多维度超声技术在胎儿脐–门–体静脉分流诊断与预后评估中的应用进展

Application Progress of Multidimensional Ultrasound in the Diagnosis and Prognosis Evaluation of Fetal Umbilical-Portal-Systemic Venous Shunts

摘要: 胎儿门体静脉分流是一种胎儿在胚胎期的严重畸形病，其病理机制是门静脉与体静脉之间的异常交通支，导致了部分经肝的血流经异常分流，导致肝脏血流灌注不足以致产生门静脉高压。其中，一些门体静脉分型，如脐静脉–下腔静脉分流、肝静脉分流等，会对胎儿的预后产生不良影响。因此，胎儿早期的产前诊断及精准的分型会对临床评估及治疗起到极其关键的作用。超声技术，作为产筛中的重要一环，在该疾病诊断和分型中具有重要的价值，并为其出生后的临床治疗提供一个较准确的参考指标。与其他影像技术不同的是，在相关临床文献中证实，超声凭借其无创性、实时动态性、可多次操作等优点，成为诊断血流畸形的重要手段。本文的目的是阐述多维度超声技术(二维、三维、四维及超声造影)在此疾病临床诊断中的应用，分析对胎儿畸形分型的筛查价值，并讨论目前技术的优势及未来发展的方向。

Abstract: Fetal umbilical-portal-systemic venous shunt is a severe congenital malformation during the embryonic period. Its pathological mechanism involves abnormal connections between the portal vein and the systemic veins, leading to the diversion of partial hepatic blood flow through these abnormal shunts. This results in inadequate hepatic perfusion and may cause portal hypertension. Certain types of portosystemic shunts, such as umbilical vein-inferior vena cava shunts and hepatic vein shunts, can adversely affect fetal prognosis. Therefore, early prenatal diagnosis and accurate classification play a critical role in clinical evaluation and treatment. Ultrasound technology, as an essential component of prenatal screening, holds significant value in the diagnosis and classification of this condition, providing a reliable reference for postnatal clinical management. Unlike other imaging techniques, clinical literature has demonstrated that ultrasound, with its non-invasive nature, real-time dynamic imaging capability, and repeatability, serves as an important tool for diagnosing vascular malformations. This article aims to elaborate on the application of multidimensional ultrasound techniques (two-dimensional, three-dimensional, four-dimensional, and contrast-enhanced ultrasound) in the clinical diagnosis of this disease, analyze their screening value for classifying fetal malformations, and discuss the current advantages and future directions of these technologies.