Bootstaylor B S, Filly R A, Harrison M R, Adzick N S
Department of Radiology, University of California, San Francisco 94143, USA.
J Ultrasound Med. 1995 Jul;14(7):515-20. doi: 10.7863/jum.1995.14.7.515.
We conducted a retrospective review of prenatal sonograms of all fetuses (n = 25) with left sided congenital diaphragmatic hernia undergoing in utero surgical repair of the defect at the University of California, San Francisco, Fetal Treatment Center. Sixteen candidates were selected for analysis to determine reliable predictors of liver herniation. Bowing of the umbilical segment of the portal vein (portal sinus) to the left of midline and coursing of portal branches to the lateral segment of the left hepatic lobe toward or above the diaphragmatic ridge were the best predictors for liver herniation into the fetal thorax (positive predictive values of 85% and 100%, respectively). The stomach position was a good predictor if observed in a posterior or midthoracic location (positive predictive value = 100%). However, this occurred in only 7 of 16 (44%) cases. Visibility of the right lung was less informative (positive predictive value = 63%). We do not recommend in utero primary closure of congenital diaphragmatic hernia when there is sonographic evidence of liver herniation into the fetal thorax.
我们对加利福尼亚大学旧金山分校胎儿治疗中心所有接受先天性膈疝宫内手术修复的左侧先天性膈疝胎儿（n = 25）的产前超声检查进行了回顾性研究。选择16名候选对象进行分析，以确定肝脏疝出的可靠预测指标。门静脉脐段（门静脉窦）向中线左侧弯曲以及门静脉分支向左侧肝叶外侧段朝向或高于膈嵴走行是胎儿胸腔内肝脏疝出的最佳预测指标（阳性预测值分别为85%和100%）。如果在后方或胸中部位置观察到胃的位置，则是一个很好的预测指标（阳性预测值 = 100%）。然而，这仅在16例（44%）病例中的7例中出现。右肺的可见性提供的信息较少（阳性预测值 = 63%）。当超声检查有证据表明肝脏疝入胎儿胸腔时，我们不建议对先天性膈疝进行宫内一期闭合。
