产前超声能否预测复杂型先天性腹裂？

Is complex gastroschisis predictable by prenatal ultrasound?

机构信息

Department of Obstetrics, Hôpital Necker Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France.

出版信息

BJOG. 2012 Jan;119(1):102-9. doi: 10.1111/j.1471-0528.2011.03183.x. Epub 2011 Oct 21.

DOI:10.1111/j.1471-0528.2011.03183.x

PMID:22017923

Abstract

OBJECTIVE

To establish a correlation between prenatal ultrasound findings and postnatal outcome in neonates with gastroschisis (GS).

DESIGN

Retrospective case-control study.

SETTING

Prenatal ultrasound reports, labour and neonatal intensive care unit notes, and paediatric surgical clinic records were reviewed.

POPULATION

Neonates with an antenatal diagnosis of isolated GS.

METHODS

The neonates were divided into two groups: one with associated bowel complications including intestinal atresia, perforation, necrosis or volvulus ('complex' GS), and the second without bowel complication ('simple' GS). Prenatal ultrasound markers: small-for-gestational-age, intra-abdominal and extra-abdominal bowel dilatation (>6 mm), thickened intestinal wall and stomach dilatation were correlated with outcome.

MAIN OUTCOME MEASURES

Fetal or neonatal death in complex versus simple GS. Time on parenteral nutrition and duration of hospital stay were also noted.

RESULTS

In all, 105 cases were eligible for analysis. Survival rate was 101/105 (96.2%). None of the ultrasound markers was predictive of fetal or neonatal death. Fourteen of 103 live-born babies (14.6%) had complex GS, which was associated with longer time on parenteral nutrition [8.0 (51.5-390) versus 33.5 (25.3-53.3) days, P<0.001] and longer duration of hospital stay [85.3 (55.5-210) versus 41.5 (33.0-64.8) days, P<0.001]. Infants with complex GS were more likely to require bowel resection and stoma placement (P<0.05). Intra-abdominal bowel dilatation was the only predictive ultrasound marker of complex GS (odds ratio 4.13, 95% CI 1.32-12.90; P=0.018). Receiver operating characteristic curve for observed/expected bowel diameter yielded 6 as the cutoff value for predicting complex GS (odds ratio 7.9, 95% CI 2.3-27.3; P=0.001) with 54% and 88% for sensibility and specificity, respectively.

CONCLUSIONS

Intra-abdominal bowel dilatation is the only ultrasound marker predictive of complex GS but it is a strong marker.

摘要

目的

建立胎儿超声检查结果与先天性腹裂（GS）新生儿出生后结局之间的相关性。

设计

回顾性病例对照研究。

地点

研究人员查阅了产前超声报告、分娩和新生儿重症监护病房记录以及儿科外科诊所记录。

人群

产前诊断为单纯性 GS 的新生儿。

方法

将新生儿分为两组：一组伴有肠闭锁、穿孔、坏死或扭转等肠并发症（“复杂” GS），另一组无肠并发症（“单纯” GS）。将产前超声标志物：小于胎龄、腹腔内和腹腔外肠扩张（>6mm）、肠壁增厚和胃扩张与结局相关联。

主要观察指标

复杂 GS 与单纯 GS 中胎儿或新生儿死亡。还记录了经肠外营养时间和住院时间。

结果

共 105 例符合分析条件。存活率为 101/105（96.2%）。没有任何超声标志物可预测胎儿或新生儿死亡。103 例活产婴儿中有 14 例（14.6%）患有复杂 GS，这与更长的肠外营养时间[8.0（51.5-390）vs 33.5（25.3-53.3）天，P<0.001]和更长的住院时间[85.3（55.5-210）vs 41.5（33.0-64.8）天，P<0.001]相关。患有复杂 GS 的婴儿更有可能需要肠切除和造口术（P<0.05）。腹腔内肠扩张是唯一预测复杂 GS 的超声标志物（优势比 4.13，95%CI 1.32-12.90；P=0.018）。观察到的/预期的肠直径比值的受试者工作特征曲线得出 6 作为预测复杂 GS 的截断值（优势比 7.9，95%CI 2.3-27.3；P=0.001），敏感性和特异性分别为 54%和 88%。