摘要
目的探讨 B 超检查胎儿肾脏回声增强的临床意义。方法选择31例产前 B 超发现胎儿肾脏回声增强的患者,征求本人意见,对选择引产放弃胎儿者(12例)行引产后患儿尸体解剖;对选择继续妊娠者(19例)定期随访。分娩时取胎儿脐带血进行胎儿染色体分析。结果 (1)31例中6例胎儿同时合并其他脏器异常,3例胎儿合并染色体异常,2例患者具有家族史。(2)12例选择终止妊娠者中,10例伴羊水过少;B 超检查胎儿肾脏回声增强的原因分别为婴儿型多囊肾10例、成人型多囊肾1例和多囊性肾发育不良1例。(3)19例选择继续妊娠者中,2例羊水过少患儿于新生儿期死亡,病理解剖结果为婴儿型多囊肾;3例患儿分别在出生后1岁内死亡,病理诊断分别为婴儿型多囊肾或多囊性肾发育不良;1例患儿在出生后26个月出现高血压症状,肾功能异常,诊断为婴儿型多囊肾;4例患儿出生后 B 超检查肾脏回声转为正常;9例肾脏 B 超表现与产前检查相同,但目前没有任何临床症状。结论 (1)胎儿期肾脏 B 超回声增强的原因多为婴儿型多囊肾、肾发育不良和非特异性肾病,也有部分为正常肾脏变异。(2)羊水量是判断胎儿预后的关键指标之一,当胎儿期肾脏回声增强伴羊水过少时提示胎儿预后不良。(3)当发现肾脏 B 超回声增强时,应仔细询问家族史,并对胎儿父母肾脏及胎儿其他部位进行详细检查,必要时建议进行胎儿染色体核型分析。
Objective To study the prenatal diagnosis and clinical significance of fetal hyperechogenic kidneys. Methods Thirty one cases with fetal hyperechogenic kidneys were prenatally diagnosed with ultrasound. Autopsy was conducted and histological examination of the kidney was performed when pregnancy was terminated. A close follow-up was given for cases continuing pregnancy. Umbilical cord blood was collected for fetal chromosome analysis after delivery. Results （ 1 ） 6 fetuses were complicated with other organ abnormalities, 3 fetuses had abnormal chromosome, and 2 cases had a family history. （2） 12 cases chose to terminate pregnancy, 10 of whom were oligohydromnios. Causes for fetal hyperechogeuic kidneys were infantile polycystic kidney disease （IPKD, 10 cases ）, adult polycystic kidney disease （APKD, 1 case）, polycystic kidney dysplasia （PKD, 1 case） after postmortem histological examination. （3） Nineteen cases continued pregnancy, 2 neonates with oligohydramnios died during neonatal period, both of them were IPKD; 3 cases that were IPKD, IPKD and KPD respectively died 3 months, 8 months and 1 year after birth, respectively; one case presented with hypertension symptom 26 months after birth, which was diagnosed as IPKD. The other 13 cases had no chuical manifestation and a close following-up is being undertaken for them at present. Conclusions （ 1 ） Fetal hyperechogeuic kidneys could be caused by IPKD, APKD, or PKD, and are sometimes a normal variant. （2） Aminotic fluid volume is a key factor for prognosis; a suggestion for termination would be given to cases with fetal hyperechogenic kidneys and ohgohydromnios. （3） For cases with fetal hyperechogenic kidneys, a complete and careful ultrasonography should be given to both parents and fetus, and fetal chromosomal analysis is suggested prenatally.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2007年第4期236-238,共3页
Chinese Journal of Obstetrics and Gynecology
基金
辽宁省教育厅高等学校科研项目计划(2004FD73)
关键词
超声检查
产前
多囊肾疾病
肾疾病
肾
Ultrasonography,prenatal
Polycystic kidney diseases
Kidney diseases
Kidney
