Bradshaw Catherine J, Thakkar Hemanshoo, Knutzen Liz, Marsh Rachel, Pacilli Maurizio, Impey Laurence, Lakhoo Kokila
Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
Department of Paediatric Surgery, Oxford Children's Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
J Pediatr Surg. 2016 Aug;51(8):1268-72. doi: 10.1016/j.jpedsurg.2016.02.001. Epub 2016 Feb 8.
This study aims to determine the rate of prenatal detection of tracheoesophageal fistula and oesophageal atresia (TOF/OA), by identifying a small or absent stomach bubble with or without polyhydramnios, on the prenatal ultrasound scans (USS).
A retrospective study of prenatal ultrasound findings of babies with a prenatal and postnatal diagnosis of TOF/OA born between 1st January 2004 and 31st December 2013 was undertaken.
A total of 58 babies were born with TOF/OA. 40% of mothers had their prenatal investigations performed within our tertiary centre, and the remaining 60% had their antenatal care at their local district general hospital (DGH). The overall sensitivity for prenatal USS was 26%, with a specificity of 99% and a positive predictive value (PPV) of 35%. However, the sensitivity of the prenatal USS within the tertiary centre was significantly higher at 57%, while only 2 cases were detected prenatally in the DGHs. Polyhydramnios was seen in 67% of mothers that had a prenatal diagnosis of TOF/OA and its presence did significantly increase the positive predictive value of prenatal USS (from 35% to 63%). Of those that were postnatally diagnosed, 21% had prenatal polyhydramnios. There was no significant difference in postnatal outcomes between those that were prenatally diagnosed and those that were postnatally diagnosed.
Prenatal diagnosis of TOF/OA remains challenging. However within a specialist centre the accuracy of successful prenatal detection can be significantly improved. This is beneficial both for prenatal counselling of families and for planning appropriate perinatal and postnatal care for the baby.
本研究旨在通过产前超声扫描（USS）识别有或无羊水过多情况下胃泡小或无胃泡，以确定产前诊断气管食管瘘和食管闭锁（TOF/OA）的比率。
对2004年1月1日至2013年12月31日期间出生的产前和产后诊断为TOF/OA的婴儿的产前超声检查结果进行回顾性研究。
共有58例婴儿出生时患有TOF/OA。40%的母亲在我们的三级中心进行了产前检查，其余60%在当地地区综合医院（DGH）接受了产前护理。产前超声检查的总体敏感性为26%，特异性为99%，阳性预测值（PPV）为35%。然而，三级中心内产前超声检查的敏感性显著更高，为57%，而在地区综合医院仅产前检测到2例。67%产前诊断为TOF/OA的母亲出现羊水过多，其存在确实显著提高了产前超声检查的阳性预测值（从35%提高到63%）。在产后诊断的病例中，21%产前有羊水过多。产前诊断和产后诊断的病例在产后结局方面没有显著差异。
TOF/OA的产前诊断仍然具有挑战性。然而，在专科中心，成功产前检测的准确性可以显著提高。这对家庭的产前咨询以及为婴儿规划适当的围产期和产后护理都有益处。
