摘要：
目的 应用超声心动图观察胎儿单纯性室间隔缺损(VSD)及其出生后1年内的自然转归情况.方法 对2012年1月至2017年6月在北京市大兴区人民医院超声心动图诊断为单纯性VSD、无染色体异常的51例胎儿心脏进行孕期和出生后1年的超声心动图随访,记录VSD发生位置、大小、愈合时间,并计算愈合率.采用Fisher确切概率法比较VSD宫内与出生后1年愈合率.采用Fisher确切概率法比较不同位置VSD愈合率、不同大小VSD愈合率,以P＜0.05为差异有统计学意义;进一步组间两两比较采用Fisher确切概率法,以P＜0.0167为差异有统计学意义.结果 51例单纯性VSD胎儿,30例为膜周部缺损,16例为肌部缺损,5例为漏斗部缺损;20例(39.2%)自然愈合,其中9例(17.6%)宫内愈合,11例(21.6 %)在出生后1年内愈合,宫内愈合率与出生后1年内愈合率比较,差异无统计学意义(P=0.804);肌部缺损16例,11例(68.8%)自然愈合,其中宫内愈合4例(25.0%),出生后1年内愈合7例(43.8%);膜周部缺损30例,9例自然愈合(30.0%),其中宫内愈合5例(16.7%),出生后1年内愈合4例(13.3%);肌部缺损愈合率均高于膜周部、漏斗部缺损愈合率,且差异均有统计学意义(P=0.007、0.012);膜周部缺损与漏斗部缺损愈合率差异无统计学意义(P=0.297);漏斗部缺损无一例愈合.缺损≤3.0 mm共35例,19例(54.3%)自然愈合,其中宫内愈合9例(25.7%),出生后1年内愈合10例(28.6%);缺损3.1~5.0 mm13例,无一例宫内愈合,出生后1年内愈合1例(7.6%);缺损直径≤3.0 mm愈合率高于缺损直径3.1~5.0 mm及＞5.0 mm愈合率,且差异均有统计学意义(P=0.007、0.013);缺损直径3.1~5.0 mm与＞5 mm愈合率差异无统计学意义(P=1.0);缺损直径＞5 mm的VSD均未愈合.结论 胎儿单纯性VSD在孕期及出生后1年内存在较高的自然愈合率.超声心动图是诊断胎儿单纯性VSD的可靠手段,对观察单纯性VSD发展和判断预后有重要意义.%Objective To evaluate the spontaneous closure of isolated fetal ventricular septal defect (VSD) in uterus and follow-up during the first year after birth using echocardiography. Methods From January 2012 to June 2017, 51 cases with isolated VSD without chromosome abnormality were observed in uterus and followed-up during the first year after birth using echocardiography in People's Hospital of Daxing District in Beijing City. The location, size, closure time of the VSD were recorded. The closure rate was calculated. The closure rate of the VSD in utero and in infant during the first year after birth were compared by Fisher exact probability method. The relation of closure rate and location and size were also analyzed (P＜0.05 was significant). The comparison between groups one by one were performed by Fisher exact probability method (P＜0.0167 was significant). Results In 51cases, 30 had perimembranous VSD, 16 with muscular VSD and 5 with infundibular VSD. In 20 closure cases (39.2%), 9 fetuses (17.6%) were closed in utero, 11 infants (21.6%) were closed during the first year after birth. There was no significant difference between the closure rate of the VSD in utero and the closure rate of VSD in infant during the first year after birth (P=0.804). In 16 with muscular VSD, 11 cases (68.8%) were closed, in whom 4 fetuses (25.0%) were closed in utero and 7 infants (43.8%) were closed during the first year after birth. In 30 perimembranous VSD, 9 cases (30.0%) were closed, in whom 5 fetuses (16.7%) were closed in utero and 4 infants (13.3%) were closed during the first year after birth. The closure rate of muscular VSD were significant higher than that of the closure rate of perimembranous VSD and infundibular VSD (P=0.007, 0.012). There were no significant difference between the closure rate of the perimembranous VSD and infundibular VSD (P=0.297). The infundibular VSD remained unclosed in all cases. In 35 cases with VSD≤3.0 mm, 19 cases (54.3%) were closed, in whom 9 fetuses (25.7%) were closed in utero and 10 infants (28.6%) were closed during the first year after birth. There was 1 closure case (7.6%) with VSD of 3.1-5.0 mm. The closure rate of VSD≤3.0 mm were significant higher than that of the VSD of 3.1-5.0 mm and the VSD＞5.0 mm (P=0.007, 0.013). There was no significant difference between the closure rate of the VSD of 3.1-5.0 mm and VSD＞5.0 mm (P=1.0). The VSD＞5.0 mm remained unclosed in all cases. Conclusions Isolated VSD has a high closure rate in utero and during the first year after birth. Echocardiography was a reliable method in diagnosis and follow-up of isolated VSD.
