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【读片】产科疑难超声病例（307）：单脐动脉、持续性右脐静脉合并双胆囊

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>>>本病例加分标准：考虑到双胆囊的加分。

>>> 为保证每人均能独立分析，公布答案前此贴设置为回帖别人不可见状态。公布答案后恢复。

>>> 凡是答对或答案接近者均会加分；另外对于难度较大的病例即便答案错误，但在病例分析过程中能充分表达自己观点的也可给予加分鼓励。

Case report
A 24-year-old woman with non-contributive history presented to our unit at 29th week of pregnancy. Our examination revealed the following findings:
一24岁孕妇妊娠29周来我处就诊，其没有明显既往病史。超声检查如下：

Images 1, 2, 3, 4:

Images 5, 6:

Videos 1, 2:

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2011-11-27 22:30 浏览 : 17658 回复 : 213

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xihuansushi 编辑于 2011-12-13 09:19

• 典型的间质性肺病影像

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A 24-year-old woman with non-contributive history presented to our unit at 29th week of pregnancy. Our examination revealed following findings:
一24岁孕妇妊娠29周来我处就诊，其没有明显既往病史。超声检查如下：

two vessel umbilical cord (single umbilical artery type IV)两血管脐带（单脐动脉IV型）
persistent right umbilical vein (PRUV)持续右脐静脉
duplication of the fetal gallbladder胎儿胆囊重复畸形

The newborn was delivered at 39 weeks (male, 4020 g, 55 cm, Apgar score: 09, 10, 10) and the prenatal findings were confirmed. Postnatal course of the newborn was normal.
孕39周分娩，新生儿男性，4020g，体长55cm，阿氏评分9,10,10。产后检查证实了产前所见，产后新生儿正常。

In our case the finding of the single umbilical artery was associated with doubled gallbladder. According Boyden's classification [1] following types of the gallbladder duplications exist:
我们的这一病例中单脐动脉合并有双胆囊。根据Boyden分类，胆囊重复畸形分为以下类型：

According to older study of Blackburn and Cooley [2] four types of single umbilical artery exist (Table 1):
根据Blackburn和Cooley以往的研究，单脐动脉可分为四种类型：

类型 TYPE	发生频率 Frequency	脐带血管数量 Number of umbilical cord vessels	单脐动脉的起源部位 Origin of single umbilical artery (SUA)	脐静脉 Umbilical vein	合并畸形 Associated anomalies
I	最为常见 Most common(98%)	2	起源于尿囊；单脐动脉来源于左侧或右侧髂总动脉 Allantoic derivation; SUA originates from either the left or right common iliac artery	左侧 Left	中枢神经系统异常；下泌尿生殖系异常；脐带过短综合症；无心畸形 Abnormalities of the central nervous system, lower genitourinary tract, short umbilical cord syndrome, acardia
II	1,5%	2	起源于卵黄囊；单脐动脉来源于肠系膜上动脉 Vitelline derivation; SUA originates from the superior mesenteric artery	左侧 Left	严重胎儿畸形-并腿畸形，尾部退化，肛门未发育。也有胎儿正常的报道 Severe fetal malformations - sirenomelia, caudal regression, anal agenesis. Normal fetal development was also reported.
III	罕见 Rare	3	起源于尿囊或卵黄囊 1 SUA - of allantoic or vitelline origin	两脐静脉-左侧和持续右侧 2 umbilical veins - left and persistent right	预后不良，肺静脉异位引流，肾脏不发育，同侧的短肢畸形，单角子宫，积水性无脑畸形。 Poor prognosis, anomalous pulmonary venous return, renal agenesis, ipsilateral limb reduction, unicornuate uterus, hydranencephaly.
IV	罕见 Rare	2	起源于尿囊或卵黄囊 1 SUA - of allantoic or vitelline origin	右侧 Right	可能在产前检查或病理学检查之前就发生胚胎消失。 Embryonic lost before prenatal or pathological assessment was possible

As the table 1 shows, our case represents a rare type of the single umbilical artery (type IV). Normal course and outcome of the pregnancy is in contradiction with Blackburn and Cooley work.
如上表所示，我们的这一病例为罕见的单脐动脉IV型，其妊娠的进展和预后正常，这与Blackburn和Cooley的研究结论不符。

Newer review (Weichert et al., 2011 [4]) reports 0.08% incidence of the persistent right umbilical artery and found it as an isolated finding in nearly 75% of cases, while 25.6 % were associated with other anomalies (cardiovascular, gastrointestinal, renal, cerebral, limb abnormalities). 7.9% of non-isolated persistent right umbilical veins had aneuploidies (trisomy 18, Turner syndrome) and so in these cases karyotype examination might be reasonable [4].
最近的文献（2011年，Weichert等）报道，持续性右脐静脉的发生率为0.08%，其中近75%的病例未合并其他畸形，25.6%的病例合并有心血管、胃肠道、肾脏、脑部以及肢体的畸形。7.9%的合并其他畸形的持续性右脐静脉存在非整倍体（18三体、特纳综合征），因此对于这些病例应该考虑进行核型检查。

In the review of Weichert et al [4], only two cases (0.7%) had association of the persistent right umbilical vein with sigle umbilical artery - type IV (as it was in our case), but the outcome was excellent, which is again in contradiction with previous studies (Blackburn and Cooley [2]).
Weichert等人的报道中，只有2例（0.7%）的持续性右脐静脉病例合并有单脐动脉IV型（就像我们的这一病例），但预后良好，这也与Blackburn和Cooley先前的分析不符。

Images 1, 2, 3, 4: Images show slightly oblique transverse abdominal scans at the level of the initial inlet portion of the umbilical vein into the fetal abdomen. The inlet is on the right side of the doubled gallbladder (which is also clearly visible) and further direction of the umbilical vein is oriented towards the fetal stomach.
图像为脐静脉进入胎儿腹部的初始段水平的腹部横切面（略有倾斜）。此段脐静脉位于双胆囊（显示的很清晰）的右侧，脐静脉的远端指向胎儿胃部。

Images 5, 6: Image 5 shows a cross section of the umbilical cord with just two vessels (single umbilical artery and umbilical vein). Image 6 shows normal flow within the ductus venosus.
图5的脐带横切面显示仅有两个血管（脐静脉和脐动脉）。图6显示静脉导管内的正常血流。

Images 7, 8: Images represent drawings comparing normal arrangement of organs at the level of transverse section of fetal abdomen (Image 7) and abnormal arrangement presented in our case (Image 8). Small part of the images in their right upper corner depicts transverse section of the umbilical cord - normal three-vessel cord (Image 7) and abnormal two-vessel cord - right umbilical vein and single umbilical artery (Image 8) - type IV of the single umbilical artery. Doubled gallbladder and its position is also depicted on the Image 8.
示意图模拟显示胎儿腹部横切面上各器官的排列形式：图7为正常排列形式，图8为我们这一病例的异常排列形式。图像的右上角分别显示脐带的横切面：图7为正常的三血管脐带；图8为异常的两血管脐带-右脐静脉和单脐动脉（IV型），同时还标注了双胆囊及其位置。

UV - umbilical vein（脐静脉）; RUV - right umbilical vein（右脐静脉）; GB - gallbladder（胆囊）; IVC - inferior vena cava（下腔静脉）; Ao - aorta（腹主动脉）.

Videos 1, 2: Videos show slightly oblique transverse abdominal scans at the level of the initial inlet portion of the umbilical vein into the fetal abdomen. The inlet is on the right side of the doubled gallbladder (which is also clearly visible) and further direction of the umbilical vein is oriented towards the fetal stomach.
视频显示脐静脉进入胎儿腹部的初始段水平的腹部横切面（略有倾斜）。此段脐静脉位于双胆囊（显示的很清晰）的右侧，脐静脉的远端指向胎儿胃部。

Postnatal findings产后表现

Videos 3, 4: The videos show postnatal finding of the doubled gallbladder.
产后视频显示双胆囊。

2011-12-09 17:58

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xihuansushi 编辑于 2011-12-10 12:21

• 胸痛患者的心电图是个什么鬼？

超声医学

【读片】产科疑难超声病例（307）：单脐动脉、持续性右脐静脉合并双胆囊

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