【摘要】 目的总结双胎反向动脉灌注序列征(TRAPS)胎儿产前超声表现及妊娠结局。方法对2012年1月至2014年12月在苏州市立医院本部产前检查诊断为TRAPS的11例胎儿(无心畸胎儿和泵血儿)的超声表现及妊娠结局进行总结分析。结果 11例TRAPS胎儿中3例为单绒毛膜单羊膜囊双胎,8例为单绒毛膜双羊膜囊双胎。无心畸胎儿超声表现:(1)畸形类型:11例无心畸胎儿中5例表现为无形无心型,4例表现为无头无心型(可见躯干和下肢,无上肢),2例表现为部分头无心型(可见躯干和四肢)。(2)伴发畸形:11例无心畸胎儿均伴发全身皮肤水肿(3例表现为淋巴水囊瘤,1例表现为胸腹腔积液),均见脐动脉血流反向进入腹腔;10例胎儿为单脐动脉。泵血儿超声表现:(1)11例泵血儿均可见胎心搏动。(2)合并畸形:11例泵血儿中1例合并多发结构畸形(包括前脑无裂畸形、中央性唇裂、左侧足内翻,室间隔缺损);1例心轴左偏,右心房和右心室增大,单脐动脉,左肾窦分离。随访及妊娠结局:11例TRAPS胎儿超声检查后均引产而终止妊娠,产后尸检病理均诊断为TRAPS。结论 TRAPS胎儿产前超声诊断可依据单绒毛膜性及无心畸胎儿的典型图像特征进行诊断,产前超声明确诊断对临床干预治疗有重要价值。更多还原

【Abstract】 Objective To summarize the prenatal ultrasound image features and pregnancy outcomes of twin reverse arterial perfusion syndrome. Methods The ultrasound images and pregnancy outcomes were analyzed in 11 cases of twin reverse arterial perfusion syndrome diagnosed prenatally in Suzhou Municipal Hospital for the period from 2012 January to 2014 December. Results Three cases of twin reverse arterial perfusion syndrome in 11 cases were monochorionic single amniotic sac twins and eight cases were monochorionic double amniotic sac twins. Acardias ultrasound foundings:(1) Malformation type: five cases were absence of the fetal body and heart, four cases were absence of fetal head and heart(visible trunk and lower limbs, no upper limbs), two cases were part absence of fetal head(visible trunk and limbs).(2) Accompanied malformation: eleven cases were absence of cardiac pump with body skin edema(three cases of lymphatic hygroma and one case of ascites and pleural effusion), in which the blood in all umbilical artery flowed back into the abdominal cavity, ten cases of single umbilical artery. Pump twins ultrasound foundings:(1) The fetal heart beat pumping was detected in all pump twins.(2) Accompanied malformation: one case of pumping fetus had multiple malformations, including former holoprosencephaly, central cleft lip, the left foot inversion and ventricular septal defect. Another case of pumping fetus heart had left axis deviation with the volume of right atrium and right ventricle increasing, single umbilical artery and left renal sinus separation. Follow-up pregnancy outcomes: eleven cases of twin reverse arterial perfusion syndrome fetus were abortion to terminate the pregnancy and postpartum autopsy pathology diagnosed TRAPS. Conclusions Twin reverse arterial perfusion syndrome has typical ultrasound image features. Ultrasonography is of great value in prenatal diagnosis and clinical intervention of twin reverse arterial perfusion syndrome.更多还原