胎儿心脏外翻畸形超声诊断的漏诊与误诊分析

摘要：目的分析胎儿心脏外翻畸形超声诊断的漏诊与误诊原因，提高胎儿心脏外翻的检出时机和检出率。方法：选取北京四季青医院2010年至2019年3000例患者中经引产或上级产前诊断机构证实诊断为心脏外翻畸形的胎儿有4例，每一例心脏外翻畸形的诊断都有产前诊断机构对照；总结超声诊断心脏外翻畸形特点，观察心脏搏动位置，心脏大血管连结方向，以及胸腹壁是否连续性中断，及胸腹壁是否有不均质回声包块，并且能在包块内发现心脏搏动。尤其是上级医院与引产后和产前诊断中心超声结果比较，分析超声发生漏诊和误诊的原因。结果：该组病例中发现心脏外翻畸形4例，其中超声诊断3例， 漏诊1例，误诊1例，其中误诊1例为将Cantrell五联征误诊为胎儿多发畸形，分别独立诊断了心脏外翻畸形，胸裂，腹裂，脊柱结构异常。结论：全面认真分析胎儿心脏外翻畸形超声检查的漏诊与误诊原因，避免出现漏诊和误诊的各种因素，准确把我提高超声对心脏外翻畸形的检出时机，达到提高疾病检出率的目的。

Analysis of missed diagnosis and misdiagnosis in ultrasonic diagnosis of fetal cardiac valgus deformity

Abstract: Objective: by analyzing the causes of ultrasonic missed diagnosis and misdiagnosis of fetal cardiac valgus deformity, improve the detection opportunity and detection rate of fetal cardiac valgus. Methods: Beijing Sijiqing Hospital from 2010 to 2019 Among the 3000 patients, 4 fetuses are diagnosed with cardiac valvular malformation by induction of labor or confirmation of superior prenatal diagnosis institutions, and the diagnosis of each case of cardiac valgus is compared with prenatal diagnosis institutions. We summarize the characteristics of ultrasonography in the diagnosis of cardiac valvular malformation, observe the location of cardiac pulses and the direction of the connection of the great vessels of the heart, as well as the continuity of the thoracic and abdominal walls, and observe the inhomogeneity of echogenic masses in the thoracic and abdominal walls where heart beats can be found. Especially compare with the ultrasound results of induced labor and prenatal diagnosis center, the reasons of missed diagnosis and misdiagnosis are analyzed. Results: Results: four cases of valgus are found in this group, including 3 cases diagnosed by ultrasound, 1 case missed diagnosis and 1 case misdiagnosed. Among them, 1 case was misdiagnosed as multiple fetal malformations due to the wulian syndrome of Cantrell, and cardiac valvular malformation, chest fissure, abdominal fissure and spinal structural abnormality were independently diagnosed.Conclusion: Analyze the causes of missed diagnosis and misdiagnosis of fetal cardiac valgus malformation by ultrasound comprehensively to avoid the various factors of missed diagnosis and misdiagnosis, as well as grasp the timing of ultrasonic detection of cardiac valgus deformity accurately, to improve the disease detection rate.