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超声诊断低位肛门闭锁并尿道直肠瘘1例

2019-04-27 尹婵 费智慧 童立里 中国超声医学杂志

孕妇,25岁。G2P0,妊娠27周来我院行第一次系统产前超声检查。该孕妇无家族史,第一胎胎死宫内,本次妊娠无特殊病史。超声检查:胎儿生物学指标测值相当于妊娠25周左右,羊水指数5.6 cm,单脐动脉。胎儿乙状结肠位于右侧腹腔(图1),内径明显增宽,较宽处约2.2 cm,肠壁回声稍增强,内容物呈星点状强回声,声影不明显,扩张的乙状结肠蠕动欠佳,横切面时靠近乙状结肠末端可见部分直肠回声——类肛门耙环征

孕妇,25岁。G2P0,妊娠27周来我院行第一次系统产前超声检查。该孕妇无家族史,第一胎胎死宫内,本次妊娠无特殊病史。超声检查:胎儿生物学指标测值相当于妊娠25周左右,羊水指数5.6 cm,单脐动脉。胎儿乙状结肠位于右侧腹腔(图1),内径明显增宽,较宽处约2.2 cm,肠壁回声稍增强,内容物呈星点状强回声,声影不明显,扩张的乙状结肠蠕动欠佳,横切面时靠近乙状结肠末端可见部分直肠回声——类肛门耙环征(图2),位置较高。
 




胎儿左肾大小约3.3 cm×2.0 cm,右肾大小约1.9 cm×1.4 cm,右侧输尿管上段扩张,内径约0.34 cm,穿越下腔与腹主动脉之间,下段显示不清。胎儿位于左侧,心尖朝向左侧,四腔心切面显示左房室沟处扩张的冠状静脉窦,大小约0.57 cmX0.34 cm,两组房室瓣活动自如,卵圆孔0.59 cm,卵圆瓣位于左房内活动,三血管气管切面肺动脉左侧可见一内径约0.22 cm的血管,汇入冠状静脉窦,未见无名静脉声像,室间隔可见一宽约0.44 cm回声中断,CDFI:该处可见右向左的过隔血流信号。
 
超声提示:宫内妊娠27周,单活胎,测值相当于妊娠25周左右;胎儿乙状结肠扩张、位置异常:疑肛门闭锁、尿道直肠瘘;胎儿右肾发育不良、右输尿管扩张及走行异常;胎儿心脏声像改变:考虑室间隔缺损、永存左上腔伴无名静脉缺如。
 
引产一男死婴,外观见外生殖器无异常,无肛门(图3),高频超声扫查可见乙状结肠位于右侧,扩张2.7 cm(图4),内可见星石征,乙状结肠可见与残存部分直肠回声相连,直肠可见盲端,盲端与外侧肛门隐窝相距0.35 cm(图5)。病理解剖可见腹腔内结肠扩张,以乙状结肠最为明显,宽约3.5 cm,扩张到右侧腹腔,直肠呈盲端并与尿道融合,二者之间可见一针尖大小交通口,挤压肠道黄绿色胎粪不能进入尿道,挤压膀胱尿液可进入肠道,从膀胱下方尿道注水可见液体从前尿道及乙状结肠下方残存的部分直肠中射出(图6)。
 








掀开肠道,可见马蹄肾,左右输尿管走行在马蹄肾峡部前方并形成压迹,左侧输尿管中段迂曲。下腔静脉走行于马蹄肾峡部右前方,右侧输尿管肾盂交界处位于下腔静脉后方。仅见左侧脐动脉,游离段单脐动脉。心脏未解剖。解剖诊断:尿直肠隔畸形(低位肛门闭锁、直肠尿道瘘)、马蹄肾、腔静脉后输尿管(右侧)。
 
讨论
 
肛门直肠畸形在产前很难诊断,常合并其他结构异常。此病例低位肛门闭锁并尿道直肠瘘(尿直肠隔序列征),合并肾畸形及心脏畸形。右位并扩张的乙状结肠是低位肛门闭锁的超声特点。乙状结肠内为星石征,可能存在尿道直肠瘘的超声特点,当进入直肠的液体量超过大肠的重吸收功能时,可出现液体在肠腔内的积聚,从而出现明显的结肠扩张;又由于胎粪与尿液混合,则在肠腔内形成钙化灶或结石。鉴别诊断时需与先天性巨结肠相鉴别。当肛门闭锁并尿道直肠瘘(尿直肠隔序列征合)并肾畸形时预后较差,病死原因是肾发育不良导致肺发育不良。
 
原始出处:

尹婵,费智慧,童立里.超声诊断低位肛门闭锁并尿道直肠瘘1例[J].中国超声医学杂志,2018(03):251-252.

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    2019-09-18 yxch36
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    2019-10-24 hxj0127
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    2019-09-06 lifestar
  4. [GetPortalCommentsPageByObjectIdResponse(id=1800298, encodeId=53dc180029845, content=<a href='/topic/show?id=83f7e247469' target=_blank style='color:#2F92EE;'>#直肠瘘#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72474, encryptionId=83f7e247469, topicName=直肠瘘)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4cea26, createdName=yxch36, createdTime=Wed Sep 18 21:52:00 CST 2019, time=2019-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1693735, encodeId=ffc01693e3568, content=<a href='/topic/show?id=c8168114412' target=_blank style='color:#2F92EE;'>#肛门#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81144, encryptionId=c8168114412, topicName=肛门)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=39bc29444908, createdName=hxj0127, createdTime=Thu Oct 24 02:52:00 CST 2019, time=2019-10-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1769145, encodeId=220c1e69145b9, content=<a href='/topic/show?id=ebef4e52844' target=_blank style='color:#2F92EE;'>#尿道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=47528, encryptionId=ebef4e52844, topicName=尿道)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b63c37986505, createdName=lifestar, createdTime=Fri Sep 06 00:52:00 CST 2019, time=2019-09-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=365438, encodeId=2a0336543895, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqYPFHuMA3bhYQrHvycmum7IJoCsLK0FP6X56Eoj9PZAECDke8zLCKxZZvk9q7B6rZmPuFgN5YCfw/132, createdBy=f52d2514454, createdName=SCI我的梦, createdTime=Mon Apr 29 04:22:36 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1559989, encodeId=d1f115599891b, content=<a href='/topic/show?id=c1eb9282699' target=_blank style='color:#2F92EE;'>#超声诊断#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92826, encryptionId=c1eb9282699, topicName=超声诊断)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ebf15056071, createdName=tcm104hq, createdTime=Mon Apr 29 03:52:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1561527, encodeId=e516156152eb4, content=<a href='/topic/show?id=e3ab81591fc' target=_blank style='color:#2F92EE;'>#肠瘘#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81591, encryptionId=e3ab81591fc, topicName=肠瘘)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a0215187077, createdName=dinorsor529, createdTime=Mon Apr 29 03:52:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1565998, encodeId=75321565998f2, content=<a href='/topic/show?id=c1eb9282699' target=_blank style='color:#2F92EE;'>#超声诊断#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92826, encryptionId=c1eb9282699, topicName=超声诊断)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6ebf15056071, createdName=tcm104hq, createdTime=Mon Apr 29 03:52:00 CST 2019, time=2019-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1567536, encodeId=f533156e5365e, content=<a href='/topic/show?id=e3ab81591fc' target=_blank style='color:#2F92EE;'>#肠瘘#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81591, encryptionId=e3ab81591fc, topicName=肠瘘)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a0215187077, createdName=dinorsor529, createdTime=Mon Apr 29 03:52:00 CST 2019, time=2019-04-29, status=1, ipAttribution=)]
    2019-04-29 SCI我的梦

    谢谢分享

    0

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