Tracy Sarah, Buchmiller Terry L, Ben-Ishay Offir, Barnewolt Carol E, Connolly Susan A, Zurakowski David, Phelps Andrew, Estroff Judy A
Department of Surgery, Boston Children's Hospital, Boston, MA.
Department of Surgery, Boston Children's Hospital, Boston, MA; Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA.
J Pediatr Surg. 2018 Jun;53(6):1137-1141. doi: 10.1016/j.jpedsurg.2018.02.073. Epub 2018 Mar 7.
BACKGROUND/PURPOSE: Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neonates are not identified until after birth. The distended hypopharynx (DHP) has been suggested as a novel prenatal sign for EA. We assess its diagnostic accuracy and predictive value on ultrasound (US) and magnetic resonance imaging (MRI), both alone and in combination with the esophageal pouch (EP) and secondary signs of EA (polyhydramnios and a small or absent fetal stomach).
We retrospectively reviewed fetal US and MRI reports and medical records of 88 pregnant women evaluated for possible EA from 2000 to 2016. Seventy-five had postnatal follow-up that confirmed or disproved the diagnosis of EA and were included in our analysis.
Seventy-five women had 107 study visits (range 1-4). DHP and/or EP were seen on US and/or MRI in 36% of patients, and 78% of those patients had EA. DHP was 24% more sensitive for EA than EP, while EP was 30% more specific. After 28weeks of gestation, DHP had a predictive accuracy for EA of 0.929 (P=0.001).
DHP is a sensitive additional prenatal sign of EA. More accurate diagnosis of EA allows for improved counseling regarding delivery, postnatal evaluation, and surgical correction.
Diagnostic.
Level II.
背景/目的：尽管食管闭锁（EA）的产前诊断已取得进展，但大多数新生儿直到出生后才被确诊。扩张的下咽（DHP）已被认为是EA的一种新的产前体征。我们评估其在超声（US）和磁共振成像（MRI）上单独及联合食管囊（EP）和EA的次要体征（羊水过多和胎儿胃小或无）时的诊断准确性和预测价值。
我们回顾性分析了2000年至2016年期间88例因可能患有EA而接受评估的孕妇的胎儿US和MRI报告及病历。75例有产后随访结果，证实或排除了EA诊断，并纳入我们的分析。
75例女性共有107次检查（范围1 - 4次）。36%的患者在US和/或MRI上可见DHP和/或EP，其中78%的患者患有EA。DHP对EA的敏感性比EP高24%，而EP的特异性高30%。妊娠28周后，DHP对EA的预测准确率为0.929（P = 0.001）。
DHP是EA一个敏感的额外产前体征。对EA更准确的诊断有助于改善关于分娩、产后评估和手术矫正的咨询。
诊断性研究。
II级。
