胎粪性腹膜炎的产前诊断特点和预后  

Prenatal diagnosis and fetal outcomes of meconium peritonitis

作　　者：祝菁[1] 杨祖菁[1] 王磊[1] 王蓓[1] 张琳[1] 

机构地区：[1]上海交通大学医学院附属新华医院产科,200092

出　　处：《中华围产医学杂志》2016年第6期432-435,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的研究胎粪性腹膜炎的产前诊断特点和新生儿预后。方法回顾性分析2004年4月1日至2014年12月31日在上海交通大学医学院附属新华医院接受产前诊断及出生后治疗的26例胎粪性腹膜炎病例的临床资料。分析其产前超声诊断特点、术后诊断和预后。采用方差分析、x^2检验或Fisher精确慨率法进行统计学分析。结果胎粪性腹膜炎的产前诊断率为96．2％（25／26），新生儿手术率为92．3％（24／26），存活率为92．3％（24／26）。26例产前超声诊断特征包括肠管扩张（23例，88．5％），腹腔内钙化（11例，42．3％），腹腔积液（8例，30．8％），腹腔内假性囊肿（4例，15．4％）和羊水过多（13例，50．0％）。术后对24例接受手术治疗的胎粪性腹膜炎患儿的病因诊断发现空肠闭锁4例（16．7％），回肠闭锁18例（75．0％），空-回肠交界处闭锁2例（8．3％）。肠管扩张、腹腔内钙化、腹腔积液、腹腔内假性囊肿和羊水过多的发生比例在各组肠闭锁之间差异无统计学意义（P值均〉0．05）。结论胎粪性腹膜炎的产前超声表现多样，在胎儿肠管扩张的基础上出现腹腔积液、腹腔内钙化灶、腹腔内囊肿均提示胎粪性腹膜炎形成，新生儿出生后早期手术治疗，可以明显降低新生儿死亡率，需要加强围产期一体化管理提高新生儿治疗效果。Objective To discuss prenatal ultrasound features and fetal outcomes of meconium peritonitis. Methods This is a retrospective study of all cases of fetal meconium peritonitis （n=26） registered in the Department of Obstetrics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from April 1, 2004 to December 31, 2014. Prenatal ultrasound features, surgical findings and fetal outcomes were discussed. Variance analysis, Chi-square test or Fisher＇s exact test were applied for statistics. Results Among the 26 cases, 25（96.2%） were diagnosed prenatally, 24 （92.3%） underwent neonatal surgery, and 24 （92.3%） survived. Prenatal ultrasound findings included bowel dilatation （88.5%,23/26）, intra-abdominal calcification （42.3%,11/26）, fetal ascites （30.8%, 8/26）, intra abdominal pseudocysts （15.4%, 4/26） and polyhydramnios（50.0%,13/26）. Surgical findings confirmed the diagnosis of meconium peritonitis was due to jejunal atresia[16.7%（4/24）], ileal atresia[75%（18/24）], and atresia of jejunal and ileal junction [8.3%（2/24）], respectively. However, no statistical significance was shown in the incidence of bowel dilatation, intra-abdominal calcification, fetal ascites, pseudocysts and polyhydramnios among the three groups of different etiology （all P〉0.05）. Conclusions The prenatal ultrasound features of meconium peritonitis may vary a lot. But bowel dilatation combined with intra-abdominal calcification, fetal ascites or pseudocysts prompts the diagnosis of meconium peritonitis. Early surgical intervention in neonatal period could reduce the neonatal mortality remarkably, thus comprehensive and standardized perinatal management are necessary to improve fetal outcomes.

关 键 词：腹膜炎 胎粪吸入综合征 超声检查 产前 治疗结果 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]