早产单绒毛膜双胎新生儿坏死性小肠结肠炎临床特点分析及相关文献复习  

Clinical characteristics of neonatal necrotizing enterocolitis in preterm monochorionic twins:two cases report and literature review

作　　者：李子贤 李向红[1] 孙梦雅[1] 李亮亮[1] 尹向云[1] 锡洪敏[1] 杨萍[1] 马丽丽[1] Li Zixian;Li Xianghong;Sun Mengya;Li Liangliang;Yin Xiangyun;Xi Hongmin;Yang Ping;Ma Lili(Department of Neonatology,Affiliated Hospital of Qingdao University,Qingdao 266555,Shandong Province,China)

机构地区：[1]青岛大学附属医院新生儿科,青岛266555

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第3期343-349,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：山东省自然科学基金青年项目(ZR2020QH054)。

摘　　要：目的探讨单绒毛膜双胎(MCT)早产儿罹患坏死性小肠结肠炎(NEC)的临床特点。方法选择2021年2月11日与1月18日,于青岛大学附属医院采取剖宫产术分娩的2例MCT罹患NEC女性早产儿(No.1、2患儿,均系MCT之小)为研究对象。采用回顾性研究方法,收集No.1、2患儿的临床病例资料,并对其临床表现、诊治进行分析。以"twins""twins pregnancy""multiple pregnancy""monochorionic twins""neonatal necrotizing enterocolitis""双胎""双胎妊娠""单绒毛膜双胎""新生儿坏死性小肠结肠炎"为关键词,在PubMed、中国知网、万方数据知识服务平台中,检索MCT罹患NEC患儿诊治相关研究文献;文献检索时间设定为上述数据库建库至2021年8月。本研究经过本院伦理委员会批准(审批文号:QYFY WZLL 26856)。结果①临床病例资料分析:No.1、2患儿均无双胎输血综合征(TTTS)及双胎反向动脉灌注序列征(TRAPS)等并发症。No.1患儿出生胎龄为34+5周,出生体重为1790 g,生后10 min因"早产、呻吟吐沫"被收治入院。生后第9天便血、第11天腹胀,腹部X射线摄片见肠壁积气,腹部超声见门静脉积气,被诊断为NEC。生后第11天开腹探查术见部分回肠坏死,接受坏死肠管切除术和小肠造瘘术。术后第10天,患儿对母乳喂养耐受差,体重不增;第48天改为深度水解配方奶喂养,仍不耐受;第60天时,接受小肠造口还纳术和小肠吻合术,术后回肠组织病理学活检显示,肠黏膜组织呈慢性炎症。本次术后母乳喂养及增加奶量均顺利,住院86 d好转出院;随访至2021年12月时,其矫正月龄为9个月,体格、语言、运动发育正常。No.2患儿出生胎龄为35+6周,出生体重为2390 g,生后14 min因"早产、生存能力低下"被收治入院。生后第4天便血,腹部X射线摄片见腹部肠管扩张、积气,被诊断为NEC。给予胃肠减压、禁食和抗菌药物等治疗后逐渐好转。生后第26天出现腹胀,腹部造影见结肠狭窄;于生后�Objective To investigate clinical characteristics of neonatal necrotizing enterocolitis(NEC)in preterm infants with monochorionic twins(MCT).Methods Two cases of MCT preterm baby girl with NEC who were delivered by cesarean section in the Affiliated Hospital of Qingdao University on February 11 and January 18,2021(case 1 and case 2,both of them were the second of MCT)were selected into this study.Clinical data of case 1 and 2 were collected by retrospective study method,and their clinical manifestations,diagnosis and treatment were analyzed.Literature about NEC in MCT was retrieved with key words of"twins""twins pregnancy""multiple pregnancy""monochorionic twins""neonatal necrotizing enterocolitis"both in Chinese and English,based on PubMed,China National Knowledge Infrastructure,and Wanfang Data Service Platform.Literature retrieval time was set from the establishment of above databases to August 2021.This study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University(Approval No.QYFY WZLL 26856).Results①Clinical data analysis:case 1 and 2 had no complications of twin-twin transfusion syndrome(TTTS)and twins reversed arterial perfusion sequence(TRAPS).Case 1 was born at 34+5 gestational weeks with birth weight of 1790 g.She was hospitalized in department of neonatology 10 min after birth due to"premature birth,groaning and spit".She was diagnosed as NEC because of hematochezia on the 9th day after birth,and had abdominal distension on the 11th day after birth,intestinal wall gas observed by abdominal X-ray examination,and portal vein gas observed by abdominal ultrasound.On the 11th day after birth,by exploratory laparotomy showed part of intestinal necrosis,necrotic bowel resection and enterostomy were performed.Case 1 had poor tolerance of breast-fed on day 10 postoperatively,and without weight gain.On day 48 postoperatively,she was fed with deeply hydrolyzed formula milk,but still feeding intolerance.Loop stoma reversal and intestinal anastomosis were performed on day 60 after pr

关 键 词：妊娠 双胎 小肠结肠炎 坏死性 单绒毛膜双胎 双胎输血综合征 双胎反向动脉灌注序列征 妊娠结局 婴儿 早产 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科] R445.1[医药卫生—临床医学]