children with LHR 1.0 ～ 1.4 and≥1.4， the difference was statistically significant（P<0.05）;The mortality rate of CDH children with O/E LHR≤35% after birth is 85.71%， which is higher than 16.67%， 10.00% and 0 of O/E LHR 35% ～ 45%， 45%～65% and≥65% children，the difference was statistically significant（P<0.05）.Conclusion  Prenatal ultrasound can be used to diagnose CDH， and can assess the development of the healthy lung and the prognosis of the fetus.

Key words：Prenatal ultrasound;Congenital diaphragmatic hernia;Color Doppler flow imaging

先天性膈疝（congenital diaphragmatichernia，CDH）是由于单侧或双侧膈肌发育缺陷或发育不全，腹腔脏器经过缺损处疝入胸腔，从而引起一系列病理生理变化的一种先天性疾病。尽管近年来在治疗方面取得了一定进展，CDH患儿存活率呈逐渐升高趋势，但CDH患儿病死率仍高达20%～40%[1]。因此，产前超声对胎儿CDH的正确诊断与评估，有利于判断患儿预后和降低医疗风险。本研究通过回顾性分析2016年8月～2019年8月我院确诊的70例胎儿左侧CDH的超声资料，探讨产前超声在左侧CDH的诊断价值，為临床工作提供参考，现报道如下。

1资料与方法