胎儿脐静脉-门静脉系统正常解剖与异常分流的超声特征分析

目的探讨胎儿脐静脉-门静脉系统的正常超声图像以及异常分流的超声诊断特征。 方法回顾性选取2018年1月至2020年12月在郑州大学第三附属医院行产前超声筛查和诊断的正常胎儿85例，观察脐静脉-门静脉系统的超声图像特征。另收集产前超声诊断为脐静脉-门静脉系统异常分流的26例胎儿的资料，对其产前超声图像及合并异常进行分析。 结果正常胎儿脐静脉-门静脉系统中门静脉主干与门静脉窦连接方式分为3种：“T”形连接60例；“X”形连接11例；“H”形连接14例。脐静脉-门静脉系统异常分流的26例胎儿中，脐静脉-体静脉分流6例，其中脐静脉回流入右心房4例，回流入下腔静脉1例，肝静脉异常分流1例，6例均合并静脉导管缺失，3例合并畸形，3例合并心脏增大；静脉导管-体静脉分流4例，其中静脉导管下腔静脉入口位置下移2例，经冠状静脉窦回流入右心房1例，直接回流至肝静脉1例，2例合并心内、心外多发畸形；肝内门静脉-体静脉分流16例，Ⅰ型1例、Ⅱ型6例、Ⅲ型3例、Ⅳ型6例。其中4例合并胎儿生长受限，2例合并心脏畸形，2例合并单脐动脉。 结论正确识别正常脐静脉-门静脉系统超声图像有助于发现和诊断异常分流；各类型异常分流有不同的超声图像特征；评估肝内门静脉系统发育、心功能及各系统发育可为临床咨询和处理提供信息和依据。

Ultrasound features of normal anatomy and abnormal shunts of fetal umbilical-portal-systemic venous system

ObjectiveTo investigate the normal ultrasound images of the fetal umbilical portal venous system (UPVS) and the ultrasound diagnostic characteristics of abnormal shunt. MethodsThe ultrasound image features of the normal UPVS in 85 fetuses were analzyed from January 2018 to December 2020, and the data of 26 cases of abnormal shunts of the fetal UPVS were collected to analyze the prenatal ultrasound images and complications. ResultsThere were three types of connection between the main portal vein and the portal sinus in the normal fetal UPVS: T-shaped connection in 60 cases, X-shaped in 11, and H-shaped in 14 cases. There were 26 cases of abnormal shunts of the fetal UPVS in the study: umbilical-systemic shunts (USS) in 6 cases, including 4 cases with the umbilical vein flowing into the right atrium, 1 case with the umbilical vein flowing into the inferior vena cava, and 1 case with the umbilical vein flowing into the hepatic vein. There was no ductus venosus in all the six cases. Three cases were associated with other malformations, and three cases with cardiac enlargement. Ductus venosus-systemic shunts (DVSS) occurred in four cases. The position of the ductus venosus (DV) flowing into the inferior vena cava moved down in two cases. The DV flew into the right atrium through the coronary sinus in one case. The DV flew into the right hepatic vein in one case. Two cases were associated with other malformations. Intrahepatic portal-systemic shunts (IHPSS) occurred in 16 cases, included 1 case of type Ⅰ, 6 cases of type Ⅱ, 3 case of type Ⅲ, and 6 cases of type Ⅳ. Among them, 4 cases were combined with fetal growth restriction (FGR), 2 were complicated with cardiac malformations, and 2 were combined with single umbilical artery. ConclusionKnowing the normal ultrasound images of the UPVS is helpful to find and diagnose abnormal shunt. Each type of abnormal shunt of the UPVS has different ultrasonic image features. Evaluating the development of intrahepatic portal venous system, cardiac function, and other malformations is helpful for clinical consultation and treatment.