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浙江大学学报（医学版）
浙江大学学报（医学版）  2019, Vol. 48 Issue (4): 453-458    DOI: 10.3785/j.issn.1008-9292.2019.08.17
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三维能量多普勒超声评价胎儿肠系膜上动脉和静脉的价值
唐贤朋1(),陶若翎2,张兴镐2,金秋子2,何炜2,*()
1. 长沙市中心医院超声科, 湖南 长沙 410004
2. 中南大学湘雅三医院超声科, 湖南 长沙 410013
Assessment of fetal superior mesenteric artery and vein by three-dimensional power Doppler sonography
TANG Xianpeng1(),TAO Ruoling2,ZHANG Xinghao2,JIN Qiuzi2,HE Wei2,*()
1. Department of Ultrasonography, Changsha Central Hospital, Changsha 410004, China
2. Department of Ultrasonography, the Third Xiangya Hospital, Central South University, Changsha 410013, China
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摘要：

目的: 分析三维能量多普勒超声（3-DPDS）技术评价孕中晚期胎儿肠系膜上动脉（SMA）和肠系膜上静脉（SMV）的可行性及临床应用价值。方法: 应用三维容积探头采集100名正常孕中晚期胎儿（22+0~24+6周50例、30+0~32+6周50例）的腹部3-DPDS血流图像，分析SMA和SMV的三维超声形态特征，同时回顾性比较分析4例中肠扭转胎儿（26+3~32+1周）的临床及影像数据。结果: 3-DPDS对健康组SMA和SMV的显像成功率均为93%（93/100），中肠扭转组中SMA和SMV的显像成功分别为4例和3例。健康组中SMV主干均位于SMA主干右侧与之平行，3例肠旋转不良致中肠扭转的胎儿可显示特征性的SMV缠绕SMA的空间关系。结论: 3-DPDS可以直观地显示中孕期胎儿SMA与SMV的空间位置关系，对中肠扭转的诊断和预后判断具有一定价值。
关键词： 肠系膜上动脉/影像诊断;  肠扭转/影像诊断;  超声检查, 产前;  胎儿;  成像, 三维;  超声检查, 多普勒    
Abstract:

Objective: To analyze the application of three-dimensional power Doppler sonography (3-DPDS) in evaluation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in second-trimester fetus. Methods: Three-dimensional volume probe was used to collect the 3-DPDS blood flow images in 50 normal fetuses of 22+0-24+6 weeks and 50 fetuses of 30+0-32+6 weeks, respectively. The characteristics of three-dimensional ultrasound were analyzed. The clinical and imaging data of 4 fetuses of 26+3-32+1 weeks with midgut volvulus were analyzed retrospectively. Results: The display rates of SMA and SMV were 93%in normal group by 3-DPDS and those in volvulus group were 4/4 and 3/4, respectively. The SMV trunk was parallel to and on the right side of the SMA in the normal group, while 3 cases in volvulus group showed the characteristic relationship of SMV swirling around SMA. Conclusion: 3-DPDS can be used to observe the spatial relationship of SMA and SMV visually in fetus during the second trimester and is of value to diagnose and predict the outcome of midgut volvulus.
Key words: Mesenteric artery, superior/ diagnostic imaging    Intestinal volvulus/diagnostic imaging    Ultrasonography, prenatal    Fetus    Imaging, three-dimensional    Ultrasonography, doppler
收稿日期: 2019-04-30 出版日期: 2019-10-30
:  R445.1  
通讯作者: 何炜     E-mail: 475701709@qq.com;wei_he@csu.edu.cn
作者简介: 唐贤朋(1989—), 男, 硕士, 住院医师, 主要从事产前筛查、超声介入研究; E-mail: 475701709@qq.com; https://orcid.org/0000-0002-8268-3153
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引用本文:

唐贤朋,陶若翎,张兴镐,金秋子,何炜. 三维能量多普勒超声评价胎儿肠系膜上动脉和静脉的价值[J]. 浙江大学学报（医学版）, 2019, 48(4): 453-458.

TANG Xianpeng,TAO Ruoling,ZHANG Xinghao,JIN Qiuzi,HE Wei. Assessment of fetal superior mesenteric artery and vein by three-dimensional power Doppler sonography. J Zhejiang Univ (Med Sci), 2019, 48(4): 453-458.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2019.08.17    或    http://www.zjujournals.com/med/CN/Y2019/V48/I4/453

图 1  三维能量多普勒超声显示健康胎儿腹部血管位置关系
序号 孕龄(周) SMA显像 SMV显像 血管“缠绕征” 肠管“漩涡征” 妊娠结局 产后处理 产后诊断
SMA：肠系膜上动脉；SMV：肠系膜上静脉.
1 26+3 阳性 阴性 阴性 阳性 引产 尸体解剖 肠旋转不良伴中肠扭转致部分肠坏死，SMV闭塞
2 30+6 阳性 阳性 阳性 阳性 剖宫产 手术 肠旋转不良伴中肠扭转
3 32+1 阳性 阳性 阳性 阳性 剖宫产 手术 肠旋转不良伴中肠扭转
4 28+2 阳性 阳性 阳性至阴性 阳性至阴性 顺产 随访观察 一过性中肠扭转(可疑肠系膜附着处狭窄)
表 1  中肠扭转组胎儿的超声表现及产科管理
图 2  中肠扭转胎儿影像图
图 3  中肠扭转新生儿超声影像显示“缠绕征”
图 4  一例一过性中肠扭转患儿产前及产后超声影像图
1 刘爽, 吴青青.胎儿肠旋转不良伴中肠扭转超声诊断研究[J/CD].中国医学超声杂志: 电子版, 2016, 13(11): 840-844.
LIU Shuang, WU Qingqing. Ultrasonographic diagnosis of intestinal malrotation with midgut volvulus in fetus[J/CD]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(11): 840-844. (in Chinese)
2 SCIAKY-TAMIR Y , COHEN S M , HOCHNER-CELNIKIER D et al. Three-dimensional power Doppler (3DPD) ultrasound in the diagnosis and follow-up of fetal vascular anomalies[J]. Am J Obstet Gynecol, 2006, 194 (1): 274- 281
doi: 10.1016/j.ajog.2005.08.045
3 HSU C Y , CHEN C P , LIN C J . An aberrant renal artery arising from the iliac artery imaged by three-dimensional power Doppler ultrasonography:a sign of fetal horseshoe kidney[J]. Ultrasound Obstet Gynecol, 2007, 29 (3): 358- 359
doi: 10.1002/uog.3940
4 VOLPE N , MAZZONE E , MUTO B et al. Three-dimensional assessment of umbilical vein deviation angle for prediction of liver herniation in left-sided congenital diaphragmatic hernia[J]. Ultrasound Obstet Gynecol, 2018, 51 (2): 214- 218
doi: 10.1002/uog.17406
5 HSU C Y , CHIBA Y , FUKUI O et al. Counterclockwise barber-pole sign on prenatal three-dimensional power Doppler sonography in a case of duodenal obstruction without intestinal malrotation[J]. J Clin Ultrasound, 2004, 32 (2): 86- 90
doi: 10.1002/jcu.10225
6 CHAOUI R , KALACHE K D , HARTUNG J . Application of three-dimensional power Doppler ultrasound in prenatal diagnosis[J]. Ultrasound Obstet Gynecol, 2001, 17 (1): 22- 29
doi: 10.1046/j.1469-0705.2001.00305.x
7 何怡华, 刘鲲, 刘琳 et al. 时间-空间关联成像联合高分辨力血流显像对胎儿动静脉循环整体显示的可行性[J]. 中国医学影像技术, 2011, 27 (9): 1887- 1890
HE Yihua , LIU Kun , LIU Lin et al. Feasibility of wholly demonstration of fetal arterial and venous system using spatio-temporal image correlation combined with high definition flow[J]. Chinese Journal of Medical Imaging Technology, 2011, 27 (9): 1887- 1890
8 GINDES L , PRETORIUS D H , ROMINE L E et al. Three-dimensional ultrasonographic depiction of fetal abdominal blood vessels[J]. J Ultrasound Med, 2009, 28 (8): 977- 988
doi: 10.7863/jum.2009.28.8.977
9 CHAKRABORTY A , AYOOB A , DISANTIS D . Coffee bean sign[J]. Abdom Imaging, 2015, 40 (7): 2904- 2905
doi: 10.1007/s00261-015-0402-3
10 JAKHERE S G , SAIFI S A , RANWAKA A A . Fetal small bowel volvulus without malrotation:the whirlpool & coffee bean signs[J]. J Neonatal Perinatal Med, 2014, 7 (2): 143- 146
11 MOSKOVICH R , CHEONG-LEEN P . Vascular compression of the duodenum[J]. J R Soc Med, 1986, 79 (8): 465- 467
doi: 10.1177/014107688607900811
12 OZKURT H , CENKER M M , BAS N et al. Measurement of the distance and angle between the aorta and superior mesenteric artery:normal values in different BMI categories[J]. Surg Radiol Anat, 2007, 29 (7): 595- 599
doi: 10.1007/s00276-007-0238-9
13 OZBULBUL N I , YURDAKUL M , DEDEOGLU H et al. Evaluation of the effect of visceral fat area on the distance and angle between the superior mesenteric artery and the aorta[J]. Surg Radiol Anat, 2009, 31 (7): 545- 549
14 LAKSHMY R S , AGNEES J , ROSE N . The upturned superior mesenteric artery sign for first-trimester detection of congenital diaphragmatic hernia and omphalocele[J]. J Ultrasound Med, 2017, 36 (3): 583- 592
doi: 10.7863/ultra.16.04047
15 ARTHURS O J, MEHTA U, SET P A. Nutcracker and SMA syndromes: What is the normal SMA angle in children?[J/OL]. Eur J Radiol, 2012, 81(8): e854-e861.
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