产前超声及MRI在胎儿先天性膈膨升的诊断及预后评估中的应用价值探讨

目的:探讨胎儿先天性膈膨升(EOD)的产前超声及磁共振成像(MRI)诊断情况,以明确两者在胎儿EOD诊断及预后评估中的应用价值。方法:回顾性分析产前超声初筛疑似EOD的21例患者的临床资料,比较胎儿产前超声及MRI的EOD诊断符合率,并结合出生后随访结果进行分析。结果:①经产后胸片或手术证实EOD13例(左侧6例,右侧7例),其中单纯性EOD3例,EOD合并患侧肺不张3例,EOD合并多发异常7例;胸骨后疝3例;疝囊型膈疝5例。产前超声诊断EOD21例,误诊8例,超声诊断EOD准确率为61.9%(13/21);MRI诊断EOD14例,误诊1例,MRI诊断EOD准确率为92.9%(13/14)。②EOD合并多发异常7例中6例选择引产,1例选择继续妊娠,新生儿出生后死亡。单纯性EOD3例及EOD合并患侧肺不张3例超声检测健侧肺头比实测值与预测值的比值(O/ELHR)在60%~91%,出生后均存活。结论:产前超声诊断胎儿EOD有一定的准确性,是产前常规筛查EOD的首选,但胸骨后疝和疝囊型膈疝易误诊为EOD,应注意鉴别,结合MRI检查能提高其准确性。单纯性EOD及EOD合并患侧肺不张胎儿出生后预后较好。

The Effect of Prenatal Ultrasound and MRI in the Diagnosis and Prognosis Assessment of Fetal Eventration of Diaphragm

Objective:To study the value of prenatal ultrasonography and MRI in diagnosis and prognosis of eventration of diaphragm(EOD).Methods:The results of prenatal ultrasonography and MRI of 21 cases of fetal congenital diaphragmatic distension were collected and the ultrasonography features were summarized,all cases were followed up.Results:Confirmed by postpartum chest radiograph or surgery,13 cased were diagnosed as EOD(6 cases in left,7 cases in right),including 3 cases of simple EOD,3 cases of EOD with atelectasis,7 cases of EOD with multiple exception,3 cases of retrosternal hernia,5 cases of hernia cystic diaphragmatic hernia.21 cases were diagnosed by ultrasonography and 8 cases were misdiagnosed,with a diagnostic accuracy rate of 61.9%(13/21);14 cases were diagnosed by MRI and 1 case was misdiagnosed,with a diagnostic accuracy rate of 92.9%(13/14).6 out of 7 cases of EOD with multiple abnormal chose labor induction,1 patients chose to continue the pregnancy while newborn not survived after birth.In 3 cases of simple EOD and 3 cases of EOD with pulmonary hypoplasia,the results of O/E LHR was ranging from 60%to 91%,all survived after birth.Conclusions:Prenatal ultrasound can diagnose fetal EOD partially,which is the first choice for prenatal EOD screening.We should take care of the difference between retrosternal hernia and hernia cystic diaphragmatic hernia and EOD.while combined with MRI examination can enhance the accuracy.At the same time,simple EOD fetus and combined with atelectasis had better prognosis after birth.