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目的:探讨胎儿肠梗阻的B超诊断与临床干预意义。方法:回顾性分析赣州市妇幼保健院2007年3月～2011年3月产前B超检查提示肠梗阻患儿34例临床资料,统计染色体检查异常情况、先天发育异常情况及生后随访资料,包括症状、外科手术类型及预后情况。结果:①34例均行染色体检查,发现21-三体综合征5例,性染色体异常2例,其中合并先心病1例,脊柱畸形1例,向家属交代预后并选择终止妊娠;②27例选择继续妊娠,定期随访。22例生后出现呕吐、腹胀,转外科手术,其中环状胰腺4例(占18.2%),行十二指肠前壁菱形吻合术;肠旋转不良4例(占18.2%),行Ladd’s术;十二指肠膜式闭锁6例(占27.3%),行隔膜切除术;空回肠闭锁7例(占31.8%),行肠切除术;胎粪性肠梗阻并腹膜炎1例(占4.5%),行粘连松解术。20例患儿术后均痊愈,2例因早产合并其他并发症死亡。5例生后随访观察未见异常。结论:产前B超对先天性消化道畸形所致胎儿肠梗阻诊断具有重要价值,经确诊常规行染色体检查,早期积极临床干预,以减少严重畸形儿的出生;而对胎儿肠梗阻应定期随访,出生后出现肠梗阻患儿早期诊断并针对病因合理选择手术方法,是提高先天性消化道畸形治愈率的关键。
Objective: To explore the significance of B-ultrasound and clinical intervention in the diagnosis of fetal intestinal obstruction. Methods: A retrospective analysis of Ganzhou MCH hospital from March 2007 to March 2011 prenatal B-ultrasound in children with intestinal obstruction prompted 34 cases of clinical data, statistical chromosomal abnormalities, congenital abnormalities and postnatal follow-up data, Including the symptoms, surgical types and prognosis. Results: ①34 patients underwent chromosomal examination and found that 21 cases of trisomy syndrome in 5 cases, 2 cases of chromosomal abnormalities, including 1 case of congenital heart disease, spinal deformity in 1 case, to explain the prognosis of the families and choose to terminate the pregnancy; 27 cases choose to continue Pregnancy, regular follow-up. Among the 22 cases, vomiting, bloating and surgery were performed in 22 cases. There were 4 cases of annular pancreas (18.2%), rhombic anastomosis of anterior duodenum, 4 cases of bad bowel rotation (18.2%), Ladd’s operation ; Duodenal membranous atresia in 6 cases (27.3%), underwent diaphragm resection; empty ileal atresia in 7 cases (31.8%), enteral resection; meconium ileus and peritonitis in 1 case (4.5% ), Line adhesion lysis. Twenty patients were cured postoperatively, and 2 died of premature labor combined with other complications. 5 cases were observed after birth, no abnormalities were observed. Conclusions: Prenatal B-ultrasound is valuable for the diagnosis of fetal intestinal obstruction due to congenital gastrointestinal malformations. Chromosome examination and routine positive clinical intervention are usually performed to reduce the birth of severe deformity. Fetal intestinal obstruction should be followed up on a regular basis , After birth, early diagnosis of intestinal obstruction in children with a reasonable choice of surgical treatment for the cause, is to improve the cure rate of congenital gastrointestinal malformations key.