先天性膈疝的产前诊断：偏侧性是否预测围产结局？
Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Department of Pediatrics, University of California, San Francisco, San Francisco, California.
出版信息
Am J Perinatol. 2018 Aug;35(10):919-924. doi: 10.1055/s-0037-1617754. Epub 2018 Jan 5.
OBJECTIVE
The objective of this study was to examine laterality as a predictor of outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH).
METHODS
This is a retrospective cohort study of pregnancies with CDH evaluated at our center from 2008 to 2016 compared cases with right-sided CDH (RCDH) versus left-sided CDH (LCDH). The primary outcome was survival to discharge. Secondary outcomes included ultrasound predictors of poor prognosis (liver herniation, stomach herniation, lung area-to-head circumference ratio [LHR]), concurrent anomalies, hydrops, stillbirth, preterm birth, mode of delivery, small for gestational age, use of extracorporeal membrane oxygenation, and length of stay. Terminations and stillbirths were excluded from analyses of neonatal outcomes.
RESULTS
In this study, 157 (83%) LCDH and 32 (17%) RCDH cases were identified. Survival to discharge was similar (64 vs. 66.4%, = 0.49) with regard to laterality. RCDH had higher rates of liver herniation (90.6 vs. 72%, = 0.03), hydrops fetalis (15.6 vs. 1.3%, < 0.01), and lower LHR (0.87 vs. 0.99, = 0.04). LCDH had higher rates of stomach herniation (69.4 vs. 12.5%, < 0.01). Rates of other outcomes were similar in univariate analyses. Adjusting for microarray abnormalities, the odds for survival to discharge for RCDH compared with LCDH was 0.93 (0.38-2.30, = 0.88).
CONCLUSION
Compared with LCDH, fetuses with RCDH had higher rates of adverse ultrasound predictors, but equivalent survival.
目的
本研究旨在探讨先天性膈疝（CDH）胎儿的侧别是否可预测其预后。
方法
这是一项回顾性队列研究，纳入了 2008 年至 2016 年在本中心接受评估的 CDH 妊娠病例，并将右侧 CDH（RCDH）与左侧 CDH（LCDH）病例进行了比较。主要结局为存活至出院。次要结局包括超声预测不良预后的指标（肝脏疝出、胃部疝出、肺面积与头围比[LHR]）、合并畸形、胎儿水肿、死胎、早产、分娩方式、小于胎龄儿、体外膜肺氧合的使用以及住院时间。本研究排除了终止妊娠和死胎的新生儿结局分析。
结果
在这项研究中，157 例（83%）LCDH 和 32 例（17%）RCDH 病例被确定。就侧别而言，存活至出院的比例相似（64%与 66.4%， = 0.49）。RCDH 的肝脏疝出率（90.6%与 72%， = 0.03）、胎儿水肿发生率（15.6%与 1.3%， < 0.01）和 LHR 较低（0.87 与 0.99， = 0.04）更高。LCDH 的胃部疝出率（69.4%与 12.5%， < 0.01）更高。单因素分析中其他结局的发生率相似。在校正微阵列异常后，与 LCDH 相比，RCDH 存活至出院的优势比为 0.93（0.38-2.30， = 0.88）。
结论
与 LCDH 相比，RCDH 胎儿的不良超声预测指标发生率更高，但存活率相当。
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