胎儿颜面部的产前超声研究

目的 探讨宫内胎儿颜面部的超声表现与显示手法，提高产前超声对胎儿颜面部正常结构及畸形的认识。方法 选择2000年8月至2002年6月在我院行彩超产前检查的连续病例4200例，确定胎位后，对每一胎儿颜面部均进行冠状、矢状及横切面扫查。结果 99．62％(4184例)的胎儿颜面部各个结构均能够通过常规胎儿颜面部冠状切面、矢状切面、横切面正确显示，其深部骨性结构大部分亦能清楚显示，但硬腭与软腭不能显示。检出各种颜面部畸形29例78个，总检出率89．66％，漏诊7例9个(10．34％)，均经产后或引产证实。产前超声诊断胎儿颜面部畸形的敏感性、特异性、准确性、阳性预告值和阴性预告值分别为85．29％，99．95％，99．83％，93．55％和99．88％。结论 常规二维超声产前对胎儿颜面部大部分表面结构与深部骨性结构均能清楚显示，是显示胎儿颜面部结构与诊断胎儿颜面部畸形的可靠影像诊断方法。

Prenatal ultrasonographic evaluation of fetal facial anatomy and fetal facial malformations

Objective To review the ultrasonographic evaluation on fetal facial anatomy and malformations in prenatal diagnosis. Methods Continuous 4 200 prenatal ultrasonographic evaluation during gestation age 14 40 weeks from August 2000 through June 2002 entered the present study. Routine coronal, sagittal and transverse planes were applied to scan the fetal facial structures after the fetal position was confirmed and/or adjusted. Results Superficial facial anatomic structures as well as the deep bony structures of the fetal faces were clearly displayed and correctly recognized on the three routine planes in 4 184 cases ( 99.62 %), but not the palate. Seventy eight facial malformations of 29 fetuses were correctly diagnosed. Whereas 9 malformations of 7 fetuses were missed to recognize, and 2 suspected cleft palate were demonstrated normal after delivery. The diagnoses were confirmed after subsequent labor or induced labor. The total detection rate reached 89.66 %. The false negative rate was 10.34 %, and the false positive rate was 0.05 %. The sensitivity, specificity, accuracy, positive and negative predictive values were 85.29 %, 99.95 %, 99.83 %, 93.55 % and 99.88 % respectively. Conclusions The majority of fetal facial superficial and deep structures is clearly demonstrated on prenatal ultrasonic imaging on the 3 routine scanning planes. Prenatal ultrasonographic evaluation of the fetal face is a reliable and accurate diagnostic modality so far as the skills become more sophisticated.