摘要
目的总结胎儿四肢超声规范化结构筛查图像特征及孕早期胎儿四肢畸形超声诊断的临床意义。方法对3267例（3882个）孕11-13＋6周胎儿（单胎妊娠2654例，双胎妊娠611例，3胎妊娠2例）行早孕期超声规范化结构筛查。结果3267例（3882个）11-13＋6孕周胎儿中产前超声检出四肢畸形5例，其中单胎妊娠4例（上肢畸形3例，下肢畸形1例），双胎妊娠1例（双胎之一上肢畸形）。超声声像图示：（1）下肢畸形1例，胎儿双下肢股骨缺如。（2）手畸形1例，胎儿右手掌指骨部分缺如合并胎儿水肿（皮下水肿、胸腹腔积液、颈淋巴水囊瘤），单心房室畸形。（3）前臂及手缺如1例，胎儿右前臂缺如。（4）手腕部姿势异常1例，胎儿双手腕关节极度内屈，合并胎儿水肿（皮下水肿、胸腹腔积液、颈淋巴水囊瘤）。（5）尺桡骨发育不良1例，双胎中1胎儿右上肢尺桡骨发育不良，胎儿水肿（颈淋巴水囊瘤），脊柱裂，脐膨出；另一胎儿无异常表现。5例胎儿随访结果：（1）1例双胎中上肢畸形胎儿经选择性减胎术后正常胎儿继续妊娠，4例引产胎儿肢体检查证实产前超声漏诊1例缺指畸形，余3例胎儿引产前与引产后超声检查结果相符合。结论孕早期胎儿四肢超声规范化结构筛查可及早发现胎儿肢体畸形，对降低较大孕周孕妇引产率及双胎和体外受精-胚胎移植胎儿的产科处理均有重要临床价值。
Objective To summarize the characteristics of fetal limbs malformations in two-dimensional ultrasonography during the first trimester and to analyze the value of standardized structural screening by ultrasound during the ifrst trimester in detecting fetal limbs malformations. Methods Totally 3 267 gravidas （including 2 654 singleton, 611 twin and 2 triplet pregnencies） and 3 882 fetuses aged 11-13＋6 weeks for standardized structural screening by ultrasound were included in this study. Results In total, 5 fetuses （4 singleton and 1 twin pregnancies） with limbs malformations were detected, including 4 upper limbs and 1 lower limb malformations. The ultrasound images follows： （1） The femora were absent of both lower limbs. （2） Metacarpal and phalangal of the right hand were partly absent with fetal hydrops （subcutaneous edema, hydrothorax and ascite and cystic hygroma） and single ventricle. （3） The right forearm was absent. （4） The wrist joints of both upper limbs were introlfexion extremely with fetal hydrops （subcutaneous edema, hydrothorax and ascite and cystic hygroma）. （5） One of twins was found that radius and ulna of the right upper limb were hypogenetic with fetal hydrops （cystic hygroma）, spina biifda and pcromphalus, while the other was normal. Follow-up results：the twin pregnencies chose elective embryo-reduction operation and continued gestation while the other four chose induced labour and one ectodactylism was misdiagnosed.Conclusions Standardized structural screening by ultrasound during the ifrst trimester plays an important role in detecting fetal limbs malformations early, reducing and avoiding large gestational age singleton pregnancy abortion and twins and IVF-fetal obstetric treatment.
出处
《中华医学超声杂志（电子版）》
2014年第4期38-42,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
江苏省医学重点学科(XK201102)
江苏省科技发展计划项目(BL2012015)
江苏省卫生厅科技项目(H201340)
关键词
超声检查
产前
胎儿
先天畸形
Ultrasonography,prenatal
Fetus
Congenial abnormalities
