目的 分析探讨产前超声检查在诊断胎儿肝脏占位性病变中的价值,为产前诊断及临床处理提供依据。方法 回顾性分析2011年7月至2015年12月本院68例经产前超声检查发现的胎儿肝脏占位性病灶,记录发现肝脏占位性病灶时的胎龄、病灶位置和大小、病灶的声像特征、产前初步诊断、伴发畸形情况、继发改变及临床结局。结果 2011年7月至2015年12月期间,本院59 139例孕妇经产前超声检查最终共发现胎儿肝脏占位68例,其中囊性占位28例,强回声占位24例,混合型占位12例,低回声占位4例。经其他影像学检查或病理检查最终诊断为肝囊肿23例,胆道闭锁1例,胆总管囊状扩张4例,肝钙化灶18例,胎粪性腹膜炎4例,肝血管瘤13例,肝母细胞瘤1例,肝局灶性结节增生2例,另有2例未能确诊。68例胎儿的临床结局为,宫内死亡2例,引产3例,出生后死亡1例,存活61例,失访1例。结论 产前超声检查对于胎儿肝脏占位性病变的发现和诊断具有一定价值,可为胎儿肝脏病变患者的围产期管理提供有力依据。
Objective: To investigate the value of prenatal ultrasonography in the diagnosis of fetal hepatic space occupying lesion. Methods: A total of 68 cases of fetal liver space occupying lesion diagnosed by prenatal ultrasonography from July 2011 to December 2015 were enrolled, and the gestational age, position and size of lesion, ultrasonic imaging characteristics, initial prenatal diagnosis, associated malformation and secondary change, as well as the clinical outcome were analyzed. Results: Among the 59 139 cases receiving prenatal ultrasonography, 68 cases were diagnosed as having fetal hepatic space occupying lesion by prenatal ultrasonography, in which 28 cases showing cystic lesion, 24 cases revealing hyperechogenic space occupying lesion, 12 cases showing mixed type space occupying lesion, and 4 cases showing low echogenic space occupying lesion. By imaging or pathologic examination, 23 cases were diagnosed as hepatic cyst, 1 case as biliary atresia, 4 cases as cystic dilatation in bile duct, 18 cases as hepatic calcification, 4 cases as meconium peritonitis, 13 cases as hepatic hemangioma, 1 case as hepatoblastoma, 2 cases as focal nodular hyperplasia, and 2 cases with no confirmed diagnosis. Clinical outcomes included intrauterine death in 2 cases, abortion in 3 cases, neonatal death in 1 case, survival in 61 cases, and lost tracking in 1 case. Conclusions: Prenatal ultrasonography is an important and efficient approach for detection and diagnosis of fetal hepatic space occupying lesion, it might provide a valuable direction for perinatal management of cases with fetal hepatic space occupying lesion.
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