Lin Tulian,Lü Junjian,He Qiuming,et al.Association of fetal diaphragmatic hernia severity with prenatal indicators[J].Journal of Clinical Pediatric Surgery,2021,20(09):832-836.[doi:10.12260/lcxewkzz.2021.09.006]
胎儿膈疝不同程度分级的临床特征及预后
- Title:
- Association of fetal diaphragmatic hernia severity with prenatal indicators
- Keywords:
- Fetus; Hernias; Diaphragmatic; Congenital/DI; Ultrasonography; Prenatal; Prenatal Diagnosis; Prognosis
- 分类号:
- R655.6;R714.5
- 摘要:
- 目的 总结胎儿膈疝不同程度分级的产前评估及预后情况。方法 以广州市妇女儿童医疗中心胎儿医学中心2017年1月1日至2020年3月31日收治的62例先天性膈疝（congenital diaphragmatic hernia，CDH）患者为研究对象。根据胎儿超声和MRI结果分为轻度CDH组（29例）和中重度CDH组（33例），对比两组间出生胎龄、出生体重、诊断孕周、肺头比实测值与预测值的比值（observed/expected lung-to-head ratio，o/e LHR）、总肺体积实测值与预测值的比值（observed/expected total fetal lung volume，o/e TFLV）、预测肺容积比（Percentage of the predicted lung volume，PPLV）、肝脏疝入、疝囊及预后情况等资料。结果 两组在性别构成、出生胎龄、出生体重、膈疝侧别、MRI是否发现疝囊方面比较，差异均无统计学意义（P>0.05）；中重度CDH组的5分钟Apgar评分<7分、肝脏疝入的人数比例高于轻度CDH组（P<0.05）；中重度CDH组的首诊孕周、o/e LHR、o/e TFLV、PPLV以及出生后存活率低于轻度CDH组（P<0.05）；中重度CDH组出生后符合ECMO指征率及PPHN发生率高于轻度CDH组（P<0.05）。结论 胎儿膈疝的严重程度与临床预后相关，产前评估有助于对胎儿膈疝进行严重程度分级，为产前咨询、规划患者出生后诊疗方案提供依据。
- Abstract:
- Objective To summarize the prenatal evaluation and prognosis of different grades of fetal diaphragmatic hernia.Methods A total of 62 CDH children admitted from January 1, 2017 to March 31, 2020 were recruited.According to the findings of fetal ultrasonography and magnetic resonance imaging (MRI), they were divided into mild CDH and moderate-severe CDH groups.The gestational age at birth, birth weight, diagnostic gestational age, o/e LHR, o/e TFLV, PPLV, liver hernia, hernia sac and prognosis and other information.Results There were 62 fetal CDH cases after prenatal evaluation, 33 cases in the moderate and severe group, and 29 cases in mild group.Gender composition, gestational age, birth weight, hernia affected side and hernia sac showed by MRI in two groups were not statistically significant (all P>0.05).The proportion of neonatal Apgar score at 5 min <7 and liver herniation was higher in moderate-to-severe CDH group; The initial diagnosed gestational age, o/e LHR, o/e TFLV, percentage of predicted lung volume (PPLV) and the survival rate were lower in moderate-to-severe CDH group (all P<0.05).The extracorporeal membrane oxygenation (ECMO) indication rate and incidence of persistent pulmonary hypertension of newborn (PPHN) were higher in moderate-to-severe CDH group (all P<0.05).Conclusion The grading of different degrees of fetal diaphragmatic hernia is related to clinical prognosis. Prenatal evaluation is helpful for grading the severity of fetal diaphragmatic hernia patients, and provides the basis for prenatal consultation and planning the treatment for the patients after birth.
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备注/Memo
收稿日期:2020-09-24。
基金项目:广东省自然科学基金-面上项目（编号：2020A1515010296）
通讯作者:吕俊健,Email:13538787151@163.com