复杂性胎粪性腹膜炎胎儿产前超声征象与新生儿结局的探讨

Relationships between manifestations of prenatal ultrasound and postnatal outcome in neonates with complex meconium peritonitis

目的探讨复杂性胎粪性腹膜炎胎儿产前超声征象与新生儿结局的关系。方法20例产前超声诊断复杂性胎粪性腹膜炎,出生后经影像学检查或开腹手术确诊的胎儿。产前行动态B超监测,大量腹水胎儿行腹水减量。新生儿怀疑肠梗阻或穿孔者,行剖腹探查术。结果复杂性胎粪性腹膜炎产前超声声像包括腹腔内钙化17/20(85%)、羊水过多13/20(65%)、腹水11/20(55%)、肠管扩张8/20(40%)、胎粪性假性囊肿3/20(15%)。新生儿手术率为10/20(50%),新生儿术后病死率2/10(20%)。KamataⅠ型和Ⅱ型较Ⅲ型手术率更高,分别为71.4%和41.7%,但差异无统计学意义(P=0.22)。KamataⅠ型和Ⅱ型较Ⅲ型生后病死率稍高,分别为14.3%和8.3%,但差异无统计学意义(P=0.61)。结论产前超声能预测胎儿复杂性胎粪性腹膜炎新生儿期手术风险。三级医院分娩、生后禁食、对有手术指征者及早手术有助于降低新生儿病死率。

Objective To study the relationships between characteristic findings of prenatal ultrasound and its postnatal course of neonates with complex meconium peritonitis. Methods 20 cases of neonates who were diagnosed which complex meconium peritonitis by prenatal ultrasound and confirmed surgically or by image studies after birth were selected in this study. Most of the neonates were monitored by ultrasound prenatally; some of them undergone intrauterine abdominal paracentesis for massive ascites and some undergone exploratory laparostomy for suspected intestinal obstruction or perforation. Results Prenatal ultrasound findings for complex meconium peritonitis were intra-abdominal calcification 17/20 （85%）, polyhydramnios 13/20（65% ）, ascites 11/20 （55%）, dilated bowel loop 8/20 （40%） and meconium pseudocyst 3/20 （ 15% ）. The operational rate of neonates with complex meconium peritonitis was 50% （ 10/20 ） after birth and post-operational mortality rate was 20% （2/10）. For neonates with Kamata type Ⅰ and Ⅱ had higher rate of operation and post-operational mortality rate than Kamata type Ⅲ, 71.4% vs. 41.7% and 14.3% vs. 8.3% respectively; but failed to show statistical significance （P = 0. 22 and 0. 61, respectively）. Conclusion The manifestations of prenatal ultrasound can predict the risk of postnatal surgery for fetuses with complex meconium peritonitis. Delivery at a tertiary hospital, fasting after birth and early operation when indicated can reduce the mortality rate.