Strategic of improving the effectiveness of prenatal ultrasound in diagnosis of fetal cleft palate
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摘要:
目的 分析临床病史结合唇腭部常规三切面、上牙槽突横切面、其他特殊切面与三维超声配合胎儿不同体位对提高产前超声诊断胎儿唇腭裂效率的协助作用。 方法 对我院2014年9月~2016年12月7000例中孕期（孕20~24+6周）胎儿行颜面部超声筛查，超声检查前常规询问病史，以规范化常规三切面、上牙槽突横切面作为筛查切面，有异常时应同时采集胎儿张口时和闭口时的二维图像，最后采集三维图像，与引产或分娩后患儿颜面部结果进行对照，比较各种方法对提高产前超声诊断唇腭裂畸形的效率与准确率的作用。 结果 7000例胎儿超声共检出唇腭裂27例，经引产和分娩证实唇腭裂29例，其中常规三切面组检出胎儿唇腭裂畸形20例，产前超声漏诊9例，超声诊断符合率为69%；常规三切面、上牙槽突横切面、其他特殊切面加三维超声组产前超声检出胎儿唇腭裂畸形27例，产前超声漏诊2例，产前超声诊断符合率为93%；对比两种方法在唇裂合并腭裂病例存在显著性差异（P<0.05）。 结论 超声医师检查前常规采集病史，检查时准确识别胎儿唇鼻部腭部正常结构和声像图特征，掌握常规三切面、上牙槽突横切面和其他特殊切面的手法和技巧，仔细观察胎儿唇鼻结构和张口闭口运动，同时应用三维超声表面成像模式，将会提高唇腭裂畸形的超声诊断率，给临床医生及孕妇提供可靠的信息。 Abstract:Objective To analyse the clinical history combined with routine lip jaws on the three aspects, alveolar sudden transverse section, other special plane and three-dimensional ultrasound fetal position,and improve the efficiency of prenatal ultrasound diagnosis of fetal cleft lip and palate. Methods The facial ultrasound screening were performed to 7000 fetus in the second trimester in our hospital from September 2014 to December 2016. Medical history were asked before ultrasound examination. We standardized the conventional three section, alveolar cross section as a screening section. A two-dimensional image were collected at the same time of opening and closing of the fetal anomaly. 3D acquisition the image were collected at last. The induction of labor or delivery in children after facial results were compared.The effects of prenatal ultrasound of different methods in diagnosis of cleft lip and palate efficiency were compared. Results In 7000 cases of fetal ultrasonography, 27 cases were detected of cleft lip and palate, 29 cases were confirmed of cleft lip and palate by labor and childbirth.Twenty cases were detected of cleft lip and cleft palate in the conventional three section group. Nine cases were missed diagnosis of prenatal ultrasound. Coincidence rate of ultrasound diagnosis was 69%. 27 cases were fetal cleft lip and palate malformation by conventional three aspects, alveolar sudden transverse section, other special section on three-dimensional ultrasound group. Two cases were missed diagnosis of prenatal ultrasound. Coincidence rate of prenatal ultrasound diagnosis was 93%. Effects of two methods in the merger of cleft lip cleft palate cases were significantly different (P<0.05). Conclusion Ultrasound doctors should do conventional acquisition history before examination.The identification of normal structure and sonographic features of cleft lip and palate nose, the conventional three section on the alveolar transverse section, a careful observation of the fetal lip nasal structure and closed mouth movement, the application of three-dimensional ultrasound surface imaging mode will improve ultrasound diagnostic rate of cleft lip and palate deformity.It can provide reliable informations for clinicians and pregnant women. -
Key words:
- prenatal /
- ultrasonography /
- fetal cleft lip and palate /
- effectiveness
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表 1 产前超声及产后检出唇腭裂结果比较（n=7000）
组别 产前超声检查唇腭裂（n） 经引产和分娩诊断唇腭裂（n） 产前超声诊断符合率（%） 常规三切面组 20 29 69 常规三切面、上牙槽突横切、其他特殊切面加三维超声组 27 29 93 
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表 2 两种检验方法对唇腭裂结果比较（n）
畸形类型 常规三切面 常规三切面、上牙槽突横切面、其他特殊切面加三维超声 χ2 P 唇裂（n=4） 4 4 0.050 0.696 唇裂合并腭裂（n=23） 16 23 4.041 0.044 单纯腭裂（n=0） 0 0 - -
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