早孕期超声筛查胎儿巨膀胱的临床价值分析

目的探讨规范化早孕期超声筛查胎儿巨膀胱的临床特征，为其临床管理提供依据。 方法回顾性分析2018年1月至2022年1月间于郑州大学第三附属医院产前超声诊断中心行规范化早孕期产前筛查的妊娠11~13⁺⁶周孕妇43 862例的产前资料，对检出的巨膀胱胎儿，记录膀胱大小、彩色多普勒显示脐动脉，追踪妊娠过程及临床结局，通过产后复查、病理检查和介入性产前诊断等方法进一步明确病因。 结果超声筛查检出胎儿发育异常952例，其中巨膀胱胎儿64例。巨膀胱胎儿合并颈后透明层增厚者10例，合并染色体异常者10例，合并脐带囊肿者11例，合并单脐动脉者21例，合并肾回声增强者9例，早孕期显示“钥匙孔”征（+）者11例，早孕期合并心脏异常者6例，合并颜面异常者2例，合并腹壁肌层异常者7例，合并肢体骨骼异常者8例；64例巨膀胱胎儿中43例进行选择性终止妊娠，15例在随访过程中停止发育，2例出生未见异常，4例男性胎儿出生后行下尿路梗阻部手术，且尸检证实有5例为梅干腹综合征。 结论早孕期超声筛查可有效地检出和诊断胎儿巨膀胱，并可对其可能存在的病因及临床结局提供适宜的建议，有助于尽早产科处理与临床管理。

Clinical value of ultrasound screening of fetal megacystis during early pregnancy

ObjectiveTo investigate the clinical characteristics of fetal megacystis screened by standardized ultrasound in early pregnancy, and to provide a basis for its clinical management. MethodsFrom January 2018 to January 2022, 43 862 pregnant women were screened by standardized ultrasound in the early pregnancy (11-13⁺⁶ weeks of pregnancy) at the Prenatal Ultrasound Diagnostic Center, the Third Affiliated Hospital of Zhengzhou University. The prenatal data were retrospectively analyzed, and the detected megacystis fetuses and the size of the bladder were recorded, as well as the umbilical artery shown by color Doppler. The pregnancy processes and clinical outcomes were followed, and the etiology was further clarified through postpartum review, pathological examination, and interventional prenatal diagnosis. ResultsA total of 952 cases of fetal dysplasia were detected by ultrasound screening, including 64 cases of megacystis. There were 10 cases with thickening of posterior translucency, 10 with chromosomal abnormalities, 11 with umbilical cyst, 21 with single umbilical artery, 9 with renal echo enhancement, 11 with 'keyhole' sign in early pregnancy, 3 with cardiac abnormalities in early pregnancy, 2 with facial abnormalities, 7 with abnormal abdominal muscle layer, and 8 with limb bone abnormalities. Among 64 cases of megacystis, 43 underwent selective termination of pregnancy, 15 stopped development during follow-up, 2 were born without abnormalities, 4 male fetuses underwent surgery for lower urinary tract obstruction after birth, and autopsy confirmed that there were 5 cases of dried plum abdomen syndrome. ConclusionUltrasound screening in early pregnancy can effectively detect and diagnose fetal megacystis, provide appropriate clinical consultation for its possible causes and clinical outcomes, and help with early obstetric and clinical management.