CAJ | 학술논문

目的探讨产前诊断、围产期管理与早期手术治疗的系统化诊疗模式在胎粪性腹膜炎患儿中的应用效果. 方法首都儿科研究所附属儿童医院与多家医院产科合作建立了产前诊断、围产期管理与早期手术治疗的系统化诊疗模式.2006年3月15日至2012年8月27日,按此模式进行管理与治疗胎粪性腹膜炎患儿共30例.总结这30例患儿的产前诊断与生后治疗效果及预后.结果 (1)产前诊断:30例胎儿均通过产前超声检查发现与胎粪性腹膜炎相关的异常腹部征象.其中肠管扩张23例次、羊水过多15例次、腹水9例次、腹部囊性包块4例次、腹部钙化4例次.(2)出生后影像学诊断:27例患儿行腹部立位X线平片检查,常见表现为腹胀(27例次)、肠管扩张伴阶梯状液平面(22例次)和腹部钙化(11例次).27例患儿接受腹部超声检查,主要表现为肠管明显扩张(19例次)、腹部囊性包块(7例次)和腹部钙化(7例次).(3)手术治疗:除3例无临床症状患儿接受保守治疗外,余27例患儿在新生儿期(平均42 h,12 h～5 d)接受了手术治疗.除病灶清除、肠粘连松解等基本处置外,1例行单纯腹腔引流术,7例行双孔肠造瘘术,11例行一期肠吻合术,8例行倒“丁”字肠吻合肠造瘘术.治愈24例,2例手术后放弃治疗,1例患儿行小肠双孔造瘘术后失访. 结论产前诊断、围产期管理与早期手术治疗的系统化诊疗模式有助于提高胎粪性腹膜炎患儿的整体治疗效果及预后.
목적 탐토산전진단、위산기관리여조기수술치료적계통화진료모식재태분성복막염환인중적응용효과. 방법 수도인과연구소부속인동의원여다가의원산과합작건립료산전진단、위산기관리여조기수술치료적계통화진료모식.2006년3월15일지2012년8월27일,안차모식진행관리여치료태분성복막염환인공30례.총결저30례환인적산전진단여생후치료효과급예후.결과 (1)산전진단:30례태인균통과산전초성검사발현여태분성복막염상관적이상복부정상.기중장관확장23례차、양수과다15례차、복수9례차、복부낭성포괴4례차、복부개화4례차.(2)출생후영상학진단:27례환인행복부립위X선평편검사,상견표현위복창(27례차)、장관확장반계제상액평면(22례차)화복부개화(11례차).27례환인접수복부초성검사,주요표현위장관명현확장(19례차)、복부낭성포괴(7례차)화복부개화(7례차).(3)수술치료:제3례무림상증상환인접수보수치료외,여27례환인재신생인기(평균42 h,12 h～5 d)접수료수술치료.제병조청제、장점련송해등기본처치외,1례행단순복강인류술,7례행쌍공장조루술,11례행일기장문합술,8례행도“정”자장문합장조루술.치유24례,2례수술후방기치료,1례환인행소장쌍공조루술후실방. 결론 산전진단、위산기관리여조기수술치료적계통화진료모식유조우제고태분성복막염환인적정체치료효과급예후.
Objective To investigate the efficacy of standardized protocol,including prenatal diagnosis,perinatal management and treatment,on babies with meconium peritonitis.Methods A standardized protocol with prenatal diagnosis,perinatal management,treatment and follow-up on congenital anomaly was founded by Capital Institute of Pediatrics and several other obstetric hospitals.Thirty neonates diagnosed as meconium peritonitis prenatally from March 15,2006 to August 27,2012 were intervened according to this protoccl.The data of diagnosis,treatment after birth and prognosis were analyzed.Results (1) Prenatal diagnosis:Abnormal meconium peritonitis relative signs were found by ultrasound in all of these 30 cases.Among them,23 cases presented with intestine dilation,15 with polyhydromnios,nine with ascites,four with abdominal cystic mass and four calcification.(2)Diagnosis after birth (n=27):The most common imaging findings in abdominal X-ray were distention (27 cases),dilated intestine with air-fluid levels (22 cases) and calcification (11 cases).The most common imaging findings in ultrasound were obvious intestinal dilation (19 cases),cystic mass (7 cases) and calcification (7 cases).(3) Operation:Except for three cases without symptoms,the other 27 infants received operation at averagely 42 hours after birth (12 h-5 d).Besides the basic treatment as removal of the fuci and dissection of adhesion,peritoneal drainage was performed in one infant,two-stoma enterostomy in seven infants,inverted T-shape enterostomy in eight infants and primary intestinal anastomosis in 11 infants.Among these 27 cases,24 cases were cured,2 cases refused following treatment after surgery and one case was lost to follow up.Conclusions Standardized protocol with prenatal diagnosis,perinatal management and earlier intervention might improve the prognosis of meconium peritonitis.