30例胎粪性腹膜炎患儿的产前诊断、围产期管理与治疗效果  

Prenatal diagnosis and perinatal management of 30 cases of meconium peritonitis

作　　者：马继东[1] 冯翠竹[1] 王莹[1] 张悦[1] 叶蓁蓁[1] 刘树立[1] 

机构地区：[1]首都儿科研究所附属儿童医院外科,北京100020

出　　处：《中华围产医学杂志》2013年第11期668-672,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨产前诊断、用产期管理与早期手术治疗的系统化诊疗模式在胎粪性腹膜炎患儿中的应用效果。方法首都儿科研究所附属儿童医院与多家医院产科合作建立了产前诊断、同产期管理与早期手术治疗的系统化诊疗模式。2006年3月15日至2012年8月27日，按此模式进行管理与治疗胎粪性腹膜炎患儿共30例。总结这30例患儿的产前诊断与生后治疗效果及预后。结果（1）产前诊断：30例胎儿均通过产前超声检查发现与胎粪性腹膜炎相关的异常腹部征象。其中肠管扩张23例次、羊水过多15例次、腹水9例次、腹部囊性包块4例次、腹部钙化4例次。（2）出生后影像学诊断：27例患儿行腹部赢位X线平片检查，常见表现为腹胀（27例次）、肠管扩张伴阶梯状液平面（22例次）和腹部钙化（11例次）。27例患儿接受腹部超声检查，主要表现为肠管明显扩张（19例次）、腹部囊性包块（7例次）和腹部钙化（7例次）。（3）手术治疗：除3例无临床症状患儿接受保守治疗外，余27例患儿存新生儿期（平均42h，12h～5d）接受了手术治疗。除病灶清除、肠粘连松解等基本处置外，1例行单纯腹腔引流术，7例行双孔肠造瘘术，11例行一期肠吻合术，8例行倒“丁”字肠吻合肠造瘘术。治愈24例，2例手术后放弃治疗，1例患儿行小肠双孔造瘘术后失访。结论产前诊断、同产期管理与早期手术治疗的系统化诊疗模式有助于提高胎粪性腹膜炎患儿的整体治疗效果及颁后。Objective To investigate the efficacy of standardized protocol, including prenatal diagnosis, perinatal management and treatment, on babies with meconium peritonitis. Methods A standardized protocol with prenatal diagnosis, perinatal management, treatment and follow up on congenital anomaly was founded by Capital Institute of Pediatrics and several other obstetric hospitals. Thirty neonates diagnosed as meconium peritonitis prenatally from March 15, 2006 to August 27, 2012 were intervened according to this protoccl. The data of diagnosis, treatment after birth and prognosis were analyzed. Results （1）Prenatal diagnosis： Abnormal meconium peritonitis relative signs were found by ultrasound in all of these 30 cases. Among them, 23 cases presented with intestine dilation, 15 with polyhydromnios, nine with ascites, four with abdominal cystic mass and four calcification. （2）Diagnosis after birth （＊~=27） ： The most common imaging findings in abdominal X-ray were distention （27 cases）, dilated intestine with air fluid levels （22 cases） and calcification （11 cases）. The most common imaging findings in ultrasound were obvious intestinal dilation （19 cases）, cystic mass （7 cases） and calcification （7 cases）. （3） Operation： Except for three cases without symptoms, the other 27 infants received operation at averagely 42 hours after birth （12 h 5 d）. Besides the basic treatment as removal of the fuci and dissection of adhesion, peritoneal drainage was performed in one infant, two stoma enterostomy in seven infants, inverted T shape enterostomy in eight infants and primary intestinal anastomosis in 11 infants. Among these 27 cases, 24 cases were cured, 2 cases refused following treatment after surgery and one case was lost to follow up. Conclusions Standardized protocol with prenatal diagnosis, perinatal management and earlier intervention might improve the prognosis of meconium peritonitis.

关 键 词：腹膜炎 婴儿 新生 疾病 超声检查 产前 肠造口术 同生期医护 治疗结果 

分 类 号：R714.5[医药卫生—妇产科学]