胎儿肾盂扩张的产前诊断及转归

目的 研究不同程度胎儿肾盂扩张的产前诊断及其临床转归,为产前遗传咨询提供依据.方法 对孕妇作产前超声检查,发现胎儿肾盂扩张时,测量肾盂前后径(APD),按肾盂APD值分别纳入轻度、中度、重度肾盂扩张组,并进行监测和随访,部分胎儿作染色体核型检测.结果 128例胎儿存在肾盂扩张,引产胎儿28例,24例合并胎儿畸形,7例存在染色体异常.继续妊娠的100例胎儿中,有155侧肾盂扩张,轻度组86侧肾盂扩张,自行消失83侧,占96.5%(83/86).中度组39侧肾盂扩张,自行消失24侧,占61.5%(24/39);生后手术治疗8侧,占20.5%(8/39).重度组30侧肾盂扩张,自行消失1侧,占3.3%(1/30),生后手术治疗22侧,占73.3 %(22/30).肾盂扩张自行消失率随扩张程度的加重而下降(x2=88.730,P<0.01);出牛后患儿手术率与产前胎儿肾盂扩张的程度呈正相关(x2=2.045,P<0.01).69例胎儿行染色体核型检测,7例异常,占10.1%.结论 胎儿单纯的轻、中度肾盂扩张多数可自行消失,若合并其他器官异常,则染色体异常的风险增大;中重度肾盂扩张者,易合并泌尿系或其他器官异常.

Antenatal diagnosis and clinical outcomes of fetal pyelectasis

Objective To study the antenatal diagnosis and clinical outcomes of fetal pyelectasis to provide evidence for prenatal counseling.Methods The anteroposterior diameter(APD) of the pelvis was measured when fetal pyelectasis was detected during prenatal sonography and all pyelectasis cases were divided into mild,moderate and severe group.All cases were followed up and some received karyotyping.Results Totally,128 fetuses were identified with different degrees of pyelectasis.Twenty-eight out of the 128 pregnancies were terminated among which 24 complicated with fetal anomalies and 7 were identified with chromosome abnormalities.The rest 100 pregnancies were continued,including 86 sides of fetal pyelectasis in the mild group,39 in the moderate group and 30 in the severe group.The spontaneous regression rate in the three groups was 96.5%(83/86),61.5%(24/39) and 3.3%(1/30) respectively and 20.5%(8/39) of those in the moderate group and 73.3%(22/30) of the severe group underwent operation after birth.The regression rates of fetal pyelectasis decreased with the increase of the severity of fetal pyelectasis(x2= 88.730,P<0.01).The proportion of operation was positively correlated to the degree of fetal pyelectasis (x2= 2.045,P<0.01).Among the 69 fetuses who received karyotyping,7 (10.1%) were abnormal.Conclusions Most of the mild and moderate fetal pyelectasis regress spontaneously.However,the risk of chromosome abnormality is increased when such fetuses complicated with other deformities,thus karyotyping is necessary.Those with moderate and severe pyelectasis are likely to have abnormalities of urinary or other systems.