45例胎儿泌尿系畸形的产前超声诊断分析

选取2009年1月～2011年1月期间经本院产前超声检查诊断为胎儿泌尿系畸形45例,并且全部经临床引产解剖病理确定或者分娩后体检确定,回顾性分析本组声像图资料。结果经本院产前超声检查诊断为胎儿泌尿系畸形45例中,超声检查发现存在肾积水19例,肾囊肿12例,单侧肾5例,多囊肾4例,肾发育不良4例,马蹄肾1例;足月分娩14例,给予引产终止妊娠29例,宫内死亡2例。产前进行超声检查对胎儿是否存在泌尿系统畸形具有比较高的临床诊断价值,可以显著提升我国优生优育水平,妊娠期妇女定期进行产前超声诊断,对了解胎儿的生长发育、畸形情况具有重要作用,值得临床推广使用。     

胎儿泌尿系畸形的产前超声诊断及预后评估

目的 探讨超声诊断胎儿泌尿系畸形的声像图特征及其临床实用价值。 方法 按产科超声常规检查胎儿，发现胎儿泌尿系统异常者，根据声像图特征评估处理。 结果 52例产前超声可疑为泌尿系畸形患者中，13例考虑到泌尿系畸形可能为致命性病变而终止妊娠，10例因一侧肾病变而自愿引产，12例胎儿出生后随访肾盂积水消失，7例胎儿肾盂扩张大于1．5cm，考虑输尿管狭窄出生后经手术治疗，1例胎儿单侧肾囊肿因合并心脏严重畸形出生后死亡，8例胎儿一侧肾脏异常、另一侧形态及结构未发现异常后均自然分娩，1例胎儿于孕24周可疑婴儿型多囊肾后经复查排除。 结论 产前超声诊断胎儿泌尿系畸形，依靠特有的声像图改变及合并其他畸形，对胎儿预后判断、临床及早采取措施提供依据，这对优生优育及新生儿早期治疗有重要临床实用价值。     

超声诊断胎儿泌尿系畸形的探讨

目的 探讨超声诊断胎儿泌尿系畸形的声像图特征和临床实用价值。方法 按产科超声常规检查胎儿。结果 本组27例胎儿泌尿系畸形，超声检测28孕周前诊断9例，28孕周后诊断18例。单肾3例、单侧肾发育不良1例、重复肾1例、肾积水8例、多囊肾12例、输尿管下段狭窄及尿道闭锁、巨膀胱各1例。合并脑积水1例、膈疝1例：全部病例经引产后尸解证实12例，出生后手术证实1例，IVP及超声随访复查证实14例。结论 前超声诊断胎儿泌尿系畸形，对胎儿预后判断、临床及早采取措施提供诊断依据，这对优生优育、对新生儿早期治疗有重要临床实用价值：     

胎儿期多囊肾的产前超声诊断及其结局分析

<正>近年来,随着超声医学和超声仪器的进步与发展以及产前超声检查的普及,明显提高了胎儿泌尿系畸形的检出率。多囊肾是较常见的泌尿系畸形,产前超声诊断多囊肾为产前遗传咨询和临床处理方案的选择提供重要的参考价值。本研究通过回顾性分析23例胎儿期多囊肾声像图特点和临床资料,探讨产前超声检查对胎儿期不同类型多囊肾的诊断价值及临床意义。     

胎儿泌尿系畸形的超声诊断

目的探讨超声诊断胎儿泌尿系畸形的价值。方法对2004年1月~2005年6月间超声诊断泌尿畸形的胎儿进行回顾总结。结果胎儿泌尿系畸形22例,其中肾积水11例,占50%,双肾不发育2例,一侧肾缺如2例,盆腔异位肾1例,肾发育不良1例,多囊肾2例,多囊性发育不良肾2例,尿道下裂1例。结论超声对胎儿泌尿系畸形的诊断有很高的价值。     

超声诊断胎儿先天性泌尿系畸形

目的 探讨超声诊断胎儿先天性泌尿系畸形的临床价值。方法按产科超声检查常规对32例孕24～41周的孕妇进行彩色多普勒超声检查。结果本组32例胎儿先天性泌尿系畸形超声检查28周前检出23例，28周后检出9例。其中双肾发育不全6例，单侧肾缺如3例，肾积水11例，多囊肾5例，肾多发囊肿5例，肾发育异常1例，一侧异位肾1例，合并其他系统畸形7例。全部病例引产后证实20例；出生后，随访及手术证实10例，失访2例。结论胎儿先天性泌尿系畸形超声检查，对胎儿畸形的检出、预后的判断及临床措施的选择有重要的实用价值。     

超声诊断胎儿肾脏畸形的临床价值

目的 探讨超声诊断胎儿肾脏畸形的临床价值.方法 在产前超声检查中发现胎儿肾脏畸形,产后婴儿行超声复查,引产者进行尸检,然后将产前超声结果和产后结果进行对照.结果 胎儿肾脏畸形29例,其中肾积水15例,单侧12例,双侧4例,多囊肾4例,重复肾3例,马蹄肾2例,双肾发育不全3例,单肾发育不全1例.结论 超声对胎儿肾脏畸形的诊断有较高的价值,并且根据不同类型,判断其病因及预后,对临床采取措施提供依据.     

超声与MRI诊断胎儿泌尿系统畸形临床应用对比分析

探讨超声与MRI对诊断胎儿泌尿系统畸形的差异。收集2013年5月~2016年5月我院进行产前孕检(132例),且住院分娩的孕妇(132例),当B超发现存在泌尿系统畸形时,同时行MRI检查进行进一步确诊。分析超声与MRI对诊断胎儿泌尿系统畸形的差异。结果(1)产前超声诊断泌尿系统畸形130例,漏诊2例,误诊5例。产前MRI诊断125例,漏诊3例,误诊1例。肾积水90例、多囊肾11例、肾缺如5例、马蹄肾4例、巨膀胱3例、泌尿系合并其他畸形14例。(2)MRI与B超对诊断泌尿系统畸形的诊断正确率分别为98.45%、97.69%,比较无差异(P0.05)。超声对诊断胎儿泌尿系统畸形具有较好的价值。     

彩色多普勒超声诊断胎儿泌尿系统畸形的临床价值

目的:探讨彩色多普勒超声诊断胎儿泌尿系统畸形的临床价值。方法:选择2014年1月至2016年12月期间在我院进行产前超声检查的孕妇作为研究对象,共检测16450例胎儿,其中发现63例泌尿系统畸形,依据超声诊断图像特征对63例胎儿进行诊断,并以经分娩后超声诊断、手术或引产尸检确诊。结果:经过彩色多普勒超声检查后发现胎儿泌尿系统畸形63例,其中肾积水27例、重复肾7例、一侧肾缺如4例、异位肾3例、肾囊肿6例、输尿管末端囊肿3例、婴儿型多囊肾1例、成人型多囊肾3例、双肾发育不良3例、马蹄肾1例、一侧肾脏发育不良1例、马蹄肾1例、巨膀胱3例。此外婴儿型多囊肾1例及双肾发育不良3例均合并羊水过少或无羊水、合并膜部室间隔缺损5例、合并侧脑室后角增宽4例、合并单脐动脉2例。结论:将彩色多普勒超声应用在胎儿泌尿系统畸形诊断中,可以实现对肾动脉的追踪显示和定位,能够有效尽早筛查出畸形胎儿,对胎儿泌尿系统畸形的相关处理提供重要的临床依据。     

胎儿泌尿生殖系统畸形产前超声及磁共振成像诊断分析

目的探讨产前超声及磁共振成像（MRI）诊断胎儿泌尿生殖系统畸形的应用指征和临床作用。 方法对产前超声诊断为泌尿生殖系统畸形的227例胎儿均于24 h内行MRI检查,与产后检查和临床随访结果对照,对产前超声漏误诊病例的图像特征进行分析。 结果产前超声检出泌尿生殖系统畸形的227例胎儿中包括肾脏囊性病变70例、梗阻性尿路疾病41例、肾缺如40例、肾位置异常24例、融合肾18例、重复肾17例、肾肿瘤8例、双肾体积小3例、膀胱病变5例、阴茎短小1例。与产后检查及临床随访结果对照,产前超声正确诊断胎儿泌尿生殖系统畸形194例（85.5%,194/227）;漏误诊33例（14.5%,33/227）,其中15例（1例输尿管息肉）梗阻性尿路疾病不能显示输尿管狭窄或梗阻部位、3例梗阻性尿路疾病不能明确诊断（1例巨输尿管、2例肾积水）、3例梗阻性尿路疾病误诊为重复肾;其余12例漏误诊病例包括3例肾位置异常、2例重复肾合并囊性肾发育不良、2例肾缺如、2例融合肾、1例多囊肾合并重度积水、1例重复肾、1例阴茎短小。产前MRI正确诊断224例（98.7%,224/227）;漏诊3例（1.3%,3/227）。另外,3例泌尿系统异常伴发的生殖器异常,产前超声、MRI均未显示,均为产后发现。 结论产前超声及MRI对胎儿泌尿系统畸形有较高显示率;但超声及MRI对胎儿生殖器畸形的显示率均不高。明确MRI应用指征有助于产前合理选用影像学检查方法,对诊断和佐证胎儿泌尿生殖系统畸形有重要临床作用。     

胎儿肾脏微囊性病变的产前超声表现及病理学观察

目的 探讨胎儿肾脏微囊性病变产前超声特征及肾脏的病理改变.方法 对产前超声检查、临床随访(家族史调查证实常染色体显性遗传性多囊肾1例)或引产后病理检查(5例)证实的6例孕22～32周肾脏微囊性病变胎儿的产前超声表现、分类诊断特征及引产后肾脏病理表现进行总结分析.结果 产前超声显示6例胎儿双侧肾脏对称均匀性增大,实质回声弥漫性增强;肝门脉区回声增粗(2例)呈纤维网格样变(2例),CDFI显示6例肾血管充盈良好,频谱呈高阻力指数血流,羊水指数低于正常或在正常范围内.引产后病理标本显示5例胎儿双侧肾脏弥漫性增大,失去胎儿肾脏特有的"桑葚"状表现,肾皮质及髓质见多发微小囊肿,集合系统发育不良;镜下显示5例胎儿肾实质内见弥漫分布大小不等的囊肿,并见肾小管囊性扩张,1例肾小球Bowman囊扩张.5例引产儿尸检病理诊断:胎儿肾小管囊性变4例,肾小球囊性变1例;1例经临床追踪随访后诊断胎儿肾脏微囊性病变.结论 胎儿肾脏微囊性病变产前超声表现为肾脏增大,弥漫性回声增强,病理表现为肾小管或肾小球的弥漫性微囊性扩张.     

三维超声对妊娠前及早期妊娠阶段意外接触致畸物质者胎儿结局的监测

【目的】探讨现代导致胎儿畸形的因素的变化和胎儿预后的监测手段。【方法】对112例在妊娠前期、妊娠早期意外的、非意愿性、或非认知性接触理化物质导致或可疑导致胎儿畸形的孕妇,进行首诊后的系列三维超声检测。对确定有畸形的胎儿实施引产并验证三维超声的诊断。【结果】共计有3例肠膨出、1例多囊肾,1例脑积水,2例唇裂,1例脑部畸形(额部肿瘤)、1例马蹄内翻足,总计胎儿畸形9例,畸形发生率8.04％。并发胎儿宫内生长迟缓(IUGR)17例,占15．18％。9例畸形者中,分别有新近住房装修史者占4例,孕早期服用喹诺酮类抗生素3例,孕前及早孕阶段职业接触恶性肿瘤化疗药物1例,长期使用移动电话者1例。17例IUGR者中,孕期继续从事电脑、复印机工作者4例,妊娠合并肝炎3例。9例胎儿畸形者均由三维超声确诊并经分娩验证,三维超声诊断胎儿畸形诊断正确率为99．11％。【结论】妊娠早期或妊娠前接触致畸物质者,可引起较高发生率的围产儿不良结局,三维超声检测可作为围产期检测的常规首选手段。     

Umbilical Cord Cysts

Objective. The purpose of this series was to determine whether the use of different 3‐dimensional (3D) sonographic modes allows better definition of umbilical cord cysts and pseudocysts in utero. Methods. Two cases of umbilical cord cysts and 1 of a pseudocyst were analyzed and compared with 2‐dimensional (2D), 3D, angiopower Doppler, tomographic ultrasound imaging (TUI), virtual organ computer‐aided analysis (VOCAL), and automatic volume calculation (AVC) sonographic modes. All cases were followed during pregnancy. A karyotype analysis was also obtained. Results. Three‐dimensional sonography, TUI, and VOCAL allowed clear visualization and evaluation of the sizes, locations, and numbers of umbilical cord cysts. A clear differentiation between a pseudocyst and the yolk sac was obtained with AVC and angiopower Doppler sonography. The 3D sonographic surface mode allowed better visualization of other accompanying fetal malformations. Conclusions. Three‐dimensional sonography allows for a more accurate diagnosis and provides a clearer visualization of malformations than 2D imaging. Cysts and pseudocysts can be defined much more accurately by using the different modes described here.     

Prenatal diagnosis of trisomy 13: analysis of 28 cases.

OBJECTIVE: The purpose of this study was to investigate the role of second-trimester sonographic examination in the prenatal diagnosis of trisomy 13. METHODS: Of 22,150 fetal chromosome analyses, 28 fetuses with trisomy 13 were found between 1990 and 2004. Sonographic findings of this aneuploidy were analyzed in this study. RESULTS: The average maternal age was 32.4 years; the average gestational age was 19.5 weeks. There was an 89.3% (n = 25) total prevalence of sonographic abnormalities in fetuses with trisomy 13 in this series. Major (structural) malformations were seen in 23 cases (82.1%), whereas minor anomalies were detected on sonography in 16 cases (57.1%). Although in 2 fetuses 1 minor anomaly was the only sonographic sign of trisomy 13, other cases with minor anomalies (87.5% [n = 14]) were multiplex malformations, in which combinations of major and minor anomalies were detected on sonography. The most frequently seen structural abnormalities were central nervous system and facial anomalies (64.3% [n = 18]). Among central nervous system anomalies, ventriculomegaly and holoprosencephaly were seen most frequently. Cardiovascular anomalies were detected in 53.6% (n = 15) of the fetuses with trisomy 13. This high frequency underlines the importance of echocardiography in diagnosing this aneuploidy. Among minor anomalies, increased nuchal translucency (21.4%) and echogenic bowel (17.9%) were the most common findings. CONCLUSIONS: Second-trimester sonographic examination is capable of showing anomalies that are characteristic of trisomy 13; thus, the scan can indicate whether fetal karyotyping is advisable. Incorporation of careful assessment of the fetal cardiovascular system by sonography certainly increases the detection rate of trisomy 13.     

Prenatally Diagnosed Fetal Split‐Hand/Foot Malformations Often Accompany a Spectrum of Anomalies

The purpose of this series was to identify cases that appeared on sonography to be split‐hand/foot malformations (SHFMs) in fetuses and correlate the sonographic findings, including 2‐dimensional (2D) and 3‐dimensional (3D) sonography, to outcomes. A retrospective review was conducted of sonographic studies from 2002 to 2012 at 2 fetal care centers. Data were collected with respect to the morphologic characteristics of split‐hand/foot abnormalities, the utility of 3D sonography, associated anatomic abnormalities, family histories, gestational ages at diagnosis, fetal outcomes, karyotype, and autopsy results. Ten cases were identified with gestational ages ranging from 15 to 29 weeks. Three‐dimensional sonography was helpful in defining anatomy in 7 of 9 cases in which it was performed. Bilateral SHFMs were found in 7 cases (3 cases involving both hands and feet, 2 cases isolated to hands, and 2 cases isolated to feet), whereas 3 cases showed unilateral split‐hand malformations. Associated anatomic anomalies were present in 6 cases, and 4 of these had recognized syndromes, including 2 with abnormal karyotypes, specifically, del(22q11) and del(7q31). Two cases occurred in the context of a positive family history of SHFM. Three cases were delivered at term, and 7 cases were electively terminated. In conclusion, SHFMs often occur with a broad range of chromosomal abnormalities, single‐gene disorders, and other congenital anomalies. Some apparent SHFMs turn out to be other limb anomalies, such as complex syndactyly. Prenatal screening using 2D sonography can identify SHFMs, and 3D sonography often further clarifies them.     

胎儿泌尿系统异常的产前超声诊断

目的总结胎儿泌尿系统异常的产前超声图像特征,探讨胎儿泌尿系统异常产前超声诊断的临床价值。 方法对产前超声检出泌尿系统异常的492例胎儿超声影像表现及合并畸形进行总结分析。 结果492例胎儿产前超声检出泌尿系统异常548处,其中以肾盂增宽（或肾积水）（47.2%,232/492）、肾缺如或萎缩（20.3%,100/492）、肾脏多囊性病变（16.9%,83/492）检出例数居多（84.3%,415/492）,其余类型泌尿系统异常（肾脏发育不良、肾脏异位、融合肾、重复肾、肾囊肿、巨膀胱、膀胱输尿管囊肿、脐尿管憩室、泄殖腔外翻、梅干腹综合征等）检出例数较少（27.0%,133/492）。早孕期发现胎儿巨膀胱5例,其余泌尿系统异常多于中晚孕期发现。492例胎儿中单纯泌尿系统异常366例（74.4%,366/492）,合并1种或多种其他异常的胎儿126例（25.6%,126/492）共214种异常。其中合并心脏（17.5%,22/126）、消化系统（15.1%,19/126）、颅脑（13.5%,17/126）、肢体（9.5%,12/126）、颜面（7.1%,9/126）、脊柱（7.1%,9/126）部位异常88例（69.8%,88/126）,羊水过少34例（27.0%,34/126）。与后期随访及临床检查结果对照,产前超声漏误诊5例（2例正常肾误诊为重复肾,1例肾上腺囊肿误诊为肾脏囊肿,2例异位肾误诊为肾缺如）。 结论超声是胎儿泌尿系统异常首选的检查方法,产前超声早期发现胎儿泌尿系统异常并进行连续随访对指导临床诊断治疗有重要意义。     

Indications for fetal echocardiography from a tertiary-care obstetric sonography practice

PURPOSE: The present study was conducted to evaluate the indications for fetal echocardiography in a tertiary-care obstetric sonography practice and to determine the incidences of confirmed congenital heart disease for each primary indication. METHODS: A retrospective analysis of all pregnant women referred to a pediatric cardiology unit for fetal echocardiography by the tertiary-care sonography unit over a 2-year period was performed. The primary indications for referral for fetal echocardiography were obtained from the sonographers' reports. Outcome data were extracted from the fetal echocardiograms, postnatal echocardiograms or pathology and autopsy reports, and patient medical records. RESULTS: Of 6,002 pregnant women who had undergone prenatal sonographic examination during the study period, 275 (4.6%) had been subsequently referred for fetal echocardiography. The most common primary indication for referral had been abnormal cardiac findings on the prenatal sonographic examination, which had been present in 64 (23.3%) of the 275 cases. In 44 (69%) of those 64 cases, congenital heart disease had been confirmed. Among the 211 patients who had had normal cardiac findings on prenatal sonography but had been referred for fetal echocardiography owing to other primary indications, congenital heart disease had been confirmed in only 7 cases (3.3%). CONCLUSIONS: An abnormal cardiac finding during prenatal sonographic examination is a common primary indication for fetal echocardiography and is more useful for identifying congenital heart disease than are other risk factors. Careful routine cardiac screening during routine prenatal sonographic examination may facilitate further investigation and treatment.