探讨产前超声诊断联体双胎的临床价值。

选择2016年6月11日与2017年7月29日，于武汉大学中南医院经产前超声诊断为联体双胎，并经引产后确诊的2对联体双胎(双胎1、2)为研究对象，采用回顾性分析方法，对其临床病例资料进行分析。①孕母情况：孕产史、个人及家族疾病史等；②产前超声表现；③产前超声诊断结果；④引产后对双胎尸体外观进行检查的结果。同时，对联体双胎相关文献进行复习。本研究对孕妇终止妊娠前，征得其本人及其家属同意，并签署临床研究知情同意书。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①对双胎1及其孕母的临床临床病例资料分析结果显示：孕母32岁，无特殊个人及家族疾病史，无不良环境接触史；对孕妇的产前腹部超声检查结果显示，宫腔内可见双胎胸、腹部相连，双胎颈部可见较宽液性暗区环绕，双胎腹部前方可见1.4 cm×1.0 cm及1.3 cm×1.1 cm等回声光团(疑为腹腔脏器)，诊断为中孕期双活胎，胎儿畸形(联体双胎、颈部淋巴囊肿)。②对双胎2及其孕母的临床病例资料分析结果显示：孕母27岁，无特殊个人及家族疾病史，无不良环境接触史；对孕妇的产前腹部超声检查结果显示，宫腔内可见双胎胸、腹部紧贴(胎动时不能分开)，心脏结构显示不清，可见多个上肢及下肢回声，胎儿表皮下可见液性暗区，诊断为中孕期双活胎，联体双胎，颈项透明层(NT)增厚、胎儿水肿。③对双胎1、2进行引产后，其尸体外观均与产前超声检查表现基本一致。

联体双胎妊娠是临床罕见的高危妊娠，产前超声检查早发现、早诊断联体双胎，有利于临床对此类胎儿的及时处理，降低出生缺陷儿的发生。

To investigate clinical values of prenatal ultrasound diagnosis of conjoined twins.

On June 11, 2016 and July 29, 2017, two pairs of twins (twins 1, 2) who were diagnosed as conjoined twins in Zhongnan Hospital of Wuhan University were selected as research subjects. The clinical case data of 2 pairs of conjoined twins with fetal malformations were analyzed by retrospective method including the pregnant mother′s conditions (pregnancy history, personal and family disease history, and so on), prenatal ultrasonic manifestations, prenatal ultrasound diagnosis results, and examination results of the general specimen appearance of the twins after induction. At the same time, research literatures of conjoined twins were reviewed. Before the termination of pregnancy, all the pregnant mothers and her family signed the clinical informed consent forms. This study met the requirements of the World Medical Association Declaration of Helsinki revised in 2013.

The clinical case data analysis results of twins 1 and 2, and their pregnant mothers were as follows. ①The pregnant mother of twins 1 was 32 years old without special personal and family disease history or adverse environmental exposure history, and her prenatal abdominal ultrasound results showed that the twin-fetal chests and abdomens were connected in the uterine cavity and a wide liquid dark area could be found in twin necks, equal echo light group with 1.4 cm × 1.0 cm and 1.3 cm × 1.1 cm also could be found in the front of twin abdomens which were suspected as abdominal organs. Twins 1 were diagnosed as live twin fetuses in the second pregnancy trimester with fetal abnormality (conjoined twins, lymphatic cysts). ② The pregnant mother of twins 2 was 27 years old without special personal and family disease history or adverse environmental exposure history, and her abdominal ultrasound results showed that the chest and abdomen of twins 2 were close to each other in the uterine cavity and could not be separated while fetal movements, heart structures of twins 2 were showed unclear, and multiple upper and lower limbs echoes could be found, and the liquid anechoic area could be found under the periderms. Twins 2 were diagnosed as live conjoined twins in the second pregnancy trimester, thickening of nuchal translucency (NT) of fetuses and fetal edema. ③Twins 1 and 2 all were induced after the prenatal ultrasound diagnosis of conjoined twins. The appearances of the gross specimens after induction of labor of 2 pairs of twins were basically the same as those of appeaiances by prenatal ultrasound examinations.

Conjoined twins are rare high-risk pregnancies. Early detection and early diagnosis of conjoined twins by prenatal ultrasound examination are beneficial to the timely treatment of conjoined twins, and can reduce the occurrence of birth defects.