三维超声体表成像在产科的临床应用

目的探讨三维超声体表成像技术及其在产科临床的应用价值。方法采用GE730对16孕周以上的3810例胎儿进行产科常规检查，再用三维超声重点观察胎儿体表结构，进行面部、脊柱、四肢等进行三维体表重建，统计并比较超声诊断与随访结果。结果16—24、25～32、33～40孕周体表成像成功率分别为602％、90．7％、64．0％。共检出体表畸形16例。二维超声检查诊断正确者12例，4例体表畸形胎儿二维超声检查不能作出明确诊断，由三维超声进一步检查确诊。误诊1例为胎儿足内翻，出生后证实正常；漏诊1例单纯唇裂，2例小耳畸形，1例多指畸形，出生后随访证实。胎儿体表成像的最佳时间为25～32孕周。三维超声对胎儿体表畸形检出的敏感性、准确性较二维超声高，但两者的差异无统计学意义（P〉0．05）。结论三维超声能更直观、立体地显示胎儿头面及四肢的体表结构，在筛查胎儿体表畸形方面与二维超声联合应用，可提高胎儿体表畸形的检出率。

The clinical application of 3D ultrasonography in obstetrics

Objective To evaluate the clinical application of three-dimensional （3D） sonography surface imaging technology in obstetrics. Methods Two dimensional （2D） routine obstetric ultrasonography was performed in 3810 fetuses over 16 weeks with GE730; then 3D reconstruction was made focusing on the surface structures including face, spine and limbs. The ultrasound diagnosis was compared with follow-up results. Results The success rates of surface imaging for fetuses 16 - 24 weeks, 25 - 32 weeks, 33 - 40 weeks were 60.2%, 90.7%, 64.0%, respectively. Sixteen cases of surface malformation were detected, including 12 cases diagnosed by 2D ultrasound and 4 was missed by 2D but diagnosed by 3D ultrasound, 1 normal case was misdiagnosed as foot inversion. One case of cleft lip, 2 cases of microtia and 1 case of multi-finger deformity were missed by ultrasonography, and confirmed by subsequent medical follow-up. Conclusion The best time for fetal surface imaging is 25 - 32 weeks. 3D ultrasound shows the evolution of embryonic development more clearly than 2D ultrasound, and the combination of two techniques may increase the detection rate of fetal surface malformation.