单脐动脉的超声诊断及意义

目的：探讨二维超声及彩色多普勒超声对单脐动脉的诊断及其临床意义。方法：应用常规产前彩色超声检查，发现胎儿异常者仔细检查脐血管；发现单脐动脉者仔细检查是否合并胎儿畸形。同时测量脐动脉血流参数，估测胎儿大小并评价其与孕周是否相符。结果：2005年2月~2006年6月来我院就诊并做超声检查的7623名孕妇中，发现单脐动脉10例，5例伴有胎儿畸形，1例脐动脉阻力指数增高，3例脐动脉舒张期血流缺失，2例胎儿大小明显小于孕周。10例患者单脐动脉及其伴发畸形均经引产或正常产证实。结论：应用超声检查可以对单脐动脉做出明确诊断。单脐动脉与诸多胎儿异常关系密切，超声诊断医师应当高度重视脐血管的检查及单脐动脉的诊断，以有效指导临床。     

超声动态血流监测重度先兆子痫前期孕妇胎儿血流动力学变化的临床意义

目的 探讨彩色多普勒超声动态检测重度先兆子痫前期孕妇胎儿脐动脉和大脑中动脉血流动力学变化的临床价值,为及时采取必要的干预措施提供依据.方法 检测30例正常孕妇(对照组)与30例重度先兆子痫前期孕妇(观察组)胎儿的脐动脉和大脑中动脉血流参数,结果进行对比分析.结果 对照组胎儿脐动脉和大脑中动脉血流阻力指数随着孕龄的增加呈降低趋势,观察组胎儿脐动脉阻力指数较对照组明显增高,而大脑中动脉血流阻力指数和胎盘小血管阻力指数明显下降,两组间比较差异均有统计学意义(均P＜ 0.05).结论 彩色多普勒超声动态血流检测晚孕期胎儿脐动脉和大脑中动脉血流参数指标可了解并评估胎儿宫内状况,为临床医师提供重要的诊断信息,降低孕产妇和新生儿的发病率及病死率.     

彩色多普勒超声对颌面部血管畸形的诊断分类

目的 探讨彩色多普勒超声对颌面部血管畸形病变的诊断、分类.方法 对110例颌面部血管畸形进行二维及彩色多普勒超声检查,根据声像图特征和血流动力学特点将血管畸形分为高流速病变和低流速病变.结果 110例血管畸形中,67例二维显示形态不规则的网格状或蜂窝状混合性回声,部分伴强回声静脉石,彩色多普勒显示血流信号稀少或较丰富,供瘤动脉收缩期峰值血流速度(PSV)为(28.53±8.1)cm/s,超声诊断为低流速血管畸形.43例显示72条供血动脉增粗,瘤内血流信号极丰富,PSV为(144.53±38.9)cm/s,呈低阻动脉型频谱,超声诊断为高流速血管畸形.经DSA检查或术后病理证实高流速和低流速两类病变的超声诊断正确率分别为100%和97%.结论 彩色多普勒超声对血管畸形病变能作出较正确的诊断分类和鉴别诊断,对临床选择合理的治疗方案具有重要的指导意义.     

系统超声诊断单脐动脉类型及伴发胎儿畸形临床研究

目的探讨系统超声在产前诊断单脐动脉类型及伴发胎儿畸形的临床价值。方法回顾性分析47例单脐动脉的形态结构、血流信号特征、类型及伴发胎儿畸形,并与产后结果及病理学检查对照。结果（1）系统超声诊断单脐动脉及其类型,准确率为100%;（2）系统超声诊断伴发胎儿畸形与产后及病理对照符合率为85.2%;（3）单脐动脉中57.4%伴发其它系统畸形,以多发畸形为主;（4）单脐动脉中,右脐动脉缺失型常见,占63.8%;右脐动脉缺失型伴发畸形率较高,为76.7%。结论系统超声能准确诊断单脐动脉类型及伴发胎儿畸形,能对单纯性单脐动脉的胎儿进行动态观察随访和监护。     

彩超对急性动脉栓塞和急性动脉血栓的鉴别诊断

目的 探讨彩色多普勒超声对急性动脉栓塞和急性动脉血栓的鉴别诊断价值。 方法 对手术证实的89条动脉栓塞及123条动脉血栓的超声特点进行分析，对病程、血管的病变部位、管壁结构、病变近端和远段的血流动力学进行比较。 结果 急性动脉栓塞和急性动脉血栓在病程、有无侧支血管、管壁结构和病变远段阻力指数两组间差异显著（P〈0．05）。病变近端内径两样本均数差异有显著意义（P〈0．05）。病变近端最高血流速度、加速度时间、阻力指数两组差异无显著性意义（P〉0．05），病变远段内径最高血流速度及加速度时间两组差异无显著性意义（P〉o．05）。 结论 彩色多普勒超声参数有助于动脉栓塞和动脉血栓鉴别诊断。     

彩色多普勒超声诊断下肢动脉闭塞性疾病

目的探讨彩色及频谱多普勒技术在诊断下肢动脉闭塞性疾病的价值。方法对52例87条临床拟诊断下肢动脉闭塞性疾病的血管进行彩色多普勒超声检查，并与CT血管成像对照。结果彩色多普勒血流显像可以直观地显示动脉管壁情况、管腔回声及血流充盈情况，频谱多普勒可以显示血流动力学改变。诊断的准确率分别为动脉硬化和（或）闭塞症100％、动脉栓塞92％、血栓闭塞性脉管炎84％。结论彩色多普勒超声诊断下肢动脉闭塞性疾病是一种敏感、准确、方便的诊断方法。     

肝血管瘤的彩色多普勒超声分析

目的：探讨肝血管瘤的血流表现和特征；血流检出率的影响因素及措施，提高对肝血管瘤的诊断和鉴别诊断水平。方法：用彩色多普勒超声观察血流多少、分布、性质和血流动力学参数。结果：1．血流检出率25％，其中动脉性血流9．4％，静脉性血流15．3％；2．大多数为少血供型，占93％；绝大部分呈低速动脉性血流。结论：彩色多普勒超声对肝血管瘤的诊断与鉴别诊断有很高价值。     

超声筛查诊断单脐动脉类型及合并胎儿畸形的新思考

目的探讨超声筛查诊断单脐动脉（SUA）及合并胎儿畸形的价值和一些新思考点。方法回顾性分析61例SUA形态结构、类型、血管走行排列、脐动脉管径与脐静脉管径比值及伴发胎儿畸形、宫内缺氧并与产后结果及病理学检查对照。结果①超声筛查诊断SUA及其类型,准确率100%;②SUA中,左脐动脉缺失型（52.5%）较右脐动脉型（47.5%）常见;③右脐动脉缺失型伴发胎儿畸形较左脐动脉缺失型为高;④SUA内血管走行是否为螺旋状与胎儿伴发畸形有一定关系;⑤单纯性SUA内径/脐静脉内径≤0.5对于胎儿宫内是否出现宫内缺氧等一系列问题有一定关联性。结论超声筛查能准确地判断SUA类型和伴发胎儿畸形情况,并能对超声随访单纯性SUA提供更多临床信息。     

单脐动脉的产前超声诊断与产后尸体解剖的对比分析

【目的】评价产前超声诊断胎儿单脐动脉的临床价值。【方法】产前应用彩色多普勒超声检查242例胎儿脐带,并进行胎儿畸形检查,与尸体解剖或产后追踪结果对照。【结果】共检出单脐动脉胎儿22例,其中合并先天性畸形12例,并有1例诊断为Holt Oram综合征。单脐动脉胎儿结束妊娠平均孕周数小于正常胎儿,单脐动脉胎儿平均体重比正常胎儿明显降低。【结论】单脐动脉与先天性畸形、遗传性疾病等密切相关,产前超声检查单脐动脉对降低围生期病死率、提高胎儿生存质量具有重要意义。     

彩色多普勒超声诊断胎儿单脐动脉临床意义

回顾分析我院2009年1月～2012年6月经产前超声诊断的23例单脐动脉伴发畸形患者资料。结果产前超声检出23例单脐动脉,其中单纯性单脐动脉15例,单脐动脉合并胎儿畸形8例,均经正常分娩或引产证实。应用彩色多普勒超声能够准确诊断单脐动脉。     

规范化早孕期超声筛查在双胎异常妊娠中的临床价值

目的 通过规范妊娠早期超声检查双胎的时间、内容和方法,探讨早孕期规范化产前超声筛查在双胎妊娠诊断中的临床应用价值.方法 前瞻性分析2009年5月至2011年6月在江苏省产前诊断中心超声室受检的655例双胎妊娠孕妇,于妊娠11～13+6周行早孕期胎儿结构超声筛查,并追踪妊娠过程和临床结局.结果 655例受检双胎妊娠孕妇,早孕期发现28例孕妇的29个疑似胎儿超声异常,其中1例为两个胎儿均异常,其余为单个胎儿异常.疑似胎儿异常包括11例单纯解剖结构异常(颈部淋巴水囊瘤、无脑儿、脐膨出、腹部囊性包块和胎盘水泡样变性)以及17例早孕期超声指标异常(NT增厚、鼻骨缺失、巨膀胱和单脐动脉),其中共有17例最后经临床证实.其余早孕期正常孕妇中,共漏诊3例,失访62例,漏诊率为0.51%(3/593),实际双胎异常妊娠发生率为3.37%(20/593),早孕期超声筛查临床符合率为60.71%(17/28).结论 统一规范化进行早孕期产前超声筛查可有效地提高双胎异常检出的准确率,尽可能地检出胎儿异常、减少漏诊率以及早期干预具有重要的临床价值.     

超声检查对诊断胎儿畸形的临床价值

目的:探讨超声在产前诊断胎儿缺陷的临床价值。方法:对9089例18～40周的孕妇采用实时彩色多普勒超声波进行系统检查,对胎儿畸形进行筛查和诊断。结果:在9089例孕妇中,经引产或出生后证实的各种畸形133例,彩超筛查诊断胎儿畸形115例,漏诊18例。结论:妊娠中晚期进行系统超声检查,可以对胎儿形态结构方面的明显畸形进行产前诊断,对于降低出生缺陷发生率、提高人口素质具有重要意义。     

Prenatal diagnosis of intrahepatic communications of the umbilical vein with atypical arteries (A-V fistulae) in two cases of trisomy 21 using color Doppler ultrasound.

We report on two cases of the prenatal diagnosis of arterio-venous communication between the intra-abdominal umbilical vein and atypical arteries. The diagnosis was made by color and spectral Doppler and 'color power angiography'. Both cases presented with hydrops fetalis, one at 14 and the other at 31 weeks of gestation. In the first case, color Doppler demonstrated an atypical arterial vessel connecting the umbilical vein with the aorta; the ductus venosus was patent. Echocardiography showed a so-called atrioventricular canal. In the second case, a complex intrahepatic vascular malformation was found. Color Doppler demonstrated communications between the umbilical vein and the hepatic artery and an atypical artery; the ductus venosus was patent. In the latter case polyhydramnios, duodenal atresia and macroglossia were additionally detected. In both cases, fetal karyotyping revealed trisomy 21. The first case resulted in a missed abortion, the second in a stillbirth. All findings were confirmed on autopsy. Of interest is that both fetuses were affected with trisomy 21. The increasing use of color Doppler in prenatal diagnosis, especially in hemodynamically compromised fetuses, will help to determine the actual incidence of complex vascular malformations of the umbilical vein and to elucidate the impact of such malformations on fetal outcome.     

胎儿脐动脉阻力指数在产前诊断双胎输血综合征中的作用

目的探讨胎儿脐动脉阻力指数(UA-RI)在产前诊断双胎输血综合征(TTTS)中的作用。方法以我院诊断为TTTS的32对双胎作为试验组,选取32对正常单绒毛膜双胎(MCT)作为对照组。彩色多普勒超声检查胎儿脐动脉血流频谱,获取胎儿UA-RI。计算每一对双胎UA-RI的差值(ΔUA-RI)。记录胎儿一般情况,对两组ΔUA-RI及胎儿出生时胎龄进行方差分析。结果试验组和对照组的ΔUA-RI及胎儿出生时胎龄差异均有统计学意义(P<0.05)。试验组ΔUA-RI值明显高于对照组;试验组胎儿出生时胎龄明显低于对照组。结论利用彩色多普勒超声检查MCT的UA-RI,比较同一对双胎间UA-RI的差值有助于产前诊断TTTS。     

超声在出生缺陷产前诊断中的临床价值

目的探讨超声在产前诊断胎儿缺陷的临床价值。方法对8089例孕13～40周的妇女采用实时彩色多普勒超声仪进行系统检查，对胎儿畸形进行筛查和诊断，随访至产后7d。结果在8089例孕妇中，共发现先天性缺陷164例，超声诊断胎儿畸形104例，与产后诊断符合率为100％。超声检查漏诊60例，漏诊病例主要表现为较小畸形和缺陷。结论妊娠中晚期进行系统超声检查可以对胎儿形态结构方面的明显畸形进行产前诊断，对于降低出生缺陷发生率，提高人口素质具有重要意义。     

Color Doppler sonographic assessment of placental circulation in the first trimester of normal pregnancy.

Our aim was to study placental circulation during the first trimester of normal pregnancy. For this purpose, 108 single pregnancies from 4 to 15 gestational weeks were evaluated through conventional Doppler ultrasonography. The flow velocity waveforms from the retrochorionic arteries (spiral-radial arteries) and the umbilical artery were assessed using the peak systolic velocity, resistive index, and pulsatility index). Intervillous flow velocity waveform was evaluated from the maximum velocity. The earliest color signal from the retrochorionic circulation was registered at 4.5 weeks along with gestational sac visualization. The venous Doppler signal from the intervillous space and the Doppler signal from the umbilical artery were recorded with an embryo visible from the end of week 5 onward. The retrochorionic, intervillous, and umbilical peak systolic velocities increase, whereas the resistive and pulsatility indices decrease progressively during early pregnancy with a significant correlation with gestational age. Similarly, intervillous maximum velocity gradually increases throughout the first trimester of pregnancy. Despite some methodologic problems related to Doppler technology and the vessels studied color Doppler sonography appears to be an adequate tool to assess the physiologic changes in the placental circulation during early pregnancy.     

Perinatal three-dimensional color power Doppler ultrasonography of vein of Galen aneurysms.

OBJECTIVE: To present the prenatal and postnatal three-dimensional color power Doppler ultrasonographic features in cases of vein of Galen aneurysmal malformation. METHODS: Prenatal three-dimensional color power Doppler ultrasonography was used to image the neurovascular malformations in 3 fetuses with vein of Galen aneurysms and in unaffected control fetuses at the same gestational age. Postnatal transfontanel three-dimensional power Doppler ultrasonography was also performed in the third affected case and in an unaffected control neonate. The feeding and drainage vessels were analyzed in the three-dimensional rendering mode. RESULTS: The first case was complicated by porencephaly and fetal heart failure, and the pregnancy was terminated. The other 2 cases were uncomplicated prenatally, but 1 of the infants died after aneurysmal embolization due to acute cerebral ischemia. The angioarchitecture of the arteriovenous fistula was characterized in greater detail by three-dimensional color power Doppler ultrasonography than by two-dimensional ultrasonography, especially regarding the anatomic features of the feeding and drainage vessels and their connections with the dilated vein of Galen. CONCLUSIONS: Three-dimensional color power Doppler ultrasonography provided detailed images of the aneurysmal malformation and its vascular connections. Further studies are needed to correlate three-dimensional vascular imaging patterns with outcome.     

彩色多普勒超声诊断胎儿永久性右脐静脉的价值

目的:探讨彩色多普勒超声对胎儿永久性右脐静脉的诊断价值及临床意义。材料与方法:对我院行系统产前超声检查的胎儿全部进行脐静脉走行跟踪,发现永久性右脐静脉胎儿后,仔细检查静脉导管,了解是否有脐静脉的异常连接。结果:2160例胎儿诊断永久性右脐静脉5例,均与静脉导管正常连接,未发现其它部位畸形,出生后2～6月随访,脐静脉闭合良好,生长发育未见异常。结论:彩色多普勒超声是胎儿永久性右脐静脉产前诊断的有效方法,无合并其它部位畸形,预后良好。     

中孕期胎儿超声筛查切面的规范化探讨

目的探讨在中孕期胎儿筛查中规范超声检查的重要性及操作程序。方法根据临床工作中的体会，应用9个标准切面进行中孕期胎儿筛查，即小脑横径切面，唇面部冠状切面，脊柱纵切面，心脏四腔心切面，左右室流出道长轴切面，双肾横切面，左右侧脐动脉起始段彩色血流，双上肢及双下肢切面。结果对2111例中孕期妇女进行超声筛查，检出211例胎儿异常，其中严重畸形胎儿83例，包括颅脑、中枢神经系统畸形22例，心脏畸形14例，唇腭裂13例，消化系统畸形8例，胎儿水肿综合征6例，单脐动脉13例，肢体畸形2例，泌尿系统畸形1例，膈疝1例，肺分离征1例，骶尾部肿块1例，右下腹肿块1例。超声检查结果与病理解剖相符。结论中孕期胎儿超声筛查切面的规范化是早期发现异常胎儿，减少漏诊的重要措施，对减少围产期死亡率，提高出生人口质量具有重要意义。