Медицинская литература. Новинки

 

 

 

 

 

 

Пренатальная ультразвуковая диагностика и тактика ведения беременности при диафрагмальной грыже плода

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Врожденная диафрагмальная грыжа – это порок, при котором часть органов брюшной полости (кишечник, желудок, печень) проникает через дефект диафрагмы в грудную клетку. Неонатальная смертность при этом пороке развития превышает 60% и связана с развитием гипоплазии легких за счет их сдавления органами брюшной полости, проникшими в грудную клетку. После рождения ребенка гипоплазированные легкие не способны к нормальному газообмену. Перинатальный исход при врожденной диафрагмальной грыже зависит в первую очередь от наличия сочетанных аномалий развития, а также от степени гипоплазии легких. Выявляемость данного порока развития при проведении пренатального ультразвукового исследования не превышает 50%. В данной статье описаны принципы пренатальной ультразвуковой диагностики диафрагмальной грыжи, методы оценки состояния плода и пренатальной хирургической коррекции при этом пороке развития.

Ключевые слова:
пренатальное ультразвуковое исследование, врожденная диафрагмальная грыжа, гипоплазия легких плода, хирургия плода.

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Prenatal Ultrasound Diagnosis and Management of Pregnancy with Fetal Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia refers to a defect in the diaphragm that allows abdominal organs (intestine, stomach, liver) to move into the chest cavity. Congenital diaphragmatic hernia is associated with a high degree of morbidity and mortality, which exceeds 60% due to lungs hypoplasia development because of the abdominal organs compression in the chest cavity. Poor outcome in these cases is primarily related to the presence of additional anomalies or abnormal karyotype and the development of pulmonary complications. Prenatal diagnosis occurs in approximately 50% of cases. The purpose of this chapter is to provide an outline of the prenatal assessment of fetuses with congenital diaphragmatic hernia and to review the imaging modalities that are currently available to assist in the diagnosis, assessment of prognosis, identification of those cases at risk for the worst outcome, and the opportunity for prenatal surgical intervention.

Keywords:
prenatal ultrasound diagnosis, congenital diaphragmatic hernia, fetal pulmonary hypoplasia, and fetal surgery.