围产期一体化管理模式下胎粪性腹膜炎患儿临床特征与结局探讨  

Clinical characteristics and outcomes of children of meconium peritonitis in perinatal integrated management model

作　　者：何炜婧[1] 孙松[1] 郑珊[1] 董岿然[1] 沈淳[1] He Weijing;Sun Song;Zheng Shan;Dong Kuiran;Shen Chun(Department of Pediatric Surgery,National Children’s Medical Center,Children’s Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]国家儿童医学中心,复旦大学附属儿科医院外科,上海201102

出　　处：《临床小儿外科杂志》2024年第12期1138-1143,共6页Journal of Clinical Pediatric Surgery

基　　金：国家临床重点专科建设项目(10000015Z155080000004)。

摘　　要：目的胎粪性腹膜炎(meconium peritonitis,MP)是新生儿常见急腹症之一。本文旨在探讨经围产期一体化管理获得产前诊断的MP患儿临床特点以及围产期一体化管理模式对于MP患儿结局的影响。方法本研究为回顾性研究,收集2014年1月至2023年12月复旦大学附属儿科医院收治的MP患儿临床资料,根据是否获得产前诊断及接受围产期一体化管理分为产前诊断组和生后诊断组。产前诊断组采取围产期一体化管理模式,生后由新生儿专业团队转运至本中心进一步诊治。生后诊断组以腹胀或呕吐就诊,经腹部X线检查诊断为MP。对比两组患儿基本信息、临床分型、手术方式、术后治疗情况及临床结局。结果本研究纳入MP患儿共120例,产前诊断组101例,生后诊断组19例;男69例,女51例;出生胎龄(36.07±2.68)周,出生体重(2.93±0.69)kg。5例术前放弃治疗;13例无明显肠梗阻表现,经保守治疗后好转出院;其余102例接受手术治疗,包括48例肠造瘘术、53例一期肠吻合术、1例腹腔引流术。产前诊断组诊断孕周(29.85±4.81)周,产前超声发现异常包括肠管扩张36例(36/101,35.64%),腹腔囊肿27例(27/101,26.73%),腹腔积液21例(21/101,20.79%),腹腔钙化灶17例(17/101,16.83%);分型为腹膜炎型56例(55.45%),肠梗阻型35例(34.65%),无症状型10例(9.9%)。生后诊断组中,腹膜炎型10例(52.63%),无症状型6例(31.58%),肠梗阻型3例(15.79%)。两组MP分型差异有统计学意义(χ^(2)=7.456,P=0.024)。产前诊断组接受手术人数占比90.10%(91/101),均为腹膜炎型和肠梗阻型;生后诊断组手术人数占比57.89%(11/19),较产前诊断组低,差异有统计学意义(χ^(2)=10.605,P=0.001),其中5例术前家长放弃治疗。产前诊断组和生后诊断组首次手术时长[(120.62±39.80)min比(110.10±14.59)min,t=1.691,P=0.102)]、一期肠吻合率(53.85%比36.36%,χ^(2)=1.285,P=0.257)、关瘘时间[(94.34±40.54)d比(99.60±44.54)d,t=-0.264,P=0.793)、最�Objective Meconium peritonitis(MP)is a common neonatal surgical emergency.This study explores the clinical characteristics of MP diagnosed prenatally under a perinatal integrated management model and the model's impact on outcomes for MP patients.Methods A retrospective study was conducted on MP cases treated at the Children's Hospital of Fudan University from January 2014 to December 2023.Patients were divided into a prenatal diagnosis group(n=101)and a postnatal diagnosis group(n=19)based on the timing of diagnosis and whether they received perinatal integrated management.The prenatal diagnosis group received integrated perinatal care and was transferred postnatally to a specialized neonatal team for further treatment.The postnatal diagnosis group presented with symptoms such as abdominal distension or vomiting and was diagnosed with MP via abdominal X-rays.Basic information,clinical classifications,surgical methods,postoperative treatments,and clinical outcomes were compared between the two groups.Results A total of 120 MP cases were included:101 in the prenatal diagnosis group.Male-to-female ratio was 69:51;mean gestational age was 36.07±2.68 weeks,and mean birth weight was 2.93±0.69 kg.Five cases discontinued treatment before surgery,and 13 were treated conservatively and discharged after improvement.Among the remaining 102 cases,surgical interventions included 48 stoma surgeries,53 primary anastomoses,and 1 peritoneal drainage procedure.Prenatal diagnosis was made at 29.85±4.81 weeks of gestation,with abnormal ultrasound findings such as intestinal dilation(36/101,35.64%),abdominal cysts(27/101,26.73%),ascites(21/101,20.79%),and intra-abdominal calcification(17/101,16.83%).The predominant types were peritonitis(55.45%),intestinal obstruction(34.65%),and asymptomatic(9.9%).In the postnatal group,the distribution was peritonitis(52.63%),asymptomatic(31.58%),and intestinal obstruction(15.79%),with a statistically significant dfference in MP types between the groups(χ^(2)=7.456,P=0.024).Surgerical rates wer

关 键 词：胎粪性腹膜炎 围产期 疾病管理 产前诊断 超声检查 产前 产后期 诊断 学科间信息交流 

分 类 号：R71[医药卫生—妇产科学]