羊膜带综合征产前超声诊断及国内个案报道的统计分析

摘要

目的 通过病例总结及结合国内个案报道分析,探讨羊膜带综合征胎儿畸形的产前超声诊断特点及临床价值.方法 (1)对我院明确诊断为羊膜带综合征的4例患者临床资料进行回顾分析,观察超声表现,与引产或出生后结果对照.(2)检索中文数据库羊膜带综合征个案报道相关文献,设定6大类畸形类别,分析羊膜带综合征引起胎儿畸形各类别发生率及产前超声漏诊情况.结果 (1)4例病例均在产前诊断羊膜带综合征,其中3例为不同程度肢体及肢体远端较轻微畸形,另1例为颅脑、颜面及肢体多发畸形.(2)文献个案报道合同本组病例共76例羊膜带综合征胎儿,包含32例(42.1％)颅脑畸形,25例(32.9％)颜面畸形,26例(34.2％)脊柱畸形,37例(48.7％)胸腹壁畸形,52例(68.4％)肢体畸形,7例(9.2％)其他畸形.76例病例中复合畸形54例(71.1％).产前超声漏诊共43个类别,其中颜面畸形27.9％ (12/43),肢体畸形53.5％ (23/43).结论 (1)羊膜带综合征胎儿以复合畸形较为常见,产前超声诊断不易漏诊;羊膜带综合征胎儿颜面及肢体畸形,产前超声诊断漏诊率高.(2)产前超声对不同程度畸形的羊膜带综合征诊断起着重要的作用,对选择临床处理方案及降低围产期病死率具有重要意义.%Objective To show the characteristics and clinical value of prenatal ultrasound diagnosis of fetal malformations in amniotic band syndrome(ABS) based on case summaries and case reports in China.Methods (1)The clinical data of 4 fetuses diagnosed as ABS analyzed.The ultrasound findings were observed and compared with the results of induced abortion or postnatal outcomes.(2)To retrieve the related articles of case report of ABS in China databases.According to the specific performances of fetal malformations caused by ABS,we set 6 categories of malforma tion categories.we analyze the category frequencies of malformation categories and missing categories of ABS.Results (1)Four cases were diagnosed ABS prenatally,three of them were distal minor limb malformations,and the other one included craniocerebral,facial and limb malformations.(2)Including our four cases,A total of 76 cases of fetal ABS have been reported,of which 32 (42.1％) were craniocerebral malformations,25 (32.9％) were facial malformations,26 (34.2％) were spinal malformations,37(48.7％) were thoracoabdominal wall malformations,Limb malformations in 52 cases (68.4 ％),other malformations in 7 cases (9.2 ％).In 76 cases,54 cases were complicated malformations (71.1％).A total of 43 categories of missed diagnosis by prenatal ultrasound,including facial malformations 27.9％ (12/43),limb malformations 53.5％ (23/43).Conclusions (1)ABS is mostly complicated malformation,prenatal ultrasound diagnosis is not easy to misdiagnosis.Fetal facial and limb malformations by ABS have a highly misdiagnosed rate by prenatal ultrasound.(2)Prenatal ultrasound plays an important role in diagnosis of ABS with varying degrees of malformations,and is of great significance for the selection of clinical treatment programs and reduction of perinatal mortality.