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目的:探讨产前超声诊断不同种类胎儿畸形的处理及预后分析。方法:总结146例产前超声检查时诊断的畸形胎儿的处理和随访结果。结果:(1)146例畸形胎儿中98例选择引产,其中有7例为染色体异常(1例13-三体,4例21-三体,2例18-三体)。(2)48例非致死性畸形在知情同意前提下选择继续妊娠。1例胎粪性腹膜炎,伴胎儿宫内发育迟缓,29周发生胎盘早剥,死胎引产,胎儿染色体正常;1例胎儿肠管明显扩张,伴羊水过多,37周早破水分娩,新生儿开腹手术后,发现未见肝脾胃,放弃手术死亡;1例先天性膈疝,伴左肺发育不良,生后当天死亡,死于双侧肺不张。3例泌尿系统异常恢复正常。1例双侧肾积水,合并羊水过多,产后44天手术,右侧肾盂与输尿管交接处狭窄;2例尚在观察中。4例卵巢囊肿生后消失,健康存活。11例轻度脑室扩张者,7例生后追踪未见异常,1例发展为显性脑积水,1例非典型Dany-walker综合症,生后1岁随访生长发育正常,智力发育与同龄儿童相当;2例尚在追踪观察中。1例胸腔积液胎儿,生后住院引流17天,健康出院。13例生后动态观察追踪。结论:非致死性胎儿畸形和异常在知情同意的前提下与儿科合作,针对异常情况可以通过手术或密切观察得到良好的结局。
Objective: To investigate the prenatal diagnosis of different types of fetus fetal malformations and prognosis analysis. Methods: To summarize 146 cases of prenatal ultrasound diagnosis of malformation fetus handling and follow-up results. Results: (1) 98 of 146 fetuses with abnormal fetus were induced to give birth, of which 7 were chromosomal abnormalities (1 trisomy 13, 4 trisomy 21 and 2 trisomy 18). (2) 48 cases of non-fatal deformity with informed consent, choose to continue pregnancy. 1 case of meconium peritonitis, with intrauterine growth retardation, placental abruption at 29 weeks, stillbirth induced abortion, normal fetal chromosome; 1 case of fetal intestinal dilatation, with polyhydramnios, 37 weeks of early broken water delivery, neonatal laparotomy After surgery, no liver, spleen and stomach were found and surgery was abandoned. One case of congenital diaphragmatic hernia with left lung dysplasia died on the day of birth and died of bilateral atelectasis. 3 cases of urinary system abnormalities returned to normal. One case of bilateral hydronephrosis, combined with polyhydramnios, 44 days postpartum surgery, right renal pelvis and ureter junction stenosis; 2 cases still under observation. Four cases of ovarian cysts disappeared after birth, healthy and alive. 11 cases of mild ventricular dilatation, 7 cases of postnatal follow-up showed no abnormalities, 1 case of development of dominant hydrocephalus, 1 case of atypical Dany-walker syndrome, 1 year after birth growth and development of normal follow-up, mental development and age Children were equal; 2 cases were still under observation. One case of pleural effusion fetus, hospitalized drainage after birth 17 days, healthy discharge. Thirteen cases were dynamically observed after birth. CONCLUSIONS: Non-fatal fetal malformations and abnormalities cooperate with pediatric patients on informed consent, and good outcomes can be obtained by surgery or close observation of abnormalities.