早孕期超聲掃描診斷胎兒唇齶裂的研究

目的：探討針對早孕期胎兒，超聲中使用不同切面組合，對唇齶裂的診斷應用價值。方法：選取2018年1月～2020年12月，於鏡湖醫院進行產前檢查的，孕週期為11-13週^(+6)的孕婦4200例。孕婦平均年齡為29.3歲（20歲～43歲）。患者分為三組：第一組11-11^(+6)孕週、第二組12-12^(+6)孕週、第三組13-13^(+6)孕週。利用“標準三平面正交法”掃描聯合“經口裂斜冠切面”和“經頜下三角切面”掃描法，探查胎兒顏面、唇、齶部。根據出生後胎兒檢查結果的金標準，評定不同切面超聲診斷在早孕期胎兒唇齶裂的敏感度、特異度、準確率，分析檢出病例和漏診病例早孕期不同超聲切面的診斷結果。結果：在3495例胎兒檢查中，“標準三平面正交法”圖像顯示率為92.6%。在705例胎兒檢查中，“經口裂斜冠切面”的顯示率為80.0%；“經頜下三角切面”的顯示率為15.2%。“標準三平面正交法”掃描聯合“經口裂斜冠切面”和“經頜下三角切面”掃描法的4200例胎兒檢查中，總顯示率為93.1%。“標準三平面正交法”、“經口裂斜冠切面”和“經頜下三角切面”掃描法在11-11^(+6)孕週、12-12^(+6)孕週、13-13^(+6)孕週組的顯示率，均沒有統計學差異。出生後確診唇齶裂共11例，而產前超聲檢出9例，共漏診兩例。本院早孕期超聲診斷的敏感性為81.82%，特異性為100%，陽性預告值為100%，假陰預告值為99.72%準。結論：相對於“標準三平面正交法”，經“口裂斜冠切面”和“經頜下三角切面”掃描在孕早期診斷先天性唇齶裂上，不具備優勢，但可以作為早期診斷唇齶裂的補充掃描切面。“標準三平面正交法”掃描法顯示率不受孕週影響，能夠有效篩查早孕期嚴重顏面部畸形。

關鍵字

早孕期超聲；標準三平面正交法；經口裂斜冠切面；經頜下三角切面掃描法；唇齶裂病

並列摘要

Objective: To compare the clinical significance of different ultrasound scan planes in diagnosing fetal cleft lip/palate. Methods: At the first-trimester pregnancy stage, fetal ultrasound images were recorded at the time of nuchal translucency (NT) scan. A total of 4200 pregnant women who signed up at KiangWu Hospital between January 2018 and December 2020 for regular prenatal care were included in this study. All patients were divided into three groups: the 11-11^(+6) pregnancy week group, the 12-12^(+6) pregnancy week group and the 13-13^(+6) pregnancy week group. After the routine ultrasound fetal profiles were obtained, the "three perpendicular planes," the "transoralrima oblique coronal plant," and the "submandibular triangle plant" scanning of the fetal face, lips, and palates were applied. The ultrasonic scanning methods' sensitivity, specificity, and positive and negative predictive values were calculated by comparing to the postnatal examination "Golden standard". The positive diagnosis and missed diagnosis cases were also examined. Results: For 3495 first trimester fetuses, the "three perpendicular planes" imaging display rate was 92.6%. For 705 first trimester fetuses, the "transoralrima oblique coronal plant" and the "submandibular triangle plant" imaging display rate was 80.0% and 15.2% respectively. For a total of 4200 first trimester fetuses, the summed-up imaging display rate of the three methods was 93.1%. There was no significant difference among the imaging display rates in the 3 groups. Nine with facial malformations were identified prospectively by ultrasonic scanning, whereas 11 newborns were identified by postnatal examination. The sensitivity, specificity, positive and negative predictive values were 81.82%, 100%, 100% and 99.72% respectively. Conclusion: The "three perpendicular planes" scanning might be the most important method to diagnose fetal cleft lip/palate at the early pregnancy stage. The imaging display rate of the facial structure was unaffected by the gestational age. The "transoralrima oblique coronal plant" and the "submandibular triangle plant" imaging were not superior to the "three perpendicular planes" imaging for early-stage diagnosis of fetal cleft lip/ palate. However, the "transoralrima oblique coronal plant" and the "submandibular triangle plant" imaging might be a complementary method for those fetuses scanned by the "three perpendicular planes" but without a clear image.

並列關鍵字

First trimester ； Three perpendicular planes ； Transoralrima oblique coronal plant ； Submandibular triangle plant ； Fetal cleft lip and palate ； Fetus

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