双胎反向动脉灌注序列征胎儿产前超声评估及特征分析

目的: 分析双胎反向动脉灌注序列征（twin reversed arterial perfusion sequence,TRAPS）胎儿产前超声的特征。方法: 回顾性分析2015年1月—2020年10月共22例在西北妇女儿童医院诊断的TRAPS超声特征。结果: ①无心无头13例,表现为无心无头,无上肢,仅可见部分脊柱及下肢;有头无心5例,可见颅骨光环或者部分颅骨,可见四肢及脊柱,未见心脏结构,此5例胎儿颅内结构均显示不清或仅见部分脑组织,或有严重颅内畸形;不定形无心4例,均表现为不规则组织的团状回声,未见明显身体结构。②无心胎儿伴随畸形：无心胎儿共有13例伴发全身水肿,其中有4例表现为淋巴水囊瘤;有1例表现为全前脑,1例表现为全前脑合并脐膨出,2例脑积水。③泵血胎儿中22例均可见胎心,其中仅1例表现为颈项透明层增厚、双肺回声增强、心内结构紊乱、心胸比增大、胸腔积液、单脐动脉,1例帆状胎盘,1例心包积液,其余胎儿均未见明显异常。④彩色多普勒显示,无心畸形胎儿均可在脐部测及脐动脉血流反向进入腹腔。结论: 产前超声是诊断TRAPS的重要手段,尽早确诊有助于判断预后,为治疗方式的选择提供可靠的依据。

Prenatal Ultrasound Evaluation and Characteristic Analysis of Twin Reverse Arterial Perfusion Sequence

Objective: To analyze the characteristics of prenatal ultrasound in twin reversed arterial perfusion sequence (TRAPS). Methods: Retrospective analysis was conducted on the ultrasound characteristics of 22 cases of the TRAPS diagnosed in Northwest Women and Children′s Hospital from January 2015 to October 2020. Results: ①There were 13 cases with no heart and no head, no upper limbs, only part of the spine and lower limbs; 5 cases with head but no heart. The halo of skull or part of skull, limbs and spine could be seen, and no heart structure was found. The intracranial structure of these 5 cases was not clear or only part of brain tissue could be seen, or there were serious intracranial malformations; 4 cases of unformed centerlessness showed mass echo of irregular tissue without body structure. ②Concomitant deformity of centerlessness: 13 cases were accompanied with systemic edema, including 4 cases of lymphangioma, 1 case of whole forebrain, 1 case of forebrain with omphalocele, and 2 cases of hydrocephalus. ③In those pump twins, all of 22 cases were found fetal heart by ultrasound. One case showed NT thickening, double lung echo enhancement, intracardiac structural disorder, cardiothoracic ratio increase, pleural effusion, single umbilical artery, and no obvious abnormality was found in other fetuses. ④Color Doppler showed that those fetuses without cardiac malformation had the umbilical artery blood flow and reverse into the abdominal cavity. Conclusions: Prenatal ultrasound is an important means of TRAPS diagnosis. The early diagnosis of TRAPS is helpful to determine the prognosis and provide reliable reference for the treatment.