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胎儿侧脑室旁假性囊肿的诊断及预后分析

Diagnosis and prognosis of fetal periventricular pseudocysts
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摘要 目的探讨胎儿侧脑室旁假性囊肿(periventricular pseudocysts, PVPC)的诊断方法、结局,以及预后及其影响因素。方法回顾性分析2014年5月至2018年10月在北京大学第一医院行产前超声检查发现的76例PVPC病例的胎儿神经学超声检查、胎儿头颅MRI检查、染色体检查、新生儿颅脑超声检查等结果。同时分析胎儿神经学超声及头颅MRI检查在PVPC诊断中的作用,以及PVPC的预后及其影响因素。采用χ^2检验或Fisher精确概率法进行统计学分析。结果(1)76例中,51例(67.1%)孤立性PVPC,25例(32.9%)非孤立性PVPC。25例非孤立性PVPC中,15例合并1种异常、10例合并多种异常;20例仅合并颅内异常,2例仅合并颅外异常,3例既合并颅内异常又合并颅外异常。(2)76例中,8例(10.5%)终止妊娠,其中2例为孤立性PVPC,5例合并明确异常(1例PVPC合并巨脑回畸形、双侧脑室轻度增宽,1例PVPC合并巨脑回或无脑回畸形、胼胝体发育不良,1例PVPC合并蛛网膜囊肿、小脑蚓部发育不良,1例PVPC合并脑皮质发育异常,1例PVPC合并肠管扩张),1例合并预后不明确的异常(PVPC合并双侧脑室轻度增宽、羊水过多);61例(80.3%)出生并有随访结果;7例(9.2%)失访。(3)截至2019年2月,61例出生并随访的患儿中,44例孤立性PVPC及15例合并预后不明确的异常的PVPC患儿均生长发育良好;2例合并明确颅内异常的患儿均为合并脑实质内囊性病变,其中1例出生2 d后因呼吸衰竭死亡,另1例生后染色体检查发现2号染色体q24.3q31.2区存在13.23 Mb缺乏,其智力及生长发育明显落后于同龄儿。(4)57.9%(44/76)生后行新生儿颅脑超声证实的PVPC患儿,其中25.0%(11/44)产前MRI漏诊或误诊。结论PVPC可能合并多种异常,以颅内异常多见,其预后取决于合并异常的严重程度。PVPC胎儿应进行详细的产前超声检查,尤其是胎儿神经学超声检查。孤立性PVPC预后良好,合并脑实质内囊性病变的PVPC可能合并染色 Objective To investigate the diagnosis, clinical outcomes and factors influencing the prognosis of fetal periventricular pseudocysts (PVPC). Methods A retrospective analysis was performed on the results of fetal neurosonography (NSG), cranial magnetic resonance imaging (MRI), chromosome karyotype and neonatal cranial ultrasound of 76 PVPC cases detected by prenatal ultrasound in Peking University First Hospital from May 2014 to October 2018. The accuracy of NSG and cranial MRI in PVPC diagnosis was assessed. Prognosis of PVPC and the influencing factors were evaluated. Statistical analysis was performed using Chi-square test or Fisher's exact test. Results (1) This study involved 51 cases (67.1%) of isolated PVPC and 25 cases (32.9%) of non-isolated PVPC. Among the 25 non-isolated PVPC cases, 15 were complicated by one abnormality and 10 by multiple abnormalities. There were 20 cases with intracranial abnormalities, two with extracranial abnormalities, and three with both intracranial and extracranial abnormalities.(2) Eight out of the 76 pregnancies (10.5%) were terminated and among them, two were isolated PVPC cases, five complicated by determined abnormalities (one case of PVPC complicated with pachygyria and bilateral mild fetal ventriculomegaly, one case of PVPC complicated with pachygyria or agyria and agenesis of corpus callosum, one case of PVPC complicated with arachnoid cyst and vermis dysplasia, one case of PVPC complicated with cortical dysplasia, one case of PVPC complicated with intestinal dilatation) and one by abnormalities of undertermined prognosis (PVPC combined with mild fetal ventriculomegaly and polyhydramnios). A total of 61 neonates (80.3%, 61/76) were born alive and followed up. Seven cases (9.2%, 7/76) were lost to follow-up.(3) As of February 2019, among the 61 followed-up infants, 44 with isolated PVPC and 15 with unclear abnormalities developed well. The other two with determined intracranial abnormalities were diagnosed as having cystic lesions in the brain parenchyma. One of them di
作者 李晨 陈俊雅 范丽欣 张潇潇 Li Chen;Chen Junya;Fan Lixin;Zhang Xiaoxiao(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)
出处 《中华围产医学杂志》 CAS CSCD 北大核心 2019年第9期663-668,共6页 Chinese Journal of Perinatal Medicine
基金 首都特色临床项目(Z171100001017122).
关键词 侧脑室 中枢神经系统囊肿 超声检查 产前 预后 Lateral ventricles Central nervous system cysts Ultrasonography, prenatal Prognosis
作者简介 通信作者:陈俊雅,Email:xindichen@sina.com,电话:010-83573011.
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