二维与三维超声联合在胎儿唇腭裂诊断中的临床应用价值

目的：探讨二维超声（2DU）与三维超声（3DU）联合诊断胎儿唇腭裂的临床应用价值及提高胎儿唇腭裂诊断准确性。方法应用美国GE公司生产的GE Voloson E8多功能彩色多普勒超声诊断仪，选择2DU及3DU成像模式诊断胎儿唇腭裂44例，并对2DU及3DU及两种方法联合诊断胎儿唇腭裂的声像图特征进行对比分析，评价两种方法及联合成像对诊断胎儿唇腭裂的准确性及优缺点。结果①44例唇腭裂胎儿产后结果：单纯唇裂16例，其中左侧10例，右侧6例；唇腭裂26例，单侧16例，双侧6例，正中2例，唇裂合并软腭裂2例；②二维超声唇腭裂诊断总符合率为72．7％，误诊2例，漏诊10例，其中单纯唇裂75．0％，唇腭裂76．9％；③三维超声唇腭裂诊断总符合率为79．6％，误诊2例，漏诊9例，其中单纯唇裂诊断符合率81．3％；唇腭裂84．6％，2DU与3DU比较，差异无显著性（ P＝0．4820）；④2DU＋3DU联合：唇腭裂诊断总符合率为90．9％，误诊1例，漏诊3例，其中单纯唇裂诊断符合率93．8％；唇腭裂符合96．2％，2DU与2DU＋3DU比较，差异有显著性（ P＝0．0114）。2例软腭裂2DU及3DU诊断均较困难。结论2DU与3DU联合诊断胎儿唇腭裂比单纯应用2DU及3DU能提高胎儿唇腭裂的检出率，尤其唇裂合并牙槽突及硬腭裂的诊断具有较高的诊断价值，但能对胎儿未合并牙槽突的软腭裂及部分轻微硬腭裂的诊断仍具有较大的难度。

The Value of Dimensional Ultrasound Associated with Three Dimensional Ultrasound in Diagnosing Fetal Cleft Lip and/or Cleft Palate

Objective To study the clinical value and the accuracy of two-dimensional ultrasound（2DU） combined with three-dimensional ultrasound（3DU） in diagnosing fetal cleft lip and/or cleft palate.Methods Forty-four cases were diagnosed fetal cleft and/or cleft palate by the 2DU and 3DU image mode of GE Voloson E8 color Doppler ultrasound .It is necessary to analyse and evaluate the accuracy of these diagnoses .Results ①The postpartum results of 44 fetuses：16 cases were cleft lip ,10 of them were on the left side of lips and 6 were on the right.26 cases were cleft lip and palate,16 of them were unilateral,6 were bilateral,2 were middle,and 2 cases were cleft lip combined with cleft soft palate.②2D ultrasound：The total coincidence rate of cleft lip and palate was 72.7%,2 cases were misdiagnosis and 10 were missed diagnosis .The cleft lip was 75.0%,the cleft lip and palate was 76.9%.③3D ultrasound：The total coincidence rate of cleft lip and palate was 79.6%,2 cases were misdiagnosis and 9 were missed diagnosis .The cleft lip was 81.3%,the cleft lip and palate was 84.6%. There was no statistically significant difference between 2DU and 3DU.④2DU＋3DU：The total coincidence rate of cleft lip and palate was 90.9%,1 cases were misdiagnosis and 3 were missed diagnosis.The cleft lip was 93.8%,the cleft lip and palate was 96.2%.There was sta-tistically significant difference between 2DU and 2DU＋3DU.Similarly,between 3DU and 2DU＋3DU.The two cases of cleft soft palate were difficult to diagnose with both 2DU and 3DU.Conclusion The examinations of 2D combined with 3D ultrasound can improve the detection rate of fetus＇cleft lip and palate obviously ,especially in the cleft lip combined with alveolar process and the cleft hard palate ,but it is still dif-ficult to dignose the cleft soft palate without alveolar process and a part of slight cleft hard palate .