胎儿十二指肠梗阻的产前超声表现与手术结果对照

胎儿十二指肠梗阻的产前超声表现与手术结果对照
刘金蓉;李姣玲;王海玉;陈文敏;杨博洋;王红英
【期刊名称】《新医学》
【年(卷),期】2017(048)008
【摘要】目的通过分析胎儿十二指肠梗阻的产前超声表现和手术结果,提高其产前诊断水平.方法回顾分析产前检查可疑为十二指肠梗阻的40例胎儿超声图像,与出生后手术结果对照分析.结果 40例产前诊断为十二指肠梗阻胎儿出生后行手术治疗,其中37例术后确诊为十二指肠梗阻,包括十二指肠狭窄8例,十二指肠闭锁9例,环状胰腺10例,先天性肠旋转不良4例,混合型6例;其产前超声表现:34例见"双泡征",2例上腹部局部肠管持续扩张,1例产前超声未见明显异常;超声首次检出"双泡征"的时间最早为23孕周,中位数为30孕周,23~32孕周检出者为81.1%(30/37),约75.7%(28/37)的病例合并羊水过多.孕中期超声误诊而孕晚期正确诊断:1例先天性胆总管囊肿、2例空肠近段狭窄/闭锁.结论产前超声通过"双泡征"、羊水过多及局部肠管持续扩张等声像图特征可检出绝大部分十二指肠梗阻胎儿,并做出定位诊断,但应动态观察及复查,与一些特殊情况相鉴别,目前梗阻的病因诊断仍存在困难.%Objective To comparatively analyze the prenatal ultrasonographic features and surgical outcome of fetal duodenal obstruction, aiming to improve the accuracy of prenatal diagnosis.Methods Prenatal ultrasonographic images of 40 fetuses suspected with duodenal obstruction by prenatal ultrasonography were retrospectively analyzed and compared with postnatal surgical outcomes.Results Thirty-seven cases were surgically diagnosed with duodenal obstruction, including 8 cases of
duodenal membraneous stenosis, 9 of duodenal membraneous atresia, 10 of annular pancreas, 4 of congenital intestinal malrotation and 6 of mixed type.Prenatal ultrasonography demonstrated that 34 cases presented with "double bubble" sign, 2 with persistent upper abdominal intestinal distention and 1 without abnormal prenatal ultrasonographic findings.The "double bubble" sign was first detected at the 23 weeks of pregnancy with a median time of 30 weeks of pregnancy.It was detected during 23 and 32 weeks of pregnancy in 30 cases (81.1%).Approximately 75.7% (28/37) were complicated with polyhydramnios.One case of congenital choledochal cyst and 2 of jejunal stenosis or atresia were misdiagnosed in the middle pregnancy and correctly diagnosed during the later pregnancy.Conclusions A majority of duodenal obstruction cases can be diagnosed and positioned by prenatal ultrasonography based upon the ultrasonographic features, such as "double bubble" sign, polyhydramnios or persistent upper abdominal intestinal distention.Discontinuously observation and examination should be delivered to differentially diagnose from specific situations.It is still challenging to identify the etiology of duodenal obstruction.
【总页数】6页(P560-565)
【作者】刘金蓉;李姣玲;王海玉;陈文敏;杨博洋;王红英
【作者单位】510180 广州,广州市妇女儿童医疗中心超声科;510180 广州,广州市妇女儿童医疗中心超声科;510180 广州,广州市妇女儿童医疗中心超声科;510180
广州,广州市妇女儿童医疗中心超声科;510180 广州,广州市妇女儿童医疗中心超声科;510180 广州,广州市妇女儿童医疗中心超声科
【正文语种】中文
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