本文選題：胎兒 + 產(chǎn)前檢查��； 參考：《現(xiàn)代婦產(chǎn)科進(jìn)展》2017年08期

【摘要】：目的:探討胎兒先天性膽管擴(kuò)張癥(CBD)的產(chǎn)前超聲特點(diǎn)及臨床轉(zhuǎn)歸。方法:回顧分析2009年9月~2015年11月經(jīng)產(chǎn)前超聲篩查疑診CBD病例的臨床資料,記錄孕婦年齡、首次診斷囊腫時(shí)孕周、囊腫位置及形態(tài)、囊腫大小變化、生后診斷、治療時(shí)機(jī)及隨訪情況。結(jié)果:產(chǎn)前疑診CBD 60例。產(chǎn)前發(fā)現(xiàn)囊腫位于肝內(nèi)11例,右上腹37例,中上腹12例;囊腫形態(tài)近圓形7例,橢圓形53例;產(chǎn)前發(fā)現(xiàn)囊腫與膽囊相通10例(10/60),出生后均證實(shí)為Ⅰ型(CBD)。產(chǎn)前疑診CBD的60例中,出生后失訪11例,獲得完全隨訪49例,其中選擇引產(chǎn)15例。余34例中,8例出生前囊腫自行消退,26例囊腫未消退至出生后,其中2例囊腫自行消退,誤診3例(回腸閉鎖1例,膽道閉鎖2例)。確診CBD者21例,其中15例在未出現(xiàn)膽道感染癥狀下行囊腫切除肝腸Roux-en-Y吻合術(shù)治療。全部病例術(shù)后恢復(fù)良好,無吻合口狹窄、反復(fù)膽管炎發(fā)作、黃疸、腸梗阻等并發(fā)癥;余6例生后囊腫無變化或呈縮小趨勢且臨床無癥狀,家屬拒絕手術(shù),一直門診隨訪。結(jié)論:CBD多于孕中晚期發(fā)現(xiàn),當(dāng)超聲發(fā)現(xiàn)囊腫與膽囊相通,診斷準(zhǔn)確率較高。胎兒時(shí)期診斷可有效改善預(yù)后。
[Abstract]:Objective: to investigate the characteristics and clinical outcome of fetal congenital cholangiectasis (CBD) by prenatal ultrasound. Methods: the clinical data of suspected CBD cases from September 2009 to November 2015 were analyzed retrospectively. The age of pregnant women, gestational weeks, location and shape of cysts, changes of cyst size and postnatal diagnosis were recorded. Time of treatment and follow-up. Results: 60 cases of CBD were suspected before delivery. There were 11 cases of intrahepatic cyst, 37 cases of right upper abdomen and 12 cases of middle upper abdomen. The shape of cyst was nearly round in 7 cases and oval in 53 cases. Among the 60 suspected CBD cases, 11 cases were lost after birth, 49 cases were followed up, 15 cases were induced labor. Among the remaining 34 cases, 8 cases had spontaneous regression of prenatal cysts and 26 cases had not receded until after birth, among which 2 cases had spontaneous regression and 3 cases were misdiagnosed (ileal atresia in 1 case, biliary atresia in 2 cases). 21 cases of CBD were diagnosed, of which 15 cases were treated with choledochal cyst resection and Roux-en-Y anastomosis without biliary tract infection. All patients recovered well without anastomotic stenosis, recurrent cholangitis attack, jaundice, intestinal obstruction and other complications, the remaining 6 cases of postnatal cysts showed no change or decreasing trend and clinical asymptomatic, family refused to operate, always outpatient follow-up. Conclusion the diagnosis accuracy is higher in the middle and late pregnancy than in the middle and late pregnancy, when the cysts are found to be connected with the gallbladder by ultrasonography. Fetal stage diagnosis can effectively improve the prognosis.
【作者單位】： 浙江大學(xué)附屬兒童醫(yī)院小兒外科;浙江大學(xué)附屬兒童醫(yī)院;金華市中心醫(yī)院;浙江大學(xué)附屬婦產(chǎn)科醫(yī)院;
【分類號(hào)】：R714.5
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本文編號(hào)：1820286