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【文摘翻译】超声及核磁对胎儿气管喉气道梗阻的产前评估 [精华]

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hxy0317

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这个帖子发布于10年零121天前，其中的信息可能已发生改变或有所发展。

仲秋佳节之际，送上自己的一篇拙劣的翻译，错误之处，战友们指正。::D

Intrinsic tracheolaryngeal obstruction
内在的气管喉梗阻

Congenital high airway obstruction syndrome (CHAOS) is a rare form of intrinsic obstruction of the larynx or trachea that results in retention of bronchial secretions and subsequent pulmonary distention from the retained fluid[4]. Obstruction of the airway in CHAOS might be related to intrinsic atresia or stenosis of the larynx or upper trachea[4]. This obstruction leads to the constellation of pulmonary and extra-pulmonary findings. Pulmonary findings include dilated airways below the level of obstruction, hyperexpanded lungs and flattened diaphragms. Extra-pulmonary findings include fetal hydrops or ascites and placentomegaly. Although the exact etiology is not clear, it is believed that hyperexpansion of the lungs results in flattening or eversion of the diaphragm.This abnormal hyperexpansion of the lungs is believed to cause impaired venous return to the heart. It has been proposed that this impaired venous return leads to the subsequent development of fetal hydrops and ascites [4, 5].
先天性高位气道梗阻综合症（CHAOS）是喉或者气管本身梗阻的一种罕见类型，致使支气管分泌物滞留并且由分泌物滞留继发肺膨胀。先天性高位气道闭锁综合症引起的气道闭锁也许归因于喉或者高位气管本身的闭锁或狭窄，这种闭锁导致了一组肺内及肺外相互影响的发现。肺内的发现包括闭锁水平以下的气道扩张，肺脏过度膨胀及膈肌变平。肺外的发现包括胎儿水肿或腹水及胎盘瘤。尽管确切的病因学尚不明了，但我们认为肺脏的过度膨胀导致了膈肌的变平或反向，同时我们也认为肺脏异常的过度膨胀引起了静脉回流入心的损伤。我们提出静脉回流的损伤导致了胎儿的水肿及腹水。

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2010-09-22 09:59 浏览 : 2711 回复 : 16

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hxy0317 编辑于 2010-09-22 10:14

• 一个读研期间执医四战四败的医学生内心独白

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hxy0317

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Sonographic findings of CHAOS have been well described [4–6], and these findings can also be recognized on MRI [5] (Figs. 2 and 3). MRI nicely depicts the findings that constitute CHAOS such as dilated airways below the level of obstruction, hyperexpanded and T2 hyperintense lungs, flattened or everted diaphragm, and fetal ascites [5]. Furthermore, MRI can help to better localize the level of obstruction [7–9]. Correct localization helps guide the decision between fetal versus neonatal intervention with the EXIT procedure [7, 9]. There is also potential prognostic indication for the success of the EXIT procedure, as obstruction low in the thoracic trachea has been described with failed EXIT procedure [7].
先天性高位气道梗阻的声像图表现已经很好的被描述[4–6]，并且这些发现也已经被MRI证实[5] (Figs. 2 and 3)。MRI很好的描述了构成先天性高位气道闭锁的这些发现，比如梗阻平面以下的气道扩张，膨胀的T2高信号的肺，扁平或外翻的膈肌及胎儿腹水。MRI能帮助更好的定位梗阻平面。正确的定位有助于指导胎儿期至新生儿“EXIT”介入手术的操作。“EXIT”成功的可能存在术前指征，同时低位的胸腔内气道梗阻被认为不适于“EXIT”。

2010-09-22 10:01

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• 【交流】你遇见过哪些令人遗憾的患儿？

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Fig. 2 MRI findings of CHAOS. a Coronal SSFSE T2-W image obtained in a 24-week 6-day fetus with suspected laryngeal atresia on prior level II。 US demonstrates expanded homogeneous lungs with flattened diaphragm(black arrow). The liver (asterisk) is surrounded by ascites. The trachea (white arrow) is also visible. b Sagittal SSFSE T2-W image of the same fetus demonstrates expanded lungs (asterisk) with intraperitoneal ascites (black arrow). The trachea (white arrow) and proximal mainstem bronchi are prominent and fluid-filled. The constellation of findings is highly suggestive of CHAOS. c Coronal gray-scale sonographic images demonstrate echogenic lungs (L). Flattening of the diaphragm is also appreciated(white arrowheads). Intraperitoneal ascites (asterisk) is also present. An EXIT procedure was performed with successful fetal tracheostomy. Postnatal laryngoscopy demonstrated laryngeal atresia secondary to underlying fusion of the false vocal cords

图2 先天性高位气道闭锁的MRI表现。（a）24周加6天胎儿的T2成像显示可疑第二水平之上喉闭锁。超声显示肺均匀扩张伴膈肌变平（黑色箭头）。肝脏周围可见腹水（星号）。气管（白色箭头）可见。（b）胎儿T2矢状面成像示扩张的肺脏（星号）及腹水（黑色箭头）。气管（白色箭头）及相邻的主支气管是凸出的，内为液体充盈。这一系列的发现高度提示先天性高位气道梗阻。（c）超声冠状面图像显示发生扩张的肺（L），膈肌变平（白色箭头），腹膜内的腹水（星号）。
EXIT操作在成功的胎儿气管造口术中被完成。生后的喉镜检查证实喉闭锁继发于融合的假声带之下。

2010-09-22 10:03

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• 今上午写报告遇到的，颅脑MR，您能看出几处异常？据说工作中很罕见！

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hxy0317

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Fig. 3 Coronal SSFSE T2-W image in a fetus at 25 weeks 1 day gestational age with polyhydramnios and fetal hydrops on US. This exam demonstrates a focal area of obstruction at the level of the larynx (white arrowhead) with dilation of the airways below the level of the obstruction (white arrow). There is flattening of the diaphragm
(black arrow). Fetal ascites(asterisk) is also visible. Fetal bronchoscopy was performed at 27 weeks where a laryngeal web was discovered and lysed. EXIT procedure was performed at 35 weeks 5 days with bronchoscopy and tracheotomy
图3 胎儿T2冠状成像，孕周25周加1天，超声示羊水过多及胎儿水肿。本次检查证实梗阻面在喉头区（白色三角箭头），梗阻平面以下气道扩张（白色箭头）。膈肌变平（黑色箭头）。胎儿腹水（星号）。27周胎儿行支气管镜发现喉蹼并且被溶。35周加5天在支气管镜及气管切开术下，行EXIT操作。

2010-09-22 10:04

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• 快问快答：为什么哮喘控制维持至少3个月才可考虑降级治疗

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