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胎儿动静脉畸形的产前超声诊断研究

谭筱檀，袁红霞 * 扫描二维码
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【摘要】 背景 胎儿动静脉畸形可发生在全身各个部位，主要依靠彩色多普勒超声进行诊断，而关于产前超声
诊断动静脉畸形类型的探讨国内外鲜有报道。目的 探讨产前超声诊断胎儿动静脉畸形的价值。方法 选取 2013 年
8 月至 2021 年 8 月在长沙市妇幼保健院超声科行产前超声筛查胎儿动静脉畸形的孕妇为研究对象，采用彩色多普勒
超声诊断仪进行胎儿系统超声筛查，发现胎儿动静脉畸形病灶时，描述其位置、大小、形态、内部回声。分析不同部
位动静脉畸形的超声特征及动静脉畸形分型，并追踪随访结果。结果 本研究中产前超声筛查发现胎儿动静脉畸形病
例 16 例，其中 6 例病灶位于胎儿骶尾部（诊断为骶尾部畸胎瘤），4 例位于胎儿颅内（包括 3 例颅内蔓状血管瘤合并
Galen 静脉瘤、1 例 Galen 静脉瘤），3 例位于胎儿肢体、软组织（包括 1 例 Parkes-Weber 综合征、2 例软组织血管瘤），
2 例位于胎儿肝脏（诊断为肝动静脉瘘），1 例位于胎儿肺部（诊断为隔离肺并肺动静脉瘘）。动静脉畸形分型：单
纯Ⅱ型 10 例（10/16），Ⅱ型和Ⅲ a 型同时存在 3 例（3/16），单纯Ⅰ型 1 例（1/16），单纯Ⅳ型 1 例（1/16），单纯
Ⅲ a 型 1 例（1/16）。随访显示，10 例引产，3 例失访，2 例足月出生后行手术治疗，1 例死胎。结论 胎儿动静脉畸
形的预后与病变部位、病灶内血流分布情况关系密切。产前超声检查可发现胎儿有无动静脉畸形病灶，对其诊断、预
后判断具有重要价值。
【关键词】 动静脉畸形；产前诊断；超声检查，产前；胎儿；超声检查，多普勒，彩色
【中图分类号】 R 654.4 【文献标识码】 B DOI：10.12114/j.issn.1007-9572.2022.0300
谭筱檀，袁红霞 . 胎儿动静脉畸形的产前超声诊断研究［J］. 中国全科医学，2022，25（29）：3691-3697. ［www.
chinagp.net］
TAN X T，YUAN H X. Prenatal ultrasound diagnosis of fetal arteriovenous malformations［J］. Chinese General Practice，
2022，25（29）：3691-3697.

Prenatal Ultrasound Diagnosis of Fetal Arteriovenous Malformations TAN Xiaotan，YUAN Hongxia *
Department of Ultrasound，Changsha Hospital for Maternal and Child Health Care，Changsha 410007，China
*
Corresponding author：YUAN Hongxia，Chief physician；E-mail：2457045622@qq.com
【Abstract】 Background Fetal arteriovenous malformations may occur in all parts of the body and are mainly
diagnosed by color Doppler ultrasound. However，there are few reports at home and abroad on the types of arteriovenous shunts
explored by prenatal ultrasound. Objective To investigate the diagnosis value of prenatal ultrasonography in fetal arteriovenous
malformation. Methods Pregnant women with fetal arteriovenous malformations who underwent prenatal ultrasound screening
in the Department of Ultrasound，Changsha Hospital for Maternal and Child Health Care from August 2013 to August 2021 were
recruited. Color Doppler ultrasonography was used for fetal systematical ultrasound screening. The location，size，shape，and
internal echoes of fetal arteriovenous malformation lesions were detected and described. The ultrasonographic features and types
of arteriovenous malformations in different parts of patients were analyzed，and the results of follow-up were tracked. Results
Prenatal ultrasound screening in this study identified sixteen cases with fetal arteriovenous malformations，of which six
lesions were located in the fetal sacrococcygeal region（diagnosed as sacrococcygeal teratoma），four were located in the fetal
intracranial region（including three intracranial cranberg hemangiomas with Galen's vein tumors，one Galen's vein tumor），
three were located in the fetal limbs，soft tissues（including one Parkes Weber syndrome，two soft tissue hemangiomas），two
were located in fetal liver（diagnosed as hepatic arteriovenous fistula） and one was located in fetal lung（diagnosed as isolated
lung with pulmonary arteriovenous fistula）. Arteriovenous malformation typing：10 patients had simple type Ⅱ（10/16），
3 patients had both type Ⅱ and type Ⅲ a（3/16），1 patient had type Ⅰ（1/16），1 patient had type Ⅳ（1/16），1 patient
had simple type Ⅲ a（1/16）. Follow up showed that 10 induced labor，3 were lost to follow-up，2 were born at term and treated
surgically，and 1 was stillborn. Conclusion The prognosis of fetal arteriovenous malformation is closely related to the location of
基金项目：湖南省卫生健康委科研计划项目资助（202209023567）
410007 湖南省长沙市妇幼保健院超声科
*
通信作者：袁红霞，主任医师；E-mail：2457045622@qq.com
本文数字出版日期：2022-07-07