胎儿胆管扩张症产前诊断及出生后评估

发布时间：2018-04-29 14:16

  本文选题：胎儿 + 产前检查　； 参考：《现代妇产科进展》2017年08期

【摘要】：目的:探讨胎儿先天性胆管扩张症(CBD)的产前超声特点及临床转归。方法:回顾分析2009年9月~2015年11月经产前超声筛查疑诊CBD病例的临床资料,记录孕妇年龄、首次诊断囊肿时孕周、囊肿位置及形态、囊肿大小变化、生后诊断、治疗时机及随访情况。结果:产前疑诊CBD 60例。产前发现囊肿位于肝内11例,右上腹37例,中上腹12例;囊肿形态近圆形7例,椭圆形53例;产前发现囊肿与胆囊相通10例(10/60),出生后均证实为Ⅰ型(CBD)。产前疑诊CBD的60例中,出生后失访11例,获得完全随访49例,其中选择引产15例。余34例中,8例出生前囊肿自行消退,26例囊肿未消退至出生后,其中2例囊肿自行消退,误诊3例(回肠闭锁1例,胆道闭锁2例)。确诊CBD者21例,其中15例在未出现胆道感染症状下行囊肿切除肝肠Roux-en-Y吻合术治疗。全部病例术后恢复良好,无吻合口狭窄、反复胆管炎发作、黄疸、肠梗阻等并发症;余6例生后囊肿无变化或呈缩小趋势且临床无症状,家属拒绝手术,一直门诊随访。结论:CBD多于孕中晚期发现,当超声发现囊肿与胆囊相通,诊断准确率较高。胎儿时期诊断可有效改善预后。
[Abstract]:Objective: to investigate the characteristics and clinical outcome of fetal congenital cholangiectasis (CBD) by prenatal ultrasound. Methods: the clinical data of suspected CBD cases from September 2009 to November 2015 were analyzed retrospectively. The age of pregnant women, gestational weeks, location and shape of cysts, changes of cyst size and postnatal diagnosis were recorded. Time of treatment and follow-up. Results: 60 cases of CBD were suspected before delivery. There were 11 cases of intrahepatic cyst, 37 cases of right upper abdomen and 12 cases of middle upper abdomen. The shape of cyst was nearly round in 7 cases and oval in 53 cases. Among the 60 suspected CBD cases, 11 cases were lost after birth, 49 cases were followed up, 15 cases were induced labor. Among the remaining 34 cases, 8 cases had spontaneous regression of prenatal cysts and 26 cases had not receded until after birth, among which 2 cases had spontaneous regression and 3 cases were misdiagnosed (ileal atresia in 1 case, biliary atresia in 2 cases). 21 cases of CBD were diagnosed, of which 15 cases were treated with choledochal cyst resection and Roux-en-Y anastomosis without biliary tract infection. All patients recovered well without anastomotic stenosis, recurrent cholangitis attack, jaundice, intestinal obstruction and other complications, the remaining 6 cases of postnatal cysts showed no change or decreasing trend and clinical asymptomatic, family refused to operate, always outpatient follow-up. Conclusion the diagnosis accuracy is higher in the middle and late pregnancy than in the middle and late pregnancy, when the cysts are found to be connected with the gallbladder by ultrasonography. Fetal stage diagnosis can effectively improve the prognosis.
【作者单位】： 浙江大学附属儿童医院小儿外科;浙江大学附属儿童医院;金华市中心医院;浙江大学附属妇产科医院;
【分类号】：R714.5
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本文编号：1820286