超声预测胎儿先天性膈疝预后的研究进展

曾朝夕; 解丽梅

中国临床医学影像杂志 ›› 2016, Vol. 27 ›› Issue (7) : 516-518.

综述

超声预测胎儿先天性膈疝预后的研究进展

作者信息 +

Progress of ultrasound in predicting prognosis of congenital diaphragm hernia

Author information +

文章历史 +

摘要

先天性膈疝（Congenital diaphragmatic hernia，CDH）属于胎儿的膈肌先天性缺损或是发育不全的表现，是由于胚胎时期膈肌闭合不全，致单侧或双侧膈肌缺陷，部分腹部脏器通过缺损处进入胸腔，造成解剖关系异常的一种疾病。本研究通过阅读大量国内外相关研究的文献，分析并整理出预测CDH胎儿存活的若干方法。目前主要有：经超声或者核磁共振检测胎儿肺头比、胎肺容积、胎肺容积与胎儿体质量比、疝入胸腔肝脏的体积以及相关基因检测评估胎儿预后。希望对CDH的产前诊断、预后的评估、围生期的干预治疗以及产后的外科手术等环节起到有意义的指导作用。

Abstract

Congenital diaphragmatic hernia(CDH) belongs to congenital fetal diaphragmatic defect or insufficiency of development. It is due to the disclosure of diaphragm during embryonic period, leading to unilateral or bilateral diaphragmatic defects and abdominal organs enter the chest through the defects. Based on a large number of domestic and foreign related research literatures, several methods for prediction of fetus survival with CDH were summarized. At present, fetal lung-head ratio, fetal lung volume, fetal lung volume and fetal weight ratio, the size of the liver in the chest detected by ultrasound or MRI and associated genetic testing are the main methods to assess fetal prognosis. This will play a significant role in guiding the diagnosis, prognosis evaluation, perinatal intervention therapy and postpartum surgery for CDH.

导出引用

曾朝夕，解丽梅. 超声预测胎儿先天性膈疝预后的研究进展[J]. 中国临床医学影像杂志. 2016, 27(7): 516-518

ZENG Zhao-xi, XIE Li-mei. Progress of ultrasound in predicting prognosis of congenital diaphragm hernia[J]. Journal of China Clinic Medical Imaging. 2016, 27(7): 516-518

中图分类号： Ｒ714.53 R655.6 Ｒ445.1

参考文献

[1]刘磊，夏慧敏. 新生儿外科学[M]. 北京：人民军医出版社，2011：275-280.
[2]Chukwu J, Iro C, Donoghue V, et al. Congenital diaphragmatic hernia neonatal outcomes following referral to a pediatric surgical centre[J]. Ir Med J, 2009, 102(8): 260-261.
[3]Kehl S, Siemer J, Brunnemer S, et al. Prediction of postnatal outcomes in fetuses with isolated congenital diaphragmatic hernias using different lung-to-head ratio measurements[J]. Ir Med J, 2014, 33(5): 759-767.
[4]Strizek B, Cos Sanchez T, Khalifé J, et al. Impact of operator experience on the variability of fetal lung volume estimation by 3D-ultrasound(VOCAL) and magnetic resonance imaging in fetuses with congenital diaphragmatic hernia[J]. J Matern Fetal Neonatal Med, 2015, 28(7): 858-864.
[5]Ruano R, Aubry MC, Dumez Y, et al. Predicting neonatal deaths and pulmonary hypoplasia in isolated congenital diaphragmatic hernia using the sonographic fetal lung volume-body weight ratio[J]. AJR, 2008, 190(5): 1216-1219.
[6]Lipshutz GS, Albanese CT, Feldstein VA, et al. Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia[J]. J Pediatr Surg, 1997, 32(11): 1634-1636.
[7]Flake AW, Crombleholme TM, Johnson MP, et al. Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion clinical experience with fifteen cases[J]. Am J Obstet Gynecol, 2000, 183(5): 1059-1066.
[8]Laudy JA, Van Gucht M, Van Dooren MF, et al. Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters[J]. Prenat Diagn, 2003, 23(8): 634-639.
[9]Jani J, Nicolaaides KH, Keller RL, et al. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia[J]. Ultrasound Obstet Gynecol, 2007, 30(1): 67-71.
[10]Jani JC, Cannie M, Peralta CF, et al. Lung volumes in fetuses with congenital diaphragmatic hernia comparison of 3D US and MR imaging assessments[J]. Radiology, 2007, 244(2): 575-582.
[11]Tanigaki S, Miyakoshi K, Tanaka M, et al. Pulmonary hypoplasia prediction with use of ratio of MR imaging-measured fetal lung volume to US-estimated fetal body weight[J]. Radiology, 2004, 232(3): 767-772.
[12]Jani JC, Peralta CF, Nicolaides KH. Lung-to-head ratio: a need to unify the technique[J]. Ultrasound Obstet Gynecol, 2012, 39(1): 2-6.
[13]Kehl S, Becker L, Eckert S, et al. Prediction of mortality and the need for neonatal extra corporeal membrane oxygenation therapy by 3-dimensional sonography and magnetic resonance imaging in fetuses with congenital diaphragmatic[J]. J Ultrasound Med, 2013, 32(6): 981-988.
[14]Jani JC, Cordier AG, Martinovic J, et al. Antenatal ultrasound prediction of pulmonary hypoplasia in congenital diaphragmatic hernia correlation with pathology[J]. Ultrasound Obstet Gynecol, 2011, 38(3): 344-349.
[15]Sandaite I, Claus F, De Keyzer F, et al. Examining the relationship between the lung-to-head ratio measured on ultrasound and lung volumetry by magnetic resonance in fetuses with isolated congenital diaphragmatic hernia[J]. Fetal Diagn Ther, 2011, 29(1): 80-87.
[16]Nawapun K, Eastwood M, Sandaite I, et al. Correlation of observed-to-expected total fetal lung volume with intrathoracic organ herniation on magnetic resonance imaging in fetuses with isolated left-sided congenital diaphragmatic hernia[J]. Ultrasound Obstet Gynecol, 2015, 46(2): 162-167.
[17]Kehl S, Eckert S, Sütterlin M, et al. Influence of different rotation angles in assessment of lung volumes by 3-dimensional sonography in comparison to magnetic resonance imaging in healthy fetuses[J]. J Ultrasound Med, 2011, 30(6): 819-825.
[18]Kehl S, Kalk AL, Eckert S, et al. Assessment of lung volume by 3-dimensional sonography and magnetic resonance imaging in fetuses with congenital diaphragmatic hernias[J]. J Ultrasound Med, 2011, 30(11): 1539-1545.
[19]Bronshitein M, Lewit N, Sujov PO, et al. Prenatal diagnosis of congenital diaphragmatic hernia timing of visceral herniation and outcome[J]. Prenat Diagn, 1995, 15(8): 695-698.
[20]Metkus AP, Filly RA, Stringer MD, et al. Sonographic predictors of survival in fetal diaphragmatic hernia[J]. J Pediatr Surg, 1996, 31(1): 148-152.