摘要目的 探讨早孕期(孕 11～13 周 +6)超声检查胎儿肠系膜上动脉(superior mesenteric artery, SMA)走行异常预测先天性膈疝(congenital diaphragmatic hernia, CDH)的临床价值. 方法 选取2017年3月至12月在广州市番禺区中心医院行早孕期颈项透明层筛查的胎儿,筛查时应用低速HD-Flow成像技术显示胎儿SMA,观察SMA走行,定义SMA与腹主动脉之间角度＞90°为异常.当怀疑SMA走行异常时,仔细扫查胎儿胸腔及腹腔脏器位置有无异常,并分别在孕16～18周、孕20～24周、孕28～32周和孕37～40周复查超声.超声诊断CDH的胎儿行MRI检查,引产后尸体解剖确诊.电话随访所有病例的妊娠结局.采用描述性统计分析. 结果 共6 899例孕妇(6 964例胎儿)行早孕期颈项透明层筛查,均成功显示SMA.3例胎儿发现SMA走行异常,其中2例分别在孕17周 +和孕23周 +超声复查时诊断为左侧CDH,均引产终止妊娠,引产后尸体解剖证实CHD;另1例在早孕期同时检出巨大脐膨出而引产.6 961例SMA走行未见异常胎儿中, 6 120例成功随访到妊娠结局,其中1例在孕32周超声检查时发现左侧CDH,活产分娩,新生儿MRI检查确诊为左侧CDH;其余病例均未检出CDH. 结论 早孕期胎儿SMA走行异常可能是一种简单、可行的预测CDH的指标,有助于提前诊断时间,从而为早期干预和治疗提供足够的准备时间.

abstractsObjective To investigate the clinical value of abnormal course of fetal superior mesenteric arteries (SMA) detected by ultrasound during the first trimester (11-13+6 weeks) in predicting congenital diaphragmatic hernia (CDH). Methods This study enrolled women who underwent fetal nuchal translucency (NT) screening during the first trimester in Central Hospital of Panyu District from March to December 2017. Low-speed high-definition flow imaging was used to observe the course of fetal SMA, and it was regarded as abnormal when the angle between SMA and abdominal aorta >90°. Once abnormal course of the SMA was suspected, the position of fetal thoracic cavity and abdominal organs would be scanned carefully. Furthermore, ultrasound examinations would be repeated at 16-18, 20-24, 28-32 and 37-40 weeks of gestation. Fetus diagnosed as CDH by ultrasound would be scheduled for MRI or autopsy to confirm the diagnosis. Pregnancy outcomes of all cases were followed up by telephone. Descriptive statistical analysis was used in this study. Results A total of 6 899 gravidas (6 964 fetuses) underwent NT scan during the first trimester were enrolled and the SMA of all fetuses were successfully displayed. Three cases with abnormal course of the SMA were identified. Two of them were diagnosed with left CDH at 17+ and 23+ weeks of gestation, which was confirmed by autopsy after termination of pregnancy, and the other one terminated pregnancy in first trimester due to a large omphalocele. Among the 6 961 fetuses with normal SMA, the pregnancy outcomes of 6 120 were successfully followed up, only one of which was found to have left CDH at 32 gestational weeks by ultrasound examination, and was later confirmed by neonatal MRI after delivery. No other fetal CDH was detected. Conclusions Abnormal course of the SMA identified in early pregnancy may be a simple and effective indicator for CDH that allow early intervention and treatment.