脐静脉穿刺术在产前诊断中的应用

目的:评价B超引导下的脐静脉穿刺术在产前诊断中的成功率、安全性及实用性。方法:回顾性分析2005年8月~2007年6月在本院进行的101例有各种产前诊断指征,并在B超引导下进行脐静脉穿刺术的孕妇临床资料,观察穿刺手术的成功率、并发症及诊断结果。脐血穿刺的指征为:染色体核型分析96例,血液病高危孕妇6例,孕妇病毒感染2例,进行性肌营养不良基因鉴定3例,其中部分病例同时合并2种及以上指征。结果:101例中98例成功抽取脐静脉血,其中1次穿刺成功71例(70.29%),2次穿刺成功25例(24.75%),两次合并成功率达95.05%。有2例行第3次穿刺且成功(1.98%),三次穿刺合并成功率为97.03%。手术并发症包括:脐带穿刺后渗血者21例,占20.79%,其中渗血超过30 s者4例,占3.96%。穿刺后胎盘渗血者6例(均发生于胎盘在前壁者),占11.76%。两者合并渗血例数27例,占26.73%。穿刺后出现胎儿心动过缓者4例,占3.96%。未出现晚期流产、胎死宫内、早产、宫内感染等并发症。结论:B超引导下的脐静脉穿刺术是一项成功率高、安全适用的产前诊断技术。

Application of Cordocentesis in Prenatal Diagnosis

Objective:To study the safety,efficacy and complications of diagnostic cordocentesis conducted by type B ultrasound during pregnancy.Methods:From August 2005 to June 2007,101 clinically suspected abnormal pregnant women were performed cordocentesis under ultrasound guidance at West China Second University Hospital of Sichuan University.The results of procedure and their complications were observed.The indications for cordocentesis were prenatal karyotyping(96 cases),fetal risk of blood disorders(6 cases),fetal risk of viral infection(2 cases) and DMD(3 cases).Results:Success rate of cordocentesis:total 98 procedures were done successfully in 101 cases(97.03%),71 procedures were done successfully at the first attempt(70.29%),25 required repeated procedures(24.75%),and 2 required the third procedure(1.98%).Complications:Transient bleeding from placentas(6 cases) and umbilical cords(21 cases) were observed(26.73%),transient fetal bradycardia in 4 cases(3.96 %).Other complications,such as premature labor,intrauterine infection and fetal death did not occur during or after this procedure.Conclusion:Cordocentesis during pregnancy is a useful,relatively safe and effective procedure for prenatal diagnosis.