产前超声发现胎儿透明隔腔异常的临床意义

目的分析产前超声发现胎儿透明隔腔(CSP)异常的临床意义。方法回顾性对比分析53胎产前超声发现CSP异常胎儿的超声及头部MRI。结果产前超声检出53胎CSP异常,包括26胎CSP未显示、18胎CSP狭小、6胎CSP增宽及3胎CSP形态异常,其中12胎产前超声及头部MRI均提示神经系统发育异常。产前超声未能显示CSP的26胎中,8胎存在神经系统异常,包括单纯性完全型胼胝体缺如3胎,完全型胼胝体缺如合并脑膨出和四肢长骨短小1胎,完全型胼胝体缺如伴脑裂畸形或叶状前脑无裂畸形各1胎,脑积水或额叶多小脑回致CSP受压未显示各1胎。产前超声显示CSP狭小的18胎中,1胎为单纯性部分型胼胝体缺如并经MRI证实。产前超声发现CSP增宽的6胎中,MRI均未检出其他神经系统异常。3胎超声显示CSP形态异常胎儿中,MRI示2胎孤立性透明隔部分发育不良及1胎部分型胼胝体缺如。结论产前超声发现胎儿CSP异常是诊断神经系统发育异常的重要线索。     

产前超声检测胎儿胸腺

产前超声检测胎儿胸腺对诊断胎儿胸腺发育异常及相关畸形或疾病有重要作用,新技术的发展和应用可更全面地评估胎儿胸腺的发育。本文对胎儿胸腺超声检测技术及临床应用进行综述。     

产前超声诊断胎儿尿道下裂进展

尿道下裂是胎儿常见泌尿系统先天畸形。产前二维及三维超声检查均可用于诊断胎儿尿道下裂,二者联合可提高诊断效能;在此基础上进行彩色多普勒超声检查可进一步明确尿道开口位置,提高诊断准确率,降低误诊率。本文对产前超声诊断胎儿尿道下裂进展进行综述。     

产前二维及三维超声测量正常胎儿胸腺

目的探讨产前二维及三维超声评估胎儿胸腺的最佳指标。方法对360胎孕22~39周正常单胎胎儿,应用二维超声检测胎儿胸腺的横径、前后径、周长、面积,三维超声检测胎儿胸腺体积。采用线性回归分析各测量指标与孕周的关系。并采用Steiger's t检验比较各指标与孕周的相关性。结果胎儿胸腺的横径、前后径、周长、面积及体积均随孕周的增加而增大,与孕周均呈线性相关。回归方程为:横径(cm)=-1.98+0.16×孕周;前后径(cm)=-0.80+0.08×孕周;周长(cm)=-5.00+0.42×孕周;面积(cm2)=-1.49+0.35×孕周;体积(ml)=-2.12+0.45×孕周(P均0.01)。Steiger's t检验显示,三维超声检测胎儿胸腺体积与孕周的相关性明显优于其他指标(P0.01)。结论对孕22~39周正常胎儿,采用三维超声测量胎儿胸腺体积是评估胸腺发育情况的最佳指标。     

产前超声诊断胎儿动脉导管提前闭合1例

正孕妇37岁,单胎妊娠,孕37周,常规产检超声发现胎儿右心增大;既往孕1产0,无特殊病史,否认近期用药史,近5天日均进食葡萄约500g。胎儿超声:四腔心切面(图1A)见心胸比0.46,右心增大,右心室壁运动良好,有极少量心包积液;三尖瓣口见瓣叶活动,血流暗淡,流速46cm/s,关闭时大量反流,反流束约占右心房面积50%,反流速度2.9m/s;卵圆孔增大,直径8.4mm,并见右向左分流;三血管切面见动脉导管呈沙漏样,主动脉端纤细,直径仅1.2mm,CDFI未见血流信号通过(图1B),频谱未测及;肺动脉增宽,与主动脉比值约1.5,见窄带样低速高阻型频谱,流速29cm/s;静脉导管a波反向;超声心动图心衰评分8分。     

产前超声联合MRI诊断胎儿先天性食管闭锁

目的探讨产前超声联合MRI对胎儿先天性食管闭锁(CEA)的诊断价值。方法回顾性分析31胎经引产后尸体解剖或出生后手术及影像学检查证实的CEA胎儿(CEA组)的产前超声及MRI资料,并与31胎产后正常胎儿(正常对照组)进行对照。以病理结果为金标准,分析产前超声联合MRI诊断胎儿CEA的阳性率。比较2组间产前超声指标胎儿双顶径(BPD)、头围(HC)、腹围(AC)、股骨长(FL)、羊水深度(AFD)、羊水指数(AFI)、胎盘厚度、脐动脉峰谷比(S/D)、胎儿吞咽指数及估算胎儿体质量(EFW)的差异。结果产前超声联合MRI诊断胎儿CEA的阳性率为67.74%(21/31)。CEA组胎儿HC、AC、吞咽指数、EFW均低于正常对照组(P均0.05),S/D、AFI均高于对照组(P均0.05);2组间BPD、FL、AFD、胎盘厚度差异均无统计学意义(P均0.05)。结论产前超声无法直接诊断胎儿CEA,当发现胃泡持续72h不显示(间隔72h复查)或羊水过多时,结合MRI对产前诊断胎儿CEA具有一定价值。产前超声指标中,胎儿HC、AC、AFI、S/D、吞咽指数、EFW可能对CEA具有一定提示作用。     

产前超声判断胎儿心脏位置的方法

产前心脏超声检查难度较大,识别胎儿心脏位置十分关键。本文就产前心脏超声检查中识别胎儿心脏位置的方法进行综述。     

胎儿主动脉弓离断的产前超声诊断现状

主动脉弓离断是一种罕见的严重先天性心脏病,胎儿期死亡率极高,其胚胎学起源复杂,表现形式多样,且多合并其他畸形,产前超声诊断困难。超声心动图作为目前临床常用的胎儿心脏检查手段,在先天性心脏病的筛查中发挥重要作用。本文主要从二维超声、三维超声在诊断中的应用及超声鉴别诊断方面对胎儿主动脉弓离断的产前超声诊断现状进行综述。     

基层医院开展产前超声筛查的临床价值分析

目的 探讨产前超声检查对胎儿畸形的临床意义.方法 2007年9月～2010年9月在笔者所在医院产前胎儿畸形超声筛查31298例.结果 31298例孕妇中产前超声筛查及产后证实胎儿畸形213例胎儿畸形,神经系统畸形最为多见.结论 开展前超声筛查尤为重要,如检测出异常,及时终止妊娠,把畸形胎儿的发生率降到最低点,以达到优生目的.     

产前超声诊断泄殖腔外翻综合征2例

正病例1,孕妇26岁,孕23周,孕1产0。超声发现胎儿下腹壁宽2.05 cm回声连续性中断,下腹部至会阴部见3.86 cm×2.75 cm包块向外突起(图1A),内见肠管、肝脏、胆囊回声,膀胱未显示;右侧脐动脉可显示,左侧脐动脉未显示;左足姿势异常,呈马蹄内翻状;脊柱骶尾段表面皮肤完整,骶尾段椎体横切面呈"V"字形,并见1.08 cm×0.91 cm无回声包块稍向外突起,骶尾段椎体骨化中心显示欠清晰;外生殖器显示不清。超声诊断:宫内单活胎     

Spontaneous regression of a cystic cavum septum pellucidum

Summary A persistent cavum septum pellucidum (CSP) is present in ∼0.73% of adults, although its incidence ranges from 0.14 to 18.9% depending on the detection method. Cystic CSP is even rarer. A cyst causing mass within the CSP can obstruct the intraventricular foramen, leading to blockage of CSF flow and possible hydrocephalus, often justifying surgical intervention. We describe spontaneous decompression of a cystic CSP in a 36-year-old man. Initial MRI showed a cystic CSP with lateral bowing of the septal walls to 1.9 cm. Follow-up MRI 15 months later demonstrated no lateral bowing, and the septal wall width was 1.0 cm. This spontaneous decompression was not explained by the one previously described case report of cystic CSP regression.     

A case of germinoma in the septum pellucidum manifesting as amnesia and hemiparesis

BACKGROUND: We report a rare case of germinoma mainly located in the septum pellucidum. CASE DESCRIPTION: A 19-year-old man presented with germinoma located in the septum pellucidum manifesting as amnesia and right hemiparesis. Magnetic resonance imaging demonstrated a heterogeneously enhanced mass in the septum pellucidum and abnormal T2-weighted signals in the left basal ganglia. An anterior transcallosal approach was performed to remove the mass in the septum pellucidum. The histological diagnosis was germinoma. Radiotherapy and chemotherapy were given. He was discharged with slight amnesia and right hemipareis. INTERPRETATION: Intracranial germinoma can arise from the septum pellucidum.     

Endodermal cyst of septum pellucidum and pregnancy: a case report

BACKGROUND

Endodermal or Neurenteric cysts are commonly found in spine. Their intracranial occurrence is rare and such a cyst in the septum pellucidum is exceptional.

METHOD

We report a woman, with 33 week pregnancy, presenting in a semiconscious state due to raised intracranial pressure (ICP) due to hydrocephalus caused by a large lesion in the septum pellucidum. Computed tomography (CT) revealed the lesion which was better characterised by the Magnetic Resonance Imaging (MRI). First baby was delivered by LSCS and bilateral ventriculo-peritoneal shunts were inserted; and later on the cyst was excised.

RESULT

There was full neurological recovery following the insertion of VP shunt. After excision of cyst cerebrospinal fluid (CSF) pathway was established and shunts could be removed. Post-operative period was complicated by septic ventriculitis. Eventually patient was discharged home in excellent condition.

CONCLUSION

Endodermal cyst of septum pellucidum is an uncommon condition. Such lesions may be large when revealed, good outcome is expected after surgical excision.     

孕28~32周针对性超声筛查胎儿肾盂分离

目的于孕28～32周以超声针对性筛查胎儿肾盂分离情况,观察其临床意义。方法针对性观察接受常规产检的孕28～32周单胎孕妇胎儿肾盂情况。根据肾盂最大前后径(APD)将肾盂分离分为肾盂轻度分离组(轻度组)及重度分离组(重度组),回顾性分析2组胎儿孕18～24周有无肾盂分离,前瞻性观察孕37～40周肾盂分离转归。结果共37 890只胎肾入组,孕28～32周见223只肾盂分离(0.59%,223/37 890),轻度组178只,重度组45只。孕18～24周时,轻度组20只无肾盂分离,126只轻度肾盂分离,32只重度肾盂分离;重度组1只无肾盂分离,18只轻度肾盂分离,26只重度肾盂分离;2组肾盂分离程度差异有统计学意义(P0.01)。孕37～40周时,轻度组65只无肾盂分离,61只轻度肾盂分离,52只重度肾盂分离;重度组12只无肾盂分离,3只轻度肾盂分离,30只重度肾盂分离;2组胎儿肾盂分离程度差异有统计学意义(P0.01)。结论胎肾肾盂分离呈动态变化,孕28～32周针对性超声检查有助于及时检出持续性肾盂分离及重度肾盂分离。     

主动脉峡部搏动指数评估子痫前期患者胎儿血流动力学改变

目的 探讨主动脉峡部（AoI）搏动指数（PI）对评价子痫前期胎儿血流动力学改变的临床价值。方法 261名单胎孕妇接受产前超声检查,以其中47例子痫前期患者作为病例组,另自214名正常孕妇中选取47名作为对照组。观察214名正常孕妇AoI-PI随孕周的变化,以及病例组胎儿出生前AoI-PI、CPR变化。结果 正常胎儿AoI-PI随孕周增加略有增加。病例组胎儿AoI-PI较对照组增加（P<0.001）,CPR较对照组降低（P<0.001）,且病例组AoI-PI异常改变早于CPR。结论 AoI-PI变化可以提示子痫前期患者胎儿血流动力学改变。