产前超声筛查诊断胎儿侧脑室增宽的价值

目的 初步探讨产前超声筛查对诊断胎儿侧脑室增宽的意义.方法 北京市昌平区医院2011年1月至2016年7月常规产前超声筛查孕妇24 150人,由取得产前筛查资格证医师检查,检出侧脑室增宽胎儿79例,均转诊至产前诊断机构北京大学人民医院,并定期观察胎儿侧脑室情况,已出生婴幼儿电话随访.结果 产前超声筛查79例侧脑室增宽胎儿产前诊断75例,筛查准确率为94.94％,有随访结果71例,侧脑室增宽＞1.5cm(脑积水)胎儿6例,均引产,中度侧脑室增宽(＞1.2～1.5cm)16例,轻度侧脑室增宽(1.0 ～ 1.2cm)49例,轻、中度两组合并畸形、脑室增宽进展和生后神经行为发育异常发生率差异有统计学意义(x2值分别为4.05、5.95、2.58,均P＜0.05).结论 产前超声筛查提高侧脑室增宽诊断的准确性,重度侧脑室增宽预后不良,轻、中度侧脑室增宽胎儿结局有差异,有进展胎儿预后差,孕期应定期观察.对于中度侧脑室增宽和宫内进展者应高度重视,转诊至产前诊断机构全面检查.

Value of prenatal ultrasonography screening in diagnosis of fetal lateral ventriculomegaly

Objective To explore the value of prenatal ultrasonography screening in diagnosis of fetal lateral ventriculomegaly.Methods Prenatal ultrasonography screening was performed for 24 150 pregnant women by ultrasonic doctors who had fetal screening certificates in Beijing Changping District Hospital from January 2011 to July 2016.Seventy-nine cases were detected with fetal lateral ventriculomegaly,and all of them were transferred to Peking University People' s Hospital.Fetal lateral ventriculomegaly change was observed till delivery.Infants were followed up by telephone interview.Results Among 79 cases of lateral ventriculomegaly screened by prenatal ultrasonography,75 cases were diagnosed before delivery with screening accuracy of 94.94％.There were 71 cases with follow-up results.Six cases with lateral ventriculomegaly (over 1.5cm) accepted induced abortion.Moderate lateral ventriculomegaly (＞ 1.2 ～ 1.5cm) were found in 16 cases and mild lateral ventriculomegaly (1.0-1.2cm) in 49 cases.The rates of structural anomalies,progressing in ventriculomegaly and neurodevelopmental delay were statistically different between moderate and mild cases (x2 value was 4.05,5.95 and 2.58,respectively,all P ＜ 0.05).Conclusion Prenatal ultrasonography screening improves accuracy of diagnosis of lateral ventriculomegaly.The prognosis of severe lateral ventriculomegaly is not good.The final result is different between moderate with mild cases.Progression in utero usually leads a poor prognosis.Regular follow-up ultrasound examination is recommended.Cases with moderate lateral ventriculomegaly and progression in utero should be observed carefully and transferred to prenatal diagnosis hospital for comprehensive examination.