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目的探讨动态三维超声在产前诊断胎儿畸形的临床价值。方法选择2009年1月至2015年12月于中国人民解放军第四五四医院进行产前检查的83 182例单胎妊娠20~26孕周孕妇,对胎儿进行动态三维超声系统检查并随访,统计畸形检出率及漏诊率。结果 83 182例胎儿中,经引产或分娩后证实的各种畸形958例,经产前动态三维超声筛查共发现例胎儿畸形923例,检出率96.35%;漏诊35例,漏诊率为3.65%,漏诊包括单纯腭裂5例,单纯室间隔缺损4例,多指、并指6例,半椎体2例,脑积水3例,肺动脉狭窄4例,主动脉狭窄4例,十二指肠闭锁4例,膈疝3例。畸形胎儿占总筛查数的1.13%,其中单发结构畸形875例,多发结构畸形83例,以先天性心脏畸形(274例,占28.60%)、颜面部畸形(131例,占13.67%)、泌尿系统畸形(109例,占11.38%)、骨骼系统畸形(81例,占8.46%)、神经系统畸形(55例,占5.74%)较为常见。2009年至2015年,各年度畸形的发生率差异无统计学意义(P>0.05)。结论孕中期产前动态三维超声检查在胎儿畸形筛查中具有准确率高、无创、简便、可重复等优点,可作为临床产前诊断的首选方法。
Objective To investigate the clinical value of dynamic three-dimensional ultrasound in prenatal diagnosis of fetal malformations. Methods A total of 83 182 pregnant women with singleton pregnancies ranging from 20 to 26 gestational weeks who had antenatal examination at the 454 Hospital of Chinese People’s Liberation Army from January 2009 to December 2015 were enrolled in this study. Dynamic three-dimensional ultrasound examination and follow-up were performed on fetuses. Deformity detection rate and misdiagnosis rate. Results Among 83 182 fetuses, 958 cases of various deformities confirmed by induced labor or childbirth were detected. 923 cases of fetal malformations were detected by prenatal dynamic three-dimensional ultrasound screening, the detection rate was 96.35%; 35 cases missed diagnosis, the missed diagnosis rate was 3.65 %, Misdiagnosis including 5 cases of simple cleft palate, simple ventricular septal defect in 4 cases, multi-finger, and refers to 6 cases, 2 cases of hemivertebra, hydrocephalus in 3 cases, 4 cases of pulmonary stenosis, aortic stenosis in 4 cases, 4 cases of intestinal obstruction, 3 cases of diaphragmatic hernia. Fetal fetuses accounted for 1.13% of the total number of screening, including single malformations in 875 cases, multiple structural malformations in 83 cases, with congenital heart defects (274 cases, 28.60%), facial deformities (131 cases, accounting for 13.67%), (109 cases, accounting for 11.38%), skeletal system deformity (81 cases, 8.46%) and nervous system malformations (55 cases, accounting for 5.74%) were more common. There was no significant difference in the incidence of deformities between 2009 and 2015 (P> 0.05). Conclusion The prenatal dynamic three-dimensional ultrasound in the second trimester has the advantages of high accuracy, noninvasive, simple and reproducible in the screening of fetal malformations. It can be used as the first choice for prenatal diagnosis.