产前超声诊断轻度胎儿脑室扩张的临床意义

目的探讨产前超声诊断轻度胎儿脑室扩张的临床意义。方法 2006年1月～2009年12月于笔者医院行常规产前检查的单胎孕妇,自妊娠20周开始,由专门B超医师仔细测量胎儿侧脑室后角宽度,共18200例,发现胎儿侧脑室增宽≥10mm且≤15mm的孕妇为研究对象,共172例,每2～4周动态观察胎儿侧脑室宽度的变化及其他异常情况,并对新生儿出生后进行随访。结果轻度胎儿脑室扩张发生率为0.095%(172/18200),以妊娠28～32周最多见,占34.3%(59/172),合并结构畸形24例(13.95%)。单纯性轻度脑室扩张宫内缩小为49.6%(69/139),稳定36.7%(51/139),进展13.7%(19/139),胎儿出生后神经行为发育异常5.4%(6/111)。脑室扩张(12～15mm)组合并畸形率,脑室扩张进展率及出生后神经行为发育异常发生率明显高于脑室扩张(10.0～11.9mm)组(分别为20.6%vs 10.0%,29.8%vs 6.5%,12.1%vs 2.6%),两组比较差异均有统计学意义(P<0.05)。结论胎儿轻度脑室扩张于孕28～32周最易发现,常合并结构畸形,孕期应根据孕周进行定期随访和系统超声检查;脑室扩张≥12mm,且宫内有进展者提示预后不良,应引起高度重视。

Clinical Significance of Mild Fetal Ventriculomegaly by Prenatal Ultrasonography Examination

Objective To investigate the clinical significance of mild fetal ventriculomegaly by prenatal ultrasonography examination.Methods Prenatal ultrasonography examination was performed on 18200 singleton pregnancy women from 20 weeks gestation.172 women with mild fetal ventriculomegaly(transverse diameter of the atrium of the lateral ventricle measuring between 10 and 15mm) were enrolled in this study.The changes of ventriculomegaly and the associated intracranial and extracranial anomalies were observed regularly every 2 or 4 weeks until delivery.The infants were also followed up.Results The incidence of mild fetal ventriculomegaly was 0.095%(172/18200).Most of them were found between 28-32 weeks(59 cases,34.3%).24 were associated with structural anomalies(13.95%).Isolated mild fetal ventriculomegaly resolved throughout pregnancy in 69 of 139(49.6%),remained stable in 51 of 139(36.7%),progressed in 19 of 139(13.7%).The rate of neurodevelopmental delay was 5.4%(6/111).The rate of structural anomalies,progressing in utero and neurodevelopmental delay of ventriculomegaly group(12-15mm) were higher than those of ventriculomegaly group(10.0-11.9mm)(20.6% vs 10.0%,29.8% vs 6.5% and 12.1% vs 2.6%,respectively) which reached significant difference(P<0.05).Conclusion Most of cases could be diagnosed between 28-32 weeks gestation.Mild fetal ventriculomegaly was often associated with structural anomalies.We recommend to perform follow-up ultrasound examinations and detailed ultrasound examination depending on the gestational age at diagnosis.Isolated mild fetal ventriculomegaly with a transverse atrial size ≥12mm and progression in utero is usually associated with a poor prognosis,which should be observed carefully.