【摘要】：目的 本課題旨在探討三維超聲TUI(Tomographic Ultrasound Imaging)和VOCAL(Virtual Organ Computer aided Analysis)技術(shù)動態(tài)監(jiān)測不同孕周正常胎兒腎臟長徑、橫徑、前后徑及體積的變化，為胎兒腎臟的異常發(fā)育及時提供線索。探討胎兒腎臟長徑、橫徑、前后徑和體積與孕周的相關(guān)性。追蹤胎兒腎盂前后徑超過正常范圍時的不同轉(zhuǎn)歸。 研究方法 篩選2012年9月至2013年12月在山西醫(yī)科大學(xué)附屬第一臨床醫(yī)院婦產(chǎn)科超聲室行常規(guī)超聲檢查的腎盂寬度在0-10mm之間的正常胎兒186例，使用三維超聲掃查腎臟，采用三維超聲TUI技術(shù)測量胎兒腎臟的長徑、橫徑及前后徑，采用三維超聲VOCAL技術(shù)測量腎臟體積。 收集病例期間對二維超聲檢查單側(cè)腎盂前后徑(PAPD, Pelvic anteriorposterior diameter)≥10mm的30例胎兒進行隨訪，使用三維超聲TUI及VOCAL技術(shù)觀察、測量并記錄腎盂前后徑（PAPD）、腎實質(zhì)的厚度(RPT, Renalparenchyma thickness)、腎門腎動脈的阻力指數(shù)（RI, Resistance index）及腎盂的體積。 結(jié)果 一、三維TUI技術(shù)測量胎兒腎臟各徑線的數(shù)據(jù)： 1.本研究組胎兒腎臟各徑線的左腎長徑、橫徑和前后徑分別從19周的1.870.22cm,1.14±0.10cm,1.100.07cm增長到38周的4.450.13cm，2.570.14cm,2.510.15cm，右腎各徑線分別從19周的1.740.24cm，1.100.09cm，1.080.06cm增長到38周的4.440.16cm,2.560.13cm,2.500.13cm。 2.雙側(cè)腎臟各徑線測量值之間無顯著差異。 3.胎兒腎臟各徑線與孕周呈正相關(guān)，左腎的長徑、前后徑和橫徑與孕周的決定系數(shù)分別為：0.93,0.723,0.75；右腎的長徑、前后徑和橫徑與孕周的決定系數(shù)分別為：0.819,0.69,0.60。二、三維VOCAL技術(shù)測量胎兒腎臟體積的數(shù)據(jù)： 1.本研究組胎兒左、右腎臟體積分別從19周的1.390.24cm3,1.330.24cm3增長到38周的14.611.55cm3，14.521.49cm3。 2.雙側(cè)腎臟體積測量值之間無顯著差異。 3.雙側(cè)腎臟體積與孕周呈冪函數(shù)相關(guān)，左、右腎與腎臟的決定系數(shù)分別0.856,0.855。三、三維超聲監(jiān)測腎盂前后徑≥10mm胎兒： 研究期間30例腎盂前后徑寬度≥10mm的胎兒，每兩周隨訪一次，，隨訪直至產(chǎn)后，10mm≤PAPD＜15mm的胎兒中，25例胎兒均于產(chǎn)后消失或減小,1例行先天性腎盂輸尿管梗阻手術(shù)；PAPD≥15mm的胎兒中,RPT＜5mm且RI≥0.7者3例，先天性腎盂輸尿管梗阻手術(shù)1例，引產(chǎn)2例。 本研究測量了15例28-38周胎兒PAPD≥10mm腎盂的體積，經(jīng)隨訪觀察至產(chǎn)后，其中有13例PAPD和腎盂體積于產(chǎn)后分別減小或消失，有1例引產(chǎn)，有1例于產(chǎn)后經(jīng)核磁確認(rèn)腎盂輸尿管連接處梗阻。 結(jié)論 1、獲得了不同孕周正常胎兒腎臟各徑線及體積的參考值范圍，為評價胎兒腎臟發(fā)育提供了重要的臨床參考價值。 2、胎兒腎臟各徑線與孕周呈線性相關(guān)，體積與孕周呈冪相關(guān)。 3、產(chǎn)前超聲檢查腎盂前后徑（APD）≥15mm,腎實質(zhì)厚度(RPT)＜5mm，腎動脈阻力指數(shù)（RI）≥0.7，腎盂體積/腎臟體積≥0.169的胎兒往往存在腎盂輸尿管不同階段的病理性梗阻，應(yīng)高度重視。 4、應(yīng)用三維超聲API(Arbitrary Planar Imaging)、TUI及VOCAl技術(shù)有助于監(jiān)測胎兒腎臟結(jié)構(gòu)的發(fā)育，能夠使腎臟與周圍組織結(jié)構(gòu)之間的相互關(guān)系更加清楚、直觀的顯現(xiàn)出來，尤其是通過三維超聲TUI技術(shù)能夠為腎盂擴張的寬度測量提供更可靠的切面，為產(chǎn)前篩查胎兒泌尿系統(tǒng)畸形提供了重要的臨床依據(jù)。
[Abstract]:objective
The purpose of this study is to explore the dynamic monitoring of the length, diameter, diameter and volume of normal fetal kidney in different gestational weeks by three-dimensional ultrasound TUI (Tomographic Ultrasound Imaging) and VOCAL (Virtual Organ Computer aided Analysis), and to provide clues for the abnormal development of fetal kidneys. Correlation between volume and gestational age. Follow up the outcome of fetal pelvis anterior and posterior diameter exceeding normal range.
research method
From September 2012 to December 2013, 186 normal fetuses with the width of renal pelvis between 0-10mm were examined in the ultrasound room of the first clinical hospital affiliated to the first clinical hospital of Shanxi Medical University. The kidney was scanned by three-dimensional ultrasound, and the length, diameter and diameter of the fetal kidney were measured by three-dimensional ultrasound TUI technique. The three-dimensional ultrasonic VOCAL technique was used. The volume of the kidney was measured.
During the collection of cases, 30 cases of PAPD, Pelvic anteriorposterior diameter and 10mm were followed up. The diameter of the renal pelvis (PAPD), the thickness of the renal parenchyma (RPT, Renalparenchyma thickness), and the resistance index of renal portal renal artery (RI,) were observed by three-dimensional ultrasound TUI and VOCAL technique. Resistance index) and the volume of the renal pelvis.
Result
First, three dimensional TUI technology was used to measure the diameter of fetal kidney.
1. the left kidney length, the transverse diameter and the front and back diameter of the fetal kidneys in the study group were from 19 weeks 1.870.22cm, 1.14 + 0.10cm, and 1.100.07cm to 38 weeks of 4.450.13cm, 2.570.14cm, 2.510.15cm, and the right kidney from 19 weeks of 1.740.24cm, 1.100.09cm, 1.080.06cm to 38 weeks of 4.440.16cm, 2.560.13cm, 2.500.13cm..
2. there was no significant difference between the measured values of the diameters of bilateral kidneys.
3. the diameters of the kidneys were positively correlated with the gestational weeks. The length of the left kidney, the front and back diameter and the transverse diameter and the gestational weeks were respectively 0.93,0.723,0.75; the length of the right kidney, the front and back diameter and the transverse diameter and the gestational weeks were respectively 0.819,0.69,0.60. two, and the three-dimensional VOCAL technique was used to measure the fetal kidney volume.
1. The volume of left and right kidneys increased from 1.390.24 cm 3, 1.330.24 cm 3 at 19 weeks to 14.611.55 cm 3, 14.521.49 cm 3 at 38 weeks, respectively.
2. there was no significant difference in bilateral renal volume measurements.
3. the volume of bilateral kidney was related to the power function of gestational weeks. The determination coefficient of left, right kidney and kidney was 0.856,0.855. three, and the diameter of renal pelvis was more than 10mm fetus.
During the study, 30 fetuses with the width of the pelvis and the width of more than 10mm were followed up every two weeks and followed up until postpartum. Among the fetus of 10mm < PAPD < 15mm, 25 fetuses disappeared or decreased postpartum, and 1 cases of congenital ureteropelvic obstruction; RPT < 5mm and RI > 0.7 in 3 cases of congenital renal pelvis ureteral obstruction. 1 cases were performed and 2 cases were induced.
In this study, the volume of PAPD > 10mm pelvis in 15 cases of fetus was measured in 28-38 weeks. After follow-up, 13 cases of PAPD and renal pelvis decreased or disappeared after postpartum, 1 cases were induced, 1 cases were confirmed after postpartum by NMR to confirm the ureteropelvic junction obstruction.
conclusion
1. The reference ranges of various diameters and volumes of normal fetal kidneys at different gestational weeks were obtained, which provided important clinical reference value for evaluating fetal kidney development.
2, the diameters of fetal kidneys are linearly related to gestational age, and the volume is correlated with gestational weeks.
3, prenatal ultrasonography (APD) is more than 15mm, renal parenchyma thickness (RPT) < 5mm, renal artery resistance index (RI) more than 0.7, renal pelvis volume / renal volume more than 0.169 of fetuses often have pathological obstruction at different stages of renal pelvis and ureter, and should be highly valued.
4, the application of three-dimensional ultrasound API (Arbitrary Planar Imaging), TUI and VOCAl technology can help monitor the development of the fetal kidney structure, and can make the relationship between the kidney and the surrounding tissue structure more clear and intuitive, especially through the three-dimensional ultrasound TUI technology to provide more reliable section for the measurement of the width of the renal pelvis. It provides important clinical evidence for prenatal screening of fetal urinary system malformations.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.5;R445.1

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