囊肿型胎粪性腹膜炎诊治进展  

Progress in Diagnosis and Treatment of Cystic Meconium Peritonitis

作　　者：项晴怡 汤海洋 潘宇霞 白晓霞(审校)[1,2] XIANG Qing-yi;TANG Hai-yang;PAN Yu-xia;BAI Xiao-xia(Department of Obstetrics,Women′s Hospital,School of Medicine,Zhejiang University,Hangzhou 310006,China;Zhejiang Province Clinical Research Center for Obstetrics and Gynecology,Zhejiang Provincial Key Laboratory of Traditional Chinese Medicine for Reproductive Health Research,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院产科,杭州310006 [2]浙江省妇产疾病临床医学研究中心,浙江省生育健康研究中医药重点实验室

出　　处：《国际生殖健康／计划生育杂志》2023年第4期343-347,共5页Journal of International Reproductive Health/Family Planning

基　　金：国家中医药管理局-浙江省中医药管理局共建科技计划重点项目(GZY-ZJ-KJ-23082);浙江省卫生创新人才项目(A0466)。

摘　　要：囊肿型胎粪性腹膜炎(cystic meconium peritonitis,CMP)属于Ⅱ型复杂性胎粪性腹膜炎,是由于患儿肠穿孔长期未封闭,胎粪刺激形成的纤维组织包裹漏液和部分肠袢形成假性囊肿。产前超声是诊断CMP的主要手段,典型特征为腹腔内囊壁欠规整的不均回声区,囊内或囊壁上可见钙化强回声,肠管可包裹其中。鉴于磁共振成像可更直观地显示病变肠段位置及范围,有助于区分腹腔囊肿与肠管解剖关系,其在复杂性CMP诊断及其与腹腔内其他囊性占位性病变的鉴别诊断方面有一定优势。合并高危因素的CMP孕妇建议进行宫内遗传学和病毒感染相关产前诊断。孤立性CMP需动态监测母胎一般情况、患儿生长发育和假性囊肿变化,必要时行患儿腹腔穿刺抽吸囊液缓解症状并延长孕周,分娩方式综合母胎产科指征、孕妇及家属意愿和多学科协作治疗条件决定。CMP患儿出生后应尽早手术治疗,关注术后并发症和肠道功能恢复情况,长期胃肠外营养者需随访远期预后,必要时行肠移植。Cystic meconium peritonitis(CMP),typeⅡcomplex meconium peritonitis,is a pseudocyst wrapping the leakage and partial intestinal loop with the fibrous tissue caused by meconium stimulation due to long-term unsealed fetal intestinal perforation.Prenatal ultrasound is the main method of diagnosing CMP,and CMP is characterized by the irregular shape of pseudocyst wall and uneven internal echo inside in the abdominal cavity,with calcification strong echo within or on the pseudocyst wall.The intestinal tract may be enveloped.Since magnetic resonance imaging(MRI)can more directly show the location and extent of the diseased intestinal segment,it helps to distinguish the anatomical location between abdominal cyst and intestinal tract.With certain advantages,MRI can be used for the diagnosis of complex CMP and the differential diagnosis of other cystic lesions in the abdominal cavity.Intrauterine genetics and viral infection-related prenatal diagnosis are recommended for the pregnant women with the CMP and high-risk factors.The isolated CMP requires the dynamic monitoring,including maternal and fetal general conditions,fetal growth and development,as well as changes in pseudocyst.Fetal abdominal paracentesis and cyst fluid aspiration treatment can relieve symptoms and prolong gestational age if necessary.The delivery pattern should be determined,based on the obstetric indications of the mother and fetus,combined with the wishes of the pregnant woman′s family and multidisciplinary collaborative treatment conditions.Newborn with CMP should be treated with surgery as soon as possible,paying attention to postoperative complications and long-term intestinal function recovery.Patients who need parenteral nutrition should be followed up for long-term prognosis,and intestinal transplantation may be considered if necessary.

关 键 词：胎儿 产前诊断 围产期 临床管理 治疗 预后 囊肿型胎粪性腹膜炎 

分 类 号：R725.7[医药卫生—儿科]