Kamata S, Ishikawa S, Usui N, Kitayama Y, Sawai T, Okuyama H, Fukui Y, Kubota A, Imura K, Okada A
Department of Pediatric Surgery, Osaka University Medical School, Japan.
J Pediatr Surg. 1996 Feb;31(2):267-71. doi: 10.1016/s0022-3468(96)90012-3.
To determine whether associated anatomic features may be useful in predicting fetal prognosis, 43 fetuses who had ultrasonographic evaluation for abdominal wall defects during a 13-year period were reviewed. Thirty-one fetuses had omphalocele and were classified into three groups according to fetal ultrasonography results: ruptured omphalocele with exposed liver, giant omphalocele with exposed liver, and small omphalocele without liver herniation. Twelve fetuses had gastroschisis. Ten of the 12 fetuses with gastroschisis survived; one died in utero. Nine of the 12 with a small omphalocele survived. Ten of 12 fetuses with giant omphalocele survived, but six of the seven with ruptured omphalocele died of pulmonary hypoplasia and respiratory insufficiency. Ruptured omphalocele recognized in utero was accompanied by intrauterine growth retardation and liver herniation and frequently was associated with deformity of the spine, diaphragmatic defects, vesicointestinal fissure, and meningocele. These results indicated that, together with the deformity of the spine, rupture and absence of the covering membrane with an exposed liver (noted through fetal ultrasonography) may suggest a poor prognosis because of pulmonary hypoplasia.
为了确定相关解剖特征是否有助于预测胎儿预后，我们回顾了在13年期间接受超声检查以评估腹壁缺陷的43例胎儿。31例胎儿患有脐膨出，并根据胎儿超声检查结果分为三组：肝脏外露的破裂脐膨出、肝脏外露的巨大脐膨出和无肝脏疝出的小脐膨出。12例胎儿患有腹裂。12例腹裂胎儿中有10例存活；1例死于宫内。12例小脐膨出胎儿中有9例存活。12例巨大脐膨出胎儿中有10例存活，但7例破裂脐膨出胎儿中有6例死于肺发育不全和呼吸功能不全。产前诊断出的破裂脐膨出伴有宫内生长受限和肝脏疝出，且常与脊柱畸形、膈肌缺损、膀胱肠裂和脑脊膜膨出有关。这些结果表明，除脊柱畸形外，（通过胎儿超声检查发现的）覆盖膜破裂及肝脏外露可能提示因肺发育不全导致预后不良。
