目的 探讨胎儿神经系统发育异常的宫内转归、妊娠结局及预后。方法 对2010年1月至2011年12月青岛市妇女儿童医院经产前诊断超声检查发现的100例侧脑室宽度≥ 8mm且﹤10mm胎儿（观察组）与230例神经系统发育异常胎儿（病例组）的超声资料进行回顾性分析，研究观察组宫内变化；对病例组进行畸形分类，分析宫内转归、随访妊娠结局及出生后婴幼儿并进行临床评估。结果 ①观察组中宫内侧脑室宽度无明显变化者92例，进展为轻度扩张者7例、重度扩张者1例。②病例组中单一畸形130例，神经系统多发畸形37例，合并其他脏器畸形者63例。单纯性侧脑室扩张51例，其中轻度组41例中稳定占19.5%（8/41），缩小者占4.9%（2/41），消失者占63.4%（26/41），进展者占12.2%（5/41）；重度组中进展者占90%（9/10）；共分娩35例，其中91.43%(32/35)随访预后良好。颅后窝池增大9例，进展者占22.2%（2/9），分娩7例，85.71%（6/7）预后良好。脉络丛囊肿9例，其中1例为18-三体综合征，8例其宫内转归良好，均分娩。1例变异型Dandy-Walker分娩，随访预后良好。1例胼胝体发育不良分娩，随访示认知障碍。2例侧脑室扩张并颅后窝池增大者分娩前恢复正常结构。③以观察组为对照组与侧脑室扩张轻度组、重度组3组及各组间两两比较宫内转归差异均有明显统计学意义，预后与侧脑室宽度是否进展有明显关系。结论 ①对于超声发现侧脑室≤8mm且<10mm的胎儿，有宫内进展可能，故应定期观察宫内变化。②不合并其他异常的胎儿单纯性轻度侧脑室扩张、颅后窝池增大、脉络丛囊肿和透明隔腔消失需动态观察其宫内变化,必要时行MRI检查，宫内良性转归者,预后较好。③对严重的胎儿颅脑畸形及宫内进展提示预后不良者应及早确诊、及早干预。
Objective To investigate the intrauterine outcome, pregnancy outcome and prognosis of fetalabnormalitiesin the nervoussystem. Method From Jan.2010 to Dec.2011, the ultrasound findings of 100 fetuses with lateral ventricular width (LVW) of 8～10mm in observation group and 230 fetuses with abnormal nervous system development in case group diagnosed prenatally by sonography were retrospectively analyzed in Qingdao Women and Children’s Hospital. The changes of observation group in uterus were studied; to classifying the case group and analyzing outcome in uterus, Pregnancy outcome and cases infant of development of neurological system were also followed up. Results ① LVW remained stable throughout pregnancy in 92 cases and progressed in 8 cases in observation group, including 7 cases in mild degree and 1 case in severe degree. ②Among case group, there were 130 cases of single malformation, 37 cases of nervous system multi-malformations, 63 cases were combined with other organs’ malformations. There were 51 cases with Isolated lateral ventriculomegaly, 41 cases were in mild group, LVW resolved throughout pregnancy in 63.4(26/41), regressed in 4.9 %( 2/41), remained stable in 19.5 %( 8/41) and progressed in 12.2 %( 5/41). severe degree group, 10 cases were in severe degree group, progressed in 90.0 %( 9/10), 35 cases were birthed, 91.43% (32/35) cases were followed up for good prognosis. Among 9 cases with cisterna magna enlargement, progressed in 22.2 %( 2/9), 7 cases were birthed, 85.71% (6/7) good prognosis. Among choroid plexus cysts of 9 cases, including 1 case of 18 - three body syndrome, 8 cases of the intrauterine outcome were good.1 case of variant Dandy – Walker were birthed, who were followed-up for good prognosis. 1 case of corpus callosum dysplasia were birthed, following-up shows cognitive impairment; 2 cases of lateral ventricle enlargement combined cisterna magna enlargement have recovered before delivery. ③Using observational group as control group，there was significant difference in the intrauterine outcome of LVW among control group, mild degree and severe degree group. There were clearly relationship betweenprognosisand the progress of IVW. Conclusions ①The changes of ventriculomegaly with LVW of 8～10mm should be observed regularly until delivery. ②The changes of fetal lateral mild ventriculomegaly, cisterna magna enlargement, choroid plexus cysts, cavum septum pellucidum disappeared should be observed dynamically, The prognosis of fully recovery in uterus is approximately good。MRI should be examined when necessary.③Theserious brain malformationsand progresses which signifies poorprognosis should be diagnosised and intervented.
