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目的探讨产前超声检测胎儿先天性肺部肿块(CLM)的体积与胎儿头围比值(CVR)对其预后的预测价值,为临床确定CLM治疗方案提供依据。方法回顾性分析经产前超声检测的82例CLM胎儿资料,分为CVR<1.6和CVR≥1.6两组。出生后存活者均随访预后情况,根据预后表现分为预后良好、预后不良趋势(出生后呼吸困难)、预后不良3种情况。结果 82例胎儿中CVR<1.6者71例(86.6%),CVR≥1.6者11例(13.4%)。5例合并胎儿水肿,除1例CVR≥2.0合并胎儿水肿胎死宫内外,其余均继续妊娠至出生。57例(69.5%)出生时无呼吸困难等症状,19例(23.2%)出生时有症状,6例预后不良(7.3%)。两组间水肿发生率、预后情况差异均有统计学意义(P<0.05),若截断值由1.6改为2.0,则水肿发生率、预后不良率差异有统计学意义(P<0.01)。结论经产前评估、监测和规范诊疗,CVR<2的CLM胎儿是相对较为安全的;CVR≥1.6水肿发生率高,其预后取决于产前专业评估和新生儿早期手术干预。
Objective To investigate the predictive value of prenatal ultrasound in detecting the volume of fetal congenital lung mass (CLM) and fetal head circumference ratio (CVR) in predicting the prognosis of CLM. Methods The data of 82 cases of CLM fetuses detected by prenatal ultrasound were retrospectively analyzed and divided into CVR <1.6 and CVR≥1.6. Survival after birth were followed up prognosis, according to the prognosis of performance is divided into good prognosis, poor prognosis (postprandial dyspnea), poor prognosis of 3 cases. Results Among the 82 fetuses, 71 (86.6%) had CVR <1.6 and 11 (13.4%) had CVR≥1.6. 5 cases of fetal edema, in addition to a case of CVR ≥ 2.0 with fetal hydrops fetal death in the uterus, the rest are pregnant to birth. 57 (69.5%) had no symptoms of dyspnea at birth, 19 (23.2%) had symptoms at birth, and 6 had a poor prognosis (7.3%). The difference of edema and prognosis between the two groups was statistically significant (P <0.05). If the cutoff value was changed from 1.6 to 2.0, the difference of edema rate and prognosis was statistically significant (P <0.01). Conclusion Prenatal assessment, monitoring and standard diagnosis and treatment of CLM fetus with CVR <2 are relatively safe. The incidence of CVR≥1.6 edema is high, the prognosis depends on prenatal professional assessment and early neonatal surgical intervention.