Division of Child Health, University of Liverpool, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
Ultrasound Obstet Gynecol. 2010 May;35(5):609-14. doi: 10.1002/uog.7586.
Intrathoracic liver herniation (ILH) is being used to estimate prognosis and hence guide antenatal interventions in fetal congenital diaphragmatic hernia (CDH). However, the literature regarding its utility in this role is conflicting. This review systematically examines the currently available evidence of ILH use in fetal CDH.
MEDLINE and EMBASE databases were searched for the terms ((congenital diaphragmatic hernia) OR CDH) AND liver. Inclusion criteria were human case series of fetuses diagnosed with CDH using either ultrasound or magnetic resonance imaging. Included studies were required to have reported the antenatal liver position and the outcome (survival or not). Case reports, reviews and eventration series were excluded. Studies reporting similar cases from the same center over an overlapping time period were considered duplicates; only the larger of the studies were therefore included. Absolute totals were extracted and sums calculated. Fisher's exact test (FET) was used to compare survival rates in different groups.
The original search retrieved 338 studies. Applying inclusion/exclusion criteria and removing duplicates left 21 case series in 20 studies. Retrieved studies differed in the definitions of liver herniation, survival and treatment modality. In total, there were 407 fetuses in the liver-up (herniated) and 303 in the liver-down (not herniated) groups. Survival rates were 45.4% and 73.9%, respectively. The difference was statistically significant (FET = 56.4, P < 0.005). Sensitivity analysis for cases that had only conventional postnatal treatment was still significant (FET = 52.8, P < 0.005).
Liver herniation is associated with poorer prognosis in fetal CDH. Grading liver herniation or using it as part of a panel of markers may enhance the value of liver herniation as a prognostic test in fetal CDH.
胸腔内肝脏疝（ILH）用于评估胎儿先天性膈疝（CDH）的预后，并指导产前干预。然而，关于其在该作用中的应用的文献存在争议。本综述系统地检查了目前关于 ILH 在胎儿 CDH 中应用的证据。
在 MEDLINE 和 EMBASE 数据库中搜索了以下术语：（先天性膈疝）或 CDH）和肝。纳入标准为使用超声或磁共振成像诊断为 CDH 的胎儿的人类病例系列。纳入的研究必须报告产前肝脏位置和结局（存活或未存活）。排除病例报告、综述和膈膨升系列。报道同一中心在重叠时间段内相似病例的研究被认为是重复的；因此，只纳入了较大的研究。提取绝对总数并计算总和。Fisher 确切检验（FET）用于比较不同组的存活率。
原始搜索检索到 338 项研究。应用纳入/排除标准并去除重复项后，有 21 项病例系列来自 20 项研究。检索到的研究在肝脏疝、存活率和治疗方式的定义上存在差异。总共有 407 例胎儿肝脏上疝（疝出）和 303 例肝脏下疝（未疝出）。存活率分别为 45.4%和 73.9%。差异具有统计学意义（FET=56.4，P<0.005）。仅接受常规产后治疗的病例的敏感性分析仍然具有统计学意义（FET=52.8，P<0.005）。
肝脏疝与胎儿 CDH 的预后较差相关。对肝脏疝进行分级或将其作为一系列标志物的一部分使用可能会提高肝脏疝作为胎儿 CDH 预后检测的价值。
