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目的探讨 B 超检查胎儿肾脏回声增强的临床意义。方法选择31例产前 B 超发现胎儿肾脏回声增强的患者,征求本人意见,对选择引产放弃胎儿者(12例)行引产后患儿尸体解剖;对选择继续妊娠者(19例)定期随访。分娩时取胎儿脐带血进行胎儿染色体分析。结果 (1)31例中6例胎儿同时合并其他脏器异常,3例胎儿合并染色体异常,2例患者具有家族史。(2)12例选择终止妊娠者中,10例伴羊水过少;B 超检查胎儿肾脏回声增强的原因分别为婴儿型多囊肾10例、成人型多囊肾1例和多囊性肾发育不良1例。(3)19例选择继续妊娠者中,2例羊水过少患儿于新生儿期死亡,病理解剖结果为婴儿型多囊肾;3例患儿分别在出生后1岁内死亡,病理诊断分别为婴儿型多囊肾或多囊性肾发育不良;1例患儿在出生后26个月出现高血压症状,肾功能异常,诊断为婴儿型多囊肾;4例患儿出生后 B 超检查肾脏回声转为正常;9例肾脏 B 超表现与产前检查相同,但目前没有任何临床症状。结论 (1)胎儿期肾脏 B 超回声增强的原因多为婴儿型多囊肾、肾发育不良和非特异性肾病,也有部分为正常肾脏变异。(2)羊水量是判断胎儿预后的关键指标之一,当胎儿期肾脏回声增强伴羊水过少时提示胎儿预后不良。(3)当发现肾脏 B 超回声增强时,应仔细询问家族史,并对胎儿父母肾脏及胎儿其他部位进行详细检查,必要时建议进行胎儿染色体核型分析。
Objective To investigate the clinical significance of ultrasound examination of fetal renal echogenicity. Methods 31 cases of prenatal ultrasound B-fetus were found in patients with enhanced fetal kidney echocardiography to seek my opinion on the choice of induction of abortion fetus (12 cases) post-induction of labor in children with autopsy; choose to continue pregnancy (19 cases) were followed up regularly. Fetal cord blood taken fetus chromosome analysis. Results (1) Among the 31 cases, 6 fetuses were accompanied by abnormalities in other organs at the same time. Three fetuses had chromosomal abnormalities and two had family history. (2) Of the 12 patients who chose to terminate pregnancy, 10 had oligohydramnios; the causes of B-ultrasound in fetal kidney enhancement were infantile polycystic kidney disease (10 cases), adult polycystic kidney disease (1 case) and polycystic kidney disease 1 case of bad. (3) Among the 19 cases who chose to continue pregnancy, 2 cases of oligohydramnios died of neonatal period, and the pathological anatomy was infantile polycystic kidney disease. Three cases died within 1 year of age after birth, respectively As polycystic kidney disease or polycystic kidney dysplasia; 1 case of hypertensive symptoms 26 months after birth, renal dysfunction, diagnosis of infantile polycystic kidney disease; 4 cases of children born after B-ultrasound Kidney echo returned to normal; 9 cases of renal B ultrasound performance and prenatal examination of the same, but there is no clinical symptoms. Conclusions (1) The causes of the enhancement of B-echo in fetal kidney are mostly infantile polycystic kidney disease, renal dysplasia and nonspecific nephropathy, and some of them are normal kidney abnormalities. (2) amniotic fluid volume is one of the key indicators to determine the prognosis of the fetus, when the fetal kidney enhanced with oligohydramnios when the fetus prompted a poor prognosis. (3) When the kidneys are found to have enhanced B-echo, family history should be carefully examined and detailed examination should be performed on the fetus’s kidneys and other parts of the fetus. If necessary, fetal karyotype analysis is recommended.