常规三切面与特殊切面法在产前筛查胎儿唇腭裂畸形中的应用

摘要

目的总结单一鼻唇冠状切面与常规三切面加特殊切面法在胎儿唇腭裂畸形筛查中的应用价值。方法对3790例胎儿唇腭部采用单一切面法（鼻唇冠状切面组965例）和常规三切面（鼻唇冠状切面、颜面部正中矢状切面、唇水平横切面）加特殊切面法（常规三切面加特殊切面组2825例，经下颌或下唇斜冠状切面、矢状切面、经梨状孔硬腭斜冠状切面、经面颊部斜横切面）行产前超声筛查，并与出生儿颜面部检查结果进行对照分析，总结鼻唇冠状切面与常规三切面和特殊切面检查方法的超声声像图特征，比较单一切面与三切面加特殊切面超声扫查方法的诊断符合率。结果3790例胎儿产前超声共检出唇腭裂畸形32例（0．84％，32／3790），其中鼻唇冠状切面组检出胎儿唇腭裂畸形8例（0．83％，8／965），出生儿颜面部检查证实唇腭裂畸形12例，产前超声诊断符合率为66．67％（8／12），漏诊4例，漏诊率为33．33％（4／12）；常规三切面加特殊切面组产前超声检出胎儿唇腭裂畸形24例，出生儿唇腭部检查证实唇腭裂畸形24例，产前超声无一例漏诊，超声诊断符合率为100％（24／24）。产后检查证实唇腭裂畸形36例，发生率为0．95％（36／3790）。32例唇腭裂胎儿产前超声声像图特征：（1）单侧唇腭裂14例，超声表现为上唇皮肤连续性中断（12／12），鼻孔塌陷和上牙槽突裂（12／12）；上腭连续性回声中断12例（12／14）。（2）双侧唇裂3例，超声均表现为上唇皮肤连续性中断，上牙槽突裂。（3）双侧唇腭裂2例，超声表现为上唇皮肤连续性中断，鼻孔塌陷和上牙槽突裂，上腭连续性回声中断。（4）中央唇腭裂1例，超声表现为上唇皮肤连续性中断，鼻孔塌陷，上牙槽突裂和上腭连续性回声中断。结论与单一鼻唇冠状切面检查法比较，产前超声采用常规三切面加特殊切面法有助于准确检出胎儿唇腭裂，尤其对唇腭部复合畸形胎儿的检查有重要临床应用价值。%Objective To discuss the value of the approach combining routine and special planes in diagnosis of cleft lip and palate .Methods The prenatal ultrasound screening for fetal lips and palate were conducted in 3790 cases with different methods: single-plane (nasolabial coronary plane ) approach in 965 cases and routine-triple-plus-special-plane approach in 2825 cases.After birth, the facial appearances of infants were observed.The diagnostic accuracy rates of the two approaches were compared .Results Among the 3790 cases, 36 (36/3790,0.95%) fetal cleft lip and palate malformations were confirmed , in which 32 cases were demonstrated in prenatal ultrasound with 4 missed cases.The overall accuracy rate of prenatal ultrasound was 88.89%(32/36).For single-plane approach, 8/12 fetal cleft lip and palate malformations were detected in prenatal ultrasound with 4 missed cases.The diagnostic accuracy rate was 66.67%(8/12) with a missed diagnosis rate of 33.33%( 4/12 ).With regard to the routine-triple-plus-special-plane approach, all 24 fetal cleft lip and palate cases were detected in prenatal ultrasound .The diagnostic accuracy rate was 100%(24/24).There was a significant difference between the two groups in accuracy rate of prenatal ultrasound in screening fetal cleft lip and palate .Conclusion For fetal cleft lips and palate, it is of great value to combine the routine and special planes in prenatal ultrasound screening , especially in the case of complex malformations.