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目的探讨胎儿肠管扩张的原因和临床意义。方法本文对107例产前超声发现胎儿肠管扩张孕妇进行临床管理和结果追踪,如产前出现明显胎儿肠管扩张(扩张的肠襻直径>30mm)或明确诊断为消化系统畸形者,可选择引产放弃胎儿,并对患儿尸体进行解剖验证;如选择继续妊娠,则严密监测,分娩后行新生儿腹部X线平片拍摄和钡灌肠造影检查是否存在梗阻,并判断梗阻类型。分娩时取脐带血进行胎儿染色体核型分析。结果(1)产前超声表现为肠管扩张的107例孕妇中,78例(72·9%)合并消化系统畸形,其中,54例(69·2%)同时伴羊水增多,5例为染色体异常(7·8%),7例并多发畸形(9·0%)。(2)当胎儿腹部超声影像表现为典型的双泡征时,提示胎儿十二指肠梗阻,临床诊断正确率为100%,绝大部分由十二指肠闭锁和狭窄引起。(3)引起胎儿期肠管扩张的消化系统畸形中,以小肠畸形最为常见,结肠和肛门直肠病变少见。(4)29例胎儿产前超声表现为肠管扩张,分娩后1个月内新生儿未发现异常表现。结论产前诊断胎儿肠管扩张与消化系统畸形密切相关,需给予正确的临床管理和指导。
Objective To investigate the causes and clinical significance of fetal intestinal dilatation. Methods The clinical management and follow-up of 107 pregnant women with fetal bowel dilatation discovered by prenatal ultrasound were performed. If obvious fetal bowel dilatation (dilated bowel diameter> 30mm) or definite diagnosis of digestive system deformity in prenatal period can be followed, Fetus, and autopsy of children with autopsy; If you choose to continue pregnancy, the close monitoring, delivery line neonatal abdominal X-ray film and barium enema contrast for the presence of obstruction and determine the type of obstruction. Umbilical cord blood taken during childbirth fetal karyotype analysis. Results (1) Of the 107 pregnant women who had bowel dilatation in prenatal diagnosis, 78 (72.9%) had digestive system malformations. Among them, 54 (69.2%) were accompanied by increased amniotic fluid and 5 were chromosomal abnormalities (7.8%), 7 patients had multiple deformities (9.0%). (2) When the fetus abdominal ultrasound image showed a typical double bubble signs, suggesting that fetal duodenal obstruction, the clinical diagnosis of the correct rate of 100%, the vast majority of atresia caused by duodenal atresia and stenosis. (3) cause fetal digestive system malformations in the expansion, the most common intestinal malformations, colon and anorectal lesions rare. (4) 29 cases of fetal prenatal ultrasound showed intestinal dilatation, within 1 month after delivery did not find abnormalities in newborns. Conclusion Prenatal diagnosis of fetal intestinal dilatation and digestive system deformity are closely related to the need to give the correct clinical management and guidance.