태아 신이상발육과 연관된 신장외기형
Extra-renal anomalies associated with fetal renal dysgenesis
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목적: 본 논문은 초음파검사를 통해 태아 신이상발육과 연관된 신장외기형을 평가하고 예후를 알아 보기 위한 것이다. 연구 방법: 1998년 3월과 2005년 2월 사이에 산전 진찰을 시행한 임신부의 산전 초음파검사에서 태아 신이상발육이 의심되는 임신부 중에서 분만 후 초음파검사나 CT를 시행하거나 임신 종결 후 부검을 통해서 확인된 경우를 대상으로 하였다. 결과: 태아 신이상발육을 가진 경우는 30예였다. 그 중 다낭성신장질환 2예, 양측성 신장무형성이 4예, 일측성 신장무형성이 4예, 양측성 낭성신장이형성 3예, 일측성 낭성신장이형성 17예가 발견되었다. 신이상발육과 연관된 신장외기형은 선천성 심질환이 7예로 가장 흔하게 발견되었으며, 단일제대동맥 5예, 무공항문 2예, 기관식도폐쇄 2예가 있었다. 다른 연관된 기형은 요도하열, 척추만곡증을 동반한 이분척추 등이 있었다. 결론: 선천성 심장기형은 태아 신이상발육과 연관된 가장 흔한 기형이다. 따라서 산전 진찰에서 태아 신이상발육이 발견되면 태아 심초음파검사를 시행하는 것이 좋다.
Abstract
Objective: The purpose of this study is to evaluate other anomalies associated with the fetal renal dysgenesis and prognosis. Methods: Level II sonography were reviewed in the pregnant women who had been diagnosed with fetal renal dysgenesis antenatally from March 1998 to February 2005. Diagnosis was comfirmed by the autopsy or the postnatal studies including sonographic and radiologic evaluation. Results: Thirty fetuses had a fetal renal dysgenesis. There were 2 cases of polycystic kidney, 4 cases of bilateral renal agenesis, 4 cases of unilateral renal agenesis, 3 cases of bilateral multicystic dysplastic kidney and 17 cases of unilateral multicystic dysplastic kidney. The common associated anomalies were congenital heart disease (7 cases), single umbilical artery (5 cases), imperforate anus (2 cases) and tracheo-esophageal fistula (2 cases). Hypospadia and scoliosis with hemivertebra were also noted. Conclusion: The most common anomaly associated with renal dysgenesis was congenital heart diseases. If fetal renal dysgenesis is detected antenatally, fetal echocardiography should be performed.
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