对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流诊断中的应用

摘要 目的：对比分析四维容积超声及彩色多普勒超声在胎儿肺静脉异位引流（APVC）诊断中的应用价值。方法：采用回顾性分析方法，2019年1月到2022年1月选择在本院进行诊治的胎儿肺静脉异位引流孕妇60例作为研究对象，都给予四维容积超声及彩色多普勒超声，记录影像学特征并判断诊断价值。结果：在60例孕妇中，彩色多普勒超声检查判断为胎儿肺静脉异位引流51例，诊断敏感性为85.0 %；四维容积超声检查判断为胎儿肺静脉异位引流59例，诊断敏感性为98.3 %，四维容积超声检查对胎儿肺静脉异位引流的诊断敏感性明显高于彩色多普勒超声检查（P<0.05）。彩色多普勒超声检查与四维容积超声检查诊断的特异性都为100.0%。在60例孕妇中，判断为胎儿肺静脉异位引流心上型32例，心下型28例；心上型的肺静脉引流途径为肺静脉-垂直静脉-右上腔静脉22例、肺静脉-垂直静脉-左上腔静脉10例，心下型的肺静脉引流途径为肺静脉-垂直静脉-左头臂静脉-右上腔静脉6例、肺静脉-垂直静脉-门静脉22例。合并心脏畸形32例，合并畸形率为53.3 %；有51例孕妇终止妊娠，9例孕妇继续妊娠，其中8例未经治疗者新生儿期死亡，1例在3月龄死亡。结论：相对于彩色多普勒超声，四维容积超声在胎儿肺静脉异位引流诊断中的应用可提高诊断敏感性，可有效反映肺静脉回流情况，可指导临床进行早期干预。

Comparative Analysis of the Application of Four-dimensional Volumetric Ultrasonography and Color Doppler Ultrasonography in the Diagnosis of Fetal Anomalous Pulmonary Venous Drainage

ABSTRACT Objective: To compare and analysis the application values of four-dimensional volumetric ultrasonography and color Doppler ultrasonography in the diagnosis of fetal anomalous pulmonary venous connection (APVC). Methods: A retrospective analysis method was used. From January 2019 to January 2022, 60 cases of pregnant women with abnormal fetal pulmonary vein drainage who were diagnosed and treated in our hospital were selected as the research subjects. Four-dimensional volume ultrasound and color Doppler ultrasound were given to diagnosis, and to record the images characteristics and determine the diagnostic values. Results: In the 60 pregnant women, there were 51 cases were diagnosed as fetal pulmonary venous drainage by color Doppler ultrasonography, and the diagnostic sensitivity was 85.0 %. Four-dimensional volume ultrasonography judged 59 cases of fetal pulmonary vein ectopic drainage, the diagnostic sensitivitye was 98.3 %. The diagnostic sensitivity of fetal pulmonary vein ectopic drainage by four-dimensional volume ultrasonography were significantly higher than that by color Doppler ultrasonography(P<0.05). The diagnostic specificity of both color Doppler ultrasonography and four-dimensional volume ultrasonography were 100.0 %. There were 32 cases were diagnosed as supracardiac type and 28 cases were inferior cardiac type. The pulmonary vein drainage route of supracardiac type was pulmonary vein-vertical vein-right superior vena cava(22 cases), pulmonary vein-vertical vein - Left superior vena cava(10 cases), the subcardiac type of pulmonary vein drainage route is pulmonary vein-vertical vein-left brachiocephalic vein-right superior vena cava(6 cases), pulmonary vein-vertical vein-portal vein(22 cases). There were 32 cases of cardiac malformation, and the combined malformation rate was 53.3 %; There were 51 cases of pregnant women terminated their pregnancy, 9 cases of pregnant women continued pregnancy, 8 cases of pregnant women were died in the neonatal period without treatment, and 1 case was died at 3 months of age. Conclusion: Compares with color Doppler ultrasound, the application of four-dimensional volume ultrasound in the diagnosis of fetal pulmonary venous drainage can improve the diagnostic sensitivity, can effectively reflect the pulmonary venous return, and can guide early clinical intervention.