产前超声诊断胎儿肾脏发育异常196例临床分析

摘要

目的:探讨各种类型的胎儿肾脏发育异常在产前进行超声诊断的临床意义.方法:回顾性分析196例产前超声诊断胎儿肾脏发育异常的超声声像特征、产后诊断的符合率和随访至产后3月情况.结果:①共有9种类型的肾脏发育异常,分别为肾积水、多囊性肾发育不良、单肾缺如、重复肾、肾囊肿、盆腔异位肾、婴儿型多囊肾、双肾缺如和融合肾.②产前诊断胎儿肾脏发育异常的196例患者,有20例引产后,未作尸检证实,另6例失访,共计170例经产后超声诊断及病理检查证实.其中肾积水、双肾缺如、多囊性肾发育不良、肾囊肿、婴儿型多囊肾和融合肾的诊断符合率较高,均达90.00％以上；而盆腔异位肾和重复肾等诊断符合率较低,分别为60.00％和40.00％.③随访至产后3月,肾积水、多囊性肾发育不良、肾囊肿、单肾缺如、盆腔异位肾和重复肾的患儿均无异常情况发生,而双肾缺如和婴儿型多囊肾多数引产,预后差.结论:胎儿肾脏发育异常的种类多样,超声检查的诊断符合率差异大,预后各异.产前超声检查能较准确地诊断多数肾脏异常,为临床提供更多的决策信息；超声检查不能明确诊断的需要加强随访,诊断需谨慎.%Objective:To explore the clinical value of prenatal sonographic diagnosis to varies types of fetal renal abnormalities. Methods:The clinical data of 196 cases of fetal renal abnormalities (including sonographic characteristic, the incidence rate and the accurate rate of every fetal renal abnormalities, and followed-up) were retrospectively analyzed. Results:There were nine types of fetal renal abnormalities,which rnwere fetal hydronephrosis, multicystic dysplastic kidney, renal agenesis of one side, double kidney, kidney cyst,pelvic kidney,infantile polycystic kidney,renal agenesis of two sides and fused kidney in incidence sequence. The diagnosis coincidence rate of seven types of fetal renal abnormalities including (fetal hydronephrosis, multicystic dysplastic kidney,renal agenesis of one side,kidney cyst,infantile polycystic kidney,renal agenesis of two sides and fused kidney)were over 90%,while those of the pelvic kidney and double kidney were low, which were 60. 00% and 40. 00% respectively. According to the follow-up after 3 months after birth,the prognosis of the sick babies with fetal hydronephrosis,multicystic dysplastic kidney and renal agenesis of one side were well,while nearly all the women with the fetals which were diagnosed as polycystic kidney and renal agenesis of two sides received induced labor. Conclusions:There are varieties of fetal kidney diseases,and the ultrasonic diagnosis coincidence rate and prognosis are different from each other. Prenatal sonography is an effective tool to diagnose most of fetal renal abnormalities,which can provide more crucial information for obstetrician. The fetal renal abnormalities should be diagnosed circumspectly, reinforced follow-up are requlred when it cannot be diagnosed exactly by ultrasound.