產前超聲測量肺頭比評估胎兒肺囊腺瘤樣畸形預后的價值

陳淑華 龔煒 梁倩虹

[摘要] 目的 通過產前超聲測量CCAM胎兒肺頭比（CVR），探討CVR在CCAM胎兒預后評估中的價值。 方法 選取2018年1—12月廣州市番禺區婦幼保健院進行產前超聲測量肺頭比評估胎兒肺囊腺瘤樣畸形預后的胎兒82例，均為產前超聲診斷為CCAM，測量胎兒CVR，分為CVR<1.6組和CVR≥1.6組，觀察并比較產前超聲聲像圖特征及分型、隨訪結果及臨床預后。 結果 在82例CCAM胎兒中，女胎29例，男胎53例;腫塊位于左肺48例，右肺34例;CCAM Ⅰ型17例，CCAM Ⅱ型41例，CCAM Ⅲ型24例。82例CCAM胎兒均可顯示肺部腫塊血供來源自肺動脈。CVR<1.6組胎兒水腫有2例（2.8%），無69例（97.2%），引產1例（1.4%），死胎0例，產后發生呼吸窘迫4例（5.7%），無66例（95.3%），產后死亡1例（1.4%）;CVR≥1.6組胎兒水腫有9例（81.8%），無2例（18.2%），引產3例（27.3%），死胎1例（9.1%），產后發生呼吸窘迫6例（85.7%），無1例（14.3%），產后死亡2例（18.2%），因此，CVR<1.6組及CVR≥1.6組在胎兒水腫、產后呼吸窘迫及產后死亡發生率方面比較，差異有統計學意義（P<0.05）。 結論 CVR≥1.6的CCAM胎兒水腫發生率及產后呼吸窘迫發生率均升高，CVR是產前評估胎兒CCAM預后的有效指標。

[關鍵詞] 肺囊腺瘤樣畸形;產前超聲;預后;測量肺頭比;胎兒

[中圖分類號] R714? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）24-0074-04

Value of prenatal ultrasound measurement of volume-to-head ratio in evaluating the prognosis of fetal congenital cystic adenomatoid malformation

CHEN Shuhua? ?GONG Wei? ?LIANG Qianhong

Department of Ultrasound， He Xian Memorial Hospital in Panyu District of Guangzhou， Panyu Maternal and Child Care Service Centre of Guangzhou， Guangzhou? ?511400， China

[Abstract] Objective To measure the fetal congenital cystic adenomatoid malformation （CCAM） volume-to-head ratio （CVR） by prenatal ultrasound，and to explore the value of CVR in evaluating the prognosis of CCAM fetus. Methods A total of 82 fetuses who were diagnosed as CCAM in Panyu Maternal and Child Care Service Centre of Guangzhou from January 2018 to December 2018 by prenatal ultrasound were selected as objects. After measuring CVR，they were divided into CVR<1.6 group and CVR≥1.6 group. Prenatal ultrasound features and classification，follow-up results and clinical prognosis were compared between two groups were observed and compared. Results Among 82 CCAM fetuses， there were 29 females and 53 males. The lump was located in the left lung in 48 cases and the right lung in 34 cases. There were 17 cases of type Ⅰ CCAM， 41 cases of type Ⅱ CCAM and 24 cases of type Ⅲ CCAM. All 82 cases of CCAM fetuses showed that the blood supply of lung mass came from pulmonary artery. In CVR<1.6 group，there were 2 cases （2.8%） of fetal edema， 69 cases （97.2%） without fetal edema， 1 case （1.4%） of induced labor， 0 case of stillbirth， 4 cases （5.7%） of postpartum respiratory distress， 66 cases （95.3%） without fetal edema and 1 case of postpartum death （1.1%）. In CVR≥1.6 group， there were 9 cases（81.8%） of fetal edema， 2 cases（18.2%） without fetal edema， 3 cases （27.3%） of induced labor， 1 case （9.1%） of stillbirth， 6 cases （85.7%） of postpartum respiratory distress， 1 case （14.3%） of non-abortion， and 2 cases （18.2%） of postpartum death. Therefore， there were statistical differences in edema rate， postpartum respiratory distress rate and postpartum death rate between CVR<1.6 group and CVR≥1.6 group （P<0.05）. Conclusion The incidences of fetal edema and postpartum respiratory distress in CCAM with CVR≥ 1.6 are increased， which show that CVR is an effective indicator for prenatal evaluation of fetal CCAM prognosis.