[1]高琼,黄强,毛翠平,等.胎儿磁共振在先天性膈疝患儿预后评估中的应用研究[J].临床小儿外科杂志,2022,21(09):838-843.[doi:10.3760/cma.j.cn101785-202206003-008]
　Gao Qiong,Huang Qiang,Mao Cuiping,et al.Prognostic values of different parameters acquired from fetal magnetic resonance imaging in congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2022,21(09):838-843.[doi:10.3760/cma.j.cn101785-202206003-008]
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胎儿磁共振在先天性膈疝患儿预后评估中的应用研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷 期数: 2022年09期 页码: 838-843 栏目: 专题·出生结构缺陷的早期干预 出版日期: 2022-09-28
Title:
Prognostic values of different parameters acquired from fetal magnetic resonance imaging in congenital diaphragmatic hernia
作者:
高琼1;  黄强2;  毛翠平3;  高亚2;  王誉都4;  李鹏2
1. 西安交通大学第二附属医院新生儿科, 西安 710004;
2. 西安交通大学第二附属医院小儿外科, 西安 710004;
3. 西安交通大学第二附属医院影像科, 西安 710004;
4. 陕西省汉中市中心医院普通外科, 汉中 723000
Author(s):
Gao Qiong1;  Huang Qiang2;  Mao Cuiping3;  Gao Ya2;  Wang Yudu4;  Li Peng2
1. Department of Neonatology, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;
2. Department of Pediatric Surgery, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;
3. Department of Radiology, Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an 710004, China;
4. Department of General Surgery, Central Municipal Hospital, Hanzhong 723000, China
关键词:
婴儿; 新生; 磁共振波谱学/仪器和设备; 疝; 横膈; 先天性/并发症; 预后
Keywords:
Infant;  Newborn; Magnetic Resonance Spectroscopy/IS; Hernias;  Diaphragmatic;  Congenital/CO; Prognosis
DOI:
10.3760/cma.j.cn101785-202206003-008
摘要:
目的 回顾性分析先天性膈疝患儿产前胎儿磁共振图像，探讨磁共振测量和评价参数与患儿预后的关系，初步探讨胎儿磁共振参数在先天性膈疝患儿预后评估中的应用价值。方法 收集西安交通大学第二附属医院2011—2020年胎儿磁共振图像结果，收集诊断为先天性膈疝的50例胎儿磁共振图像，包括左侧膈疝37例，右侧膈疝13例，检测并分析观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线的完整性、肝脏及胃泡位置等与患儿预后的关系。结果 50例患儿中，存活35例（为存活组），死亡15例（为死亡组）。胎儿磁共振图像观察-预期肺容积比：存活组比死亡组为（35.09±10.87）比（24.29±6.86）；肺肝比：存活组比死亡组为（2.68±1.01）比（1.93±0.93）；纵膈移位角：存活组比死亡组为（30.88±7.07）比（39.05±4.21）；差异均有统计学意义（P<0.05）。图像分析结果显示，胎儿磁共振肺底基线不完整、肝脏及胃泡位置疝入胸腔患儿的预后较差，差异具有统计学意义（P<0.05）。受试者操作特征曲线分析结果显示，联合应用观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线的完整性、肝脏及胃泡位置等判断患儿预后，较单一参数判断更为准确，差异具有统计学意义（P<0.05）。结论 胎儿磁共振观察-预期肺容积比、肺肝比、纵膈移位角、肺底基线完整性、肝脏及胃泡位置均可作为判断先天性膈疝患儿预后的评价指标，联合应用上述六项参数可以更加准确地判断患儿预后，以上述参数为基础构建先天性膈疝的评估体系，有助于先天性膈疝患儿的肺发育评估、体外膜肺氧合的应用判断以及手术方式的选择。
Abstract:
Objective To perform retrospective analysis of fetal magnetic resonance imaging (MRI) to examine the prognostic values of measurement and evaluation parameters for predicting the neonatal survival of congenital diaphragmatic hernia (CDH).Methods From 2011 to 2020, MRI findings were reviewed for 50 fetuses prenatally diagnosed as CDH.Involved side was left (n=37) and right (n=13).Observed-to-expected (O/E) values of total lung volume (TLV), lung-to-liver signal intensity ratio (LLSIR), mediastinal shift angle (MSA), incomplete pulmonary baseline (IPB), liver up (LU) and retrocardiac stomach (RCS) on MRI were evaluated.Results Among them, 35 neonates survived while 15 died after birth.Lung volume (survival vs death:35.09±10.87 vs.24.29±6.86), lung-to-liver intensity ratio (survival vs death:2.68±1.01 vs.1.93±0.93) and mediastinal shift angle (survival vs death:30.88±7.07 vs.39.05±4.21) had significant differences in survival (P < 0.05).And IPB, LU and RCS on MRI were correlated with a higher mortality rate (P < 0.05).Receiver operating characteristic (ROC) analysis indicated MSA was an ideal single parameter and the prognostic value of combining 6 parameters (O/E TLV, LLSIR, MSA, IPB, LU & RCS) was optimal for predicting the prognosis.Conclusion TLV, LLSIR, MSA, IPB, LU and RCS are correlated with perinatal outcomes in terms of survival.The combination of all six parameters is optimal for predicting neonatal survival.Constructing an evaluation system based upon the above parameters may aid in predicting the occurrence of pulmonary hypoplasia, necessity for extracorporeal membrane oxygenation (ECMO) and a proper selection of surgical approaches.

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备注/Memo

收稿日期:2022-02-18。
基金项目:西安交通大学第二附属医院新技术新疗法（201602）
通讯作者:黄强,E-mail:drhuang@xjtu.edu.cn

更新日期/Last Update: 1900-01-01