大阪府立母子保健総合医療センター小児循環器科Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health ◇ Osaka, Japan
背景：近年，本邦でも胎児心エコー検査が普及して先天性心疾患（CHD）の胎児診断例が増加している現状である．
目的：当センターにおける最近の胎児心エコー検査の動向をまとめ，改善点を見出すことを目的とする．
方法：2013年までの10年間に当科の胎児心エコー検査で診断したCHD687例を対象とし，前半5年間の241症例をA群，後半5年間の446症例をB群として後方視的に検討した．
結果：胎児心エコー検査施行例中のCHD有病率は，A群241例（29.1％），B群446例（49.0％）とB群で有意に高かった（p＜0.01）．紹介理由は両群ともにCHD疑い，先天異常，胎児発育不全の順で多く，2群間での有意差はなかった．在胎22週未満のCHD症例数は，A群36例（14.9％），B群91例（20.4％）であり，B群において有意に多かった（p＜0.05）．軽症CHD症例数は，A群101例（41.9％），B群235例（52.7％）であり，B群において有意に多かった（p＜0.01）．胎児期および出生後の生命予後においては2群間に有意差はなかった．
結論：近年，胎児心エコー検査施行例中のCHD有病率が上昇していた．なかでも22週未満の早期CHD診断例が増加しており，関連各科の連携やカウンセリングを含めた家族へのサポートが必要となっていた．軽症CHD症例の増加に対しては，分娩施設の選定を含めて施設間の連携が今後必要であると考えられた．
Background: In recent years, greater use of fetal echocardiography has resulted in an increased number of patients diagnosed with fetal congenital heart disease (CHD). Moreover, contextual factors relating to diagnosis are changing in Japan.
Purpose: To summarize a trend in recent fetal echocardiography in our institution and develop ways to improve it.
Methods: We retrospectively studied 687 cases diagnosed with CHD between 2004 and 2013, dividing them into the following two groups: Group A (2004–2008) with 241 cases and Group B (2009–2013) with 446 cases. We retrospectively evaluated various patient factors between the two groups.
Results: The prevalence rate of fetal CHD at our institution was 29.1％ for Group A and 49.0％ for Group B (p＜0.01). The number of CHD cases prenatally diagnosed before 22 gestational weeks significantly increased from 36 cases (14.9％) in Group A to 91 cases (20.4％) in Group B (p＜0.05). Reasons for referral were as follows: suspected CHD, congenital anomaly, and fetal growth restriction with no significant difference between the two groups. The number of non-severe CHD cases significantly increased from 101 cases (41.9％) in Group A to 235 cases (52.7％) in Group B (p＜0.01). There was no significant difference in morbidity between the two groups during the fetal period and after birth.
Conclusion: The number of fetuses diagnosed with CHD increased, particularly those that were less than 22 gestational weeks. Adequate counseling and support should be provided for mothers whose fetus is diagnosed with CHD prior to 22 gestational weeks. In addition, due to the increased number of diagnoses, greater cooperation between delivery hospitals would be beneficial.
Key words: fetal echocardiography; congenital heart disease; prenatal diagnosis; prognosis; prenatal counseling
© 2016 特定非営利活動法人日本小児循環器学会© 2016 Japanese Society of Pediatric Cardiology and Cardiac Surgery
This page was created on 2015-12-18T16:11:26.899+09:00
This page was last modified on 2016-01-27T11:28:42.24+09:00
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