胎儿肠梗阻的产前诊断和临床预后

目的探讨胎儿肠梗阻产前诊断的临床意义.方法本文应用超声产前诊断89例胎儿肠梗阻患者,向其交代可能的预后,如患者选择引产放弃胎儿,则对患儿尸体进行解剖验证;如选择继续妊娠患者,定期随访,严密监测,必要时行新生儿腹部X线平片拍摄和钡灌肠造影,检查是否存在梗阻部位和梗阻类型,诊断明确后行手术或保守治疗.分娩后取胎儿脐带血进行胎儿染色体分析.结果 1.89例产前发现胎儿肠梗阻患者,产后证实为消化系统畸形66例(74.16%),伴羊水增多47例.具体表现为:十二指肠病变为17例,16例合并羊水增多(94.12%);小肠病变41例,30例合并羊水增多 (73.17%);大肠病变8例,1例并发羊水增多 (12.5%).2.23例 (25.84%) 新生儿未发现异常表现.3.6例为多发畸形(9.09%),5例合并染色体异常(9.26%).结论产前诊断胎儿肠梗阻,并给予严密监护和正确的临床管理,对优生优育及出生后早期、及时治疗具有重要临床指导意义.

Prenatal diagnosis of fetal bowel obstruction

Objective:To study the clinical significance and causes of fetal bowel obstruction. Methods:89 cases with fetal bowel obstruction were prenatally diagnosed with ultrasound. Ultrasonographic diagnosis was made by demonstrating distended loops of bowel according to Baxi's criteria. All the cases were followed up closely, neonatal abdominal X-ray or barium clysis was used to make sure the diagnosis after birth, also operation or autopsy was used to prove the prenatal diagnosis. Results:1. Among 89 cases with prenatal fetal bowel obstruction, 66 cases were bowel malformations (74.16%), 47 cases accompanied with polyhydromnios. They were as follows: 17 cases were duodenal malformations, 94.12% of them accompanied with polyhydramnios; 41 cases were small bowel malformation, 73.17% of them accompanied with polyhydramnios; 8 cases were big bowel malformation, 12.5% of them accompanied with polyhydramnios. 2. 23 cases (25.84%) with fetal bowel dilatation were normal after birth. 3. 6 cases were multi-malformations (9.09%), 5 cases were abnormal chromosome (9.26%). Conclusion:Fetal bowel obstruction is closed correlated with intestinal malformation, a careful and appropriate clinical management and instruction should be given for them.