【摘要】 目的探讨胎儿泌尿系统异常产前超声特征与妊娠结局。方法采用胎儿系统超声检查法对14120例孕15～39周孕妇中的58例泌尿系统异常胎儿产前超声特点及产后结果进行对照分析。结果胎儿泌尿系统异常发生率为0.41%(58/14120),引产后尸检或分娩后新生儿超声随访证实51例,失随访4例,产前超声诊断准确率为87.9%,漏误诊3例(5.2%,1例重复肾漏诊、2例盆腔异位肾产前误诊为单侧肾缺如)。58例胎儿泌尿系统异常产前超声表现及妊娠结局:(1)胎儿肾脏形态结构的改变,泌尿系统梗阻表现为肾盂积水或伴发输尿管扩张及膀胱形态改变。(2)单侧泌尿系统异常34例,羊水量正常。(3)双侧泌尿系统异常与下尿路梗阻23例,无羊水或羊水过少。(4)非梗阻性原因所致巨膀胱1例,表现为膀胱增大而羊水量正常。(5)随诊54例(失随访4例):保留分娩28例,均为单侧泌尿系统异常无伴发畸形,其中15例手术治疗预后良好;引产26例,尸检证实双侧泌尿系统异常17例(9例伴发其他系统异常)、单侧泌尿系统异常4例(3例伴发其他系统异常)、巨膀胱5例(4例下尿路梗阻)。结论胎儿单侧泌尿系统异常无伴发畸形者预后良好,可继续妊娠;双侧泌尿系统异常与下尿路梗阻或多发畸形者产后出生儿多不能存活或预后差。更多还原

【Abstract】 Objective To discuss the characteristics of abnormal prenatal ultrasonography for fetus urinary system and to evaluate their pregnancy outcomes.Methods A total of 58 cases with fetus urinary system abnormalities were reviewed and analyzed by prenatal ultrasound in fetus system.The results of induction and postpartum in 14 120 pregnant women with 15~39 weeks of pregnancy were compared with prenatal ultrasound.Results The rate of abnormality in fetus urinary system was 0.41% (58/14 120).By the follow-up and autopsy check,51 cases were confirmed (51/58,87.9%),4 cases were missed,3 cases (3/58,5.2%) missed diagnosis (1) and misdiagnosed (2).Fifty-eight cases of characteristics by abnormal prenatal ultrasonography and their pregnancy outcomes were: (1) The renal structures were changed.Urinary system obstruction showed hydronephrosis combined with ureterectasia and change of bladder structure.(2) The unilateral urinary system abnormality (34 cases) had the normal amniotic fluid volume.(3) The bilateral urinary system abnormality and lower urinary tract obstruction (23 cases) had no amniotic fluid or less.(4) One case of megacystis caused by non-obstruction reason showed bladder enlargement with the normal amniotic fluid.(5) Fifty-four cases were followed up and their results were: 28 cases were retained delivery with abnormal unilateral urinary system but no deformity,in which 15 cases had the operation with promising infant expectant outcome.Twenty-six cases of induction,17 cases of abnormal bilateral urinary system by autopsy check confirmation (9 cases combined with other system abnormality),4 cases of unilateral urinary system abnormality (3 cases with other combined system),5 cases of megacystis (4 cases with lower urinary tract obstruction) were included.Conclusions The fetuses of unilateral urinary system abnormality without other combined deformity had a promising outcome and can continue encyesis.The ones with bilateral involvement,lower urinary tract obstruction and multipleabnormalities are the influence factors for surivival.更多还原