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目的 探讨胎儿肾脏微囊性病变产前超声特征及肾脏的病理改变。方法 对产前超声检查、临床随访(家族史调查证实常染色体显性遗传性多囊肾1例)或引产后病理检查(5例)证实的6例孕22～32周肾脏微囊性病变胎儿的产前超声表现、分类诊断特征及引产后肾脏病理表现进行总结分析。结果 产前超声显示6例胎儿双侧肾脏对称均匀性增大,实质回声弥漫性增强;肝门脉区回声增粗(2例)呈纤维网格样变(2例),CDFI显示6例肾血管充盈良好,频谱呈高阻力指数血流,羊水指数低于正常或在正常范围内。引产后病理标本显示5例胎儿双侧肾脏弥漫性增大,失去胎儿肾脏特有的“桑葚”状表现,肾皮质及髓质见多发微小囊肿,集合系统发育不良;镜下显示5例胎儿肾实质内见弥漫分布大小不等的囊肿,并见肾小管囊性扩张,1例肾小球Bowman囊扩张。5例引产儿尸检病理诊断:胎儿肾小管囊性变4例,肾小球囊性变1例;1例经临床追踪随访后诊断胎儿肾脏微囊性病变。结论 胎儿肾脏微囊性病变产前超声表现为肾脏增大,弥漫性回声增强,病理表现为肾小管或肾小球的弥漫性微囊性扩张。
Objective To investigate the characteristics of prenatal ultrasound and renal pathology in fetal kidney microencapsulated lesions. Methods Prenatal ultrasound examination, clinical follow-up (family history survey confirmed autosomal dominant polycystic kidney disease in 1 case) or postnatal pathological examination (5 cases) confirmed 6 cases of pregnant 22-32 weeks of renal microcirculatory lesions of fetus Prenatal ultrasound performance, classification and diagnostic characteristics of renal pathology after induction of labor were summarized. Results The prenatal ultrasound showed that the symmetry of both kidneys in 6 fetuses was increased and their echogenic diffuseness was enhanced. The thickening of echo in hepatic portal area (2 cases) showed fibrosis (2 cases), CDFI showed 6 cases of kidney Blood vessels filled well, the spectrum showed a high resistance index blood flow, amniotic fluid index below normal or within the normal range. Postnatal pathology specimens showed diffuse enlargement of bilateral fetal kidneys in 5 fetuses, loss of “mulberry” -like manifestations of fetal kidneys, multiple microscopic cysts in renal cortex and medulla, and poor collection system. In the microscopic examination, 5 fetuses See the diffuse distribution of renal parenchyma cysts of varying sizes, and see the cystic dilatation of the tubules, glomerular Bowman balloon dilatation. 5 cases of induced abortion autopsy pathological diagnosis: fetal tubular cystic change in 4 cases, glomerular cystic change in 1 case; 1 case of clinical follow-up diagnosis of fetal renal microcapsule lesions. Conclusions The prenatal ultrasound findings of fetal kidney microencapsular lesions are enlarged kidneys, diffuse echogenicity and diffuse microcapsule dilatation of renal tubules or glomerulus.