新生儿宫内肠扭转临床与超声特点及预后分析  

Clinical and ultrasonic characteristics and prognosis of neonatal intrauterine volvulus

作　　者：肖秀漫[1] 朱利斌[2] 姜娜[1] 潘尹[3] 林进汉[2] 王荣跃[4] 朱将虎[1] 陈尚勤[1] XIAO Xiuman;ZHU Libin;JIANG Na;PAN Yin;LIN Jinhan;WANG Rongyue;ZHU Jianghu;CHEN Shangqin(Department of Neonatology,Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325027,China;不详)

机构地区：[1]温州医科大学附属第二医院育英儿童医院新生儿科,浙江温州325027 [2]温州医科大学附属第二医院育英儿童医院小儿外科 [3]温州医科大学附属第二医院育英儿童医院超声科 [4]温州医科大学附属第二医院育英儿童医院产科

出　　处：《中华全科医学》2023年第5期801-804,828,共5页Chinese Journal of General Practice

基　　金：浙江省基础公益研究计划项目(LGF21H040009);温州市基础性科研项目(Y2020075)。

摘　　要：目的分析宫内肠扭转患儿的临床特点和预后,为减少漏诊误诊、改善预后提供依据。方法回顾性分析2015年6月—2020年4月温州医科大学附属第二医院育英儿童医院收治的经生后术中证实为宫内肠扭转患儿的临床资料。结果共10例患儿纳入研究,男4例,女6例;剖宫产6例,阴道分娩4例;早产6例(4例因宫内窘迫行剖宫产),足月4例。产前二维超声显示7例有肠管扩张,2例有典型的“漩涡征”,3例有腹水,4例二维超声表现为腹腔囊性包块,2例存在羊水过多。产前胎心率异常5例。生后主要表现为立即出现腹胀(10例),呕吐胆汁样物质(4例),胎便未排8例(8例),血便(2例),贫血(7例);腹腔穿刺7例,6例为血性不凝血,1例为粪汁样液。10例患儿均在48 h内手术,术中节段性肠扭转5例,中肠扭转5例。7例肠管坏死,其中1例肠管大范围坏死,家属术中放弃治疗;1例因住院期间继发感染放弃治疗死亡。8例存活,存活率为80%(8/10)。结论产前二维超声提示典型“漩涡征”、肠管扩张伴腹水或腹腔包块进行性增大时需警惕胎儿宫内肠扭转。若产前二维超声提示肠管扩张,生后立即出现腹胀、呕吐胆汁样物质或血便等消化道症状,同时伴有贫血,应高度怀疑宫内肠扭转,腹腔穿刺液为血性基本能明确诊断。多学科合作,选择合适的时机分娩,生后尽早手术探查和积极的围手术期治疗是提高患儿存活率的关键。Objective To analyse the clinical characteristics and prognosis of children with intrauterine volvulus for reducing misdiagnosis and improving prognosis.Methods A retrospective review was conducted with intrauterine volvulus confirmed by postnatal operation in Second Affiliated Hospital&Yuying Children's Hospital of Wenzhou Medical University from June 2015 to April 2020.Results Ten children(4 males and 6 females)were included in the study.Six of them were born through caesarean section and 4 were via vaginal delivery.Among the children,6 were preterm infants(4 cases born for caesarean section due to foetal distress)and 4 were full-term infants.Of the 10 foetuses,7 had intestinal dilatation,2 showed typical"vortex sign",3 had ascites,4 had abdominal cystic mass and 2 had polyhydramnios,which was discovered by antenatal 2D ultrasound.5 cases had abnormal foetal heart rate before delivery.Among all the cases,10 had abdominal distension,4 vomited bile-like material,8 had no foetal discharge,2 had bloody stool immediately after birth and 7 had anaemia.Of the 10 cases,7 had abdominal puncture,6 had uncoagulable blood and 1 had faecal turbid liquid.All the 10 cases were operated within 48 hours,5 cases with segmental volvulus and 5 cases with midgut volvulus.Eight cases were recovered and discharged from hospital.One neonate died because of massive necrosis of small intestine,and one baby died due to secondary infection.The survival rate was 80%(8/10).Conclusion Foetal intrauterine volvulus should be considered when prenatal ultrasound showed typical"vortex"sign and intestinal dilatation with ascites or progressive enlargement of abdominal cystic mass.If prenatal ultrasound showed intestinal dilatation and the patient had gastrointestinal symptoms such as abdominal distension,vomiting bile-like material or bloody stool immediately after birth,accompanied by anaemia,then intrauterine volvulus should be highly suspected.If peritoneal puncture fluid was bloody,then a definite diagnosis could be made.The key to improve the

关 键 词：宫内肠扭转 临床特点 超声 预后 新生儿 

分 类 号：R722[医药卫生—儿科] R445.1[医药卫生—临床医学]