| 王 科,高 源,吴娅妮,米 波,华 兴.超声诊断持续性右脐静脉合并畸形的价值及其对于胎儿预后意义研究[J].,2022,(2):383-387 |
| 超声诊断持续性右脐静脉合并畸形的价值及其对于胎儿预后意义研究 |
| The Value of Ultrasonography in the Diagnosis of Persistent Right Umbilical Vein with Malformation and Its Prognostic Significance for Fetus |
| 投稿时间：2021-05-21 修订日期：2021-06-18 |
| DOI：10.13241/j.cnki.pmb.2022.02.036 |
| 中文关键词: 超声心动图 持续性右脐静脉 畸形 胎儿 预后 |
| 英文关键词: Ultrasonic cardiogram Persistent right umbilical vein Malformation Fetus Prognosis |
| 基金项目:国家自然科学基金项目（30500478）；重庆市科委科研基金项目（cstc2015jcyjA10327） |
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| 摘要 目的：探讨超声诊断持续性右脐静脉（PRUV）合并畸形的价值及其对于胎儿预后意义研究。方法：收集我院2014年1月至2020年1月定期产检的孕妇6258例。对所有胎儿行超声心动图产前评估，对发现存在PRUV的胎儿进一步确诊。对所有PRUV病例进行胎儿超声心动图详细的解剖扫描，以确定是否合并有其他畸形。在我院分娩的孕妇病例系统均详细记录有孕妇和胎儿的住院情况。对未在我院分娩的PRUV胎儿进行电话随访，以了解胎儿出生时的情况。对26例PRUV胎儿均进行了至少为期12个月的电话随访，以了解胎儿的预后情况。结果：PRUV超声表现为脐静脉向胆囊外侧和右侧走行，可能与向胃方向走行的右门静脉融合（肝内型），也可能流入右心房、下腔静脉心下部分或髂静脉（肝外型）。在肝内型变异中，脐静脉与右门静脉在静脉窦处融合，胎盘血液继续流入静脉导管，最终流入下腔静脉。在6258例定期产检孕妇中共发现26例患有PRUV的胎儿，PRUV发生率为0.42%（26/6258），其中肝内型为0.39%（24/6258），肝外型为0.03%（2/6258）。单纯型PRUV胎儿（除PRUV外不合并其他畸形）16例，占61.54%（16/26），其中1例因胎儿体重过大行剖腹产，产后胎儿健康；其余胎儿均自然分娩，产后胎儿健康。非单纯型PRUV胎儿（除PRUV外合并其他畸形）10例，占38.46%（10/26），其中8例为肝内型PRUV，2例为肝外型PRUV。8例非单纯型肝内型PRUV中，法洛四联症伴单脐动脉胎儿生后手术治疗，预后较差，1岁时因感染性心内膜炎死亡；房间隔缺损生后随访自行关闭，胎儿健康；其余胎儿生后手术治疗，预后良好。2例非单纯型肝外型PRUV分别合并肢端畸形和大动脉转位，1例宫内死亡，1例剖腹产后1周因心力衰竭死亡。结论：详细的产前超声检查可用于确诊PRUV及其可能合并畸形。单纯型PRUV胎儿预后良好，非单纯型PRUV胎儿预后则取决于伴随畸形的类型和严重程度，且非单纯型肝外型PRUV预后不佳、死亡率较高。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the value of ultrasonography in the diagnosis of persistent right umbilical vein (PRUV) with malformation and its prognostic significance for fetus. Methods: A total of 6258 pregnant women were collected from our hospital during January 2014 to January 2020. Prenatal evaluation with echocardiography was performed on all fetuses, and further diagnosis was made in fetuses with PRUV. Detailed fetal echocardiographic anatomic scans were performed in all PRUV cases to determine the presence of additional malformations. Hospitalization of pregnant women and their fetuses was recorded in detail in the system of maternal cases delivered in our hospital. The PRUV fetuses that were not delivered in our hospital were followed up by telephone to understand the condition of the fetuses at birth. All 26 PRUV fetuses were followed up by telephone for at least 12 months to understand the prognosis of the fetuses. Results: PRUV ultrasound showed that the umbilical vein ran laterally and to the right side of the gallbladder, and may fuse with the right portal vein running toward the stomach(intrahepatic type), or may drain into the right atrium, inferior part of the inferior vena cava, or iliac vein(extrahepatic type). In the intrahepatic variant, the umbilical vein fuses with the right portal vein at the venous sinus, and placental blood continues to flow into the venous duct and eventually into the inferior vena cava. A total of 26 fetuses with PRUV were found in 6258 pregnant women with regular antenatal examination, the incidence of PRUV was 0.42%(26/6258), of which the intrahepatic type was 0.39%(24/6258) and the extrahepatic type was 0.03% (2/6258). There were 16 (61.54%) cases were PRUV simplex fetuses (except PRUV without other malformations), in which 1 case was delivered by caesarean section due to fetal weight, and the postpartum fetus was healthy. All the other fetuses were delivered naturally and the postpartum fetuses were healthy. There were 10 (38.46%) cases of non-simple PRUV fetuses (except PRUV with other malformations), including 8 cases of intrahepatic PRUV and 2 cases of extrahepatic PRUV. In 8 cases of PRUV of non-simple intrahepatic type, the fetuses with tetralogy of Fallot and single umbilical artery were surgically treated after birth, and the prognosis was poor and they died of infective endocarditis at the age of 1 year. Atrial septal defect closed spontaneously after birth and the fetus was healthy. The prognosis of the other fetuses was good after the operation. 2 cases of non-simple extrahepatic PRUV were combined with acromitis and transposition of the great artery, 1 case died intrauterine and the other died of heart failure 1 week after cesarean section. Conclusion: Detailed prenatal ultrasound may be used to confirm PRUV and its possible concomitant deformities. The prognosis of PRUV fetuses is good with simple PRUV fetuses, and the prognosis of PRUV fetuses with non-simple PRUV fetuses depends on the type and severity of the associated malformations, and the prognosis of PRUV fetuses with non-simple extrahepatic PRUV is poor and the mortality rate is high. |
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