新生儿围产期肝脾出血的临床特点和预后分析

Characteristics and prognosis of neonatal hepatorrhagia and splenorrhagia

目的总结新生儿围产期肝脾出血的临床特点、诊治方法和预后。方法回顾分析1992年6月1日至2009年6月1日南京医科大学附属南京儿童医院新生儿内、外科收治的围产期肝脾出血新生儿的临床资料，分析病因、临床表现、治疗及预后情况。结果围产期肝脾出血新生儿共23例，其中巨大儿12例，早产儿6例。主要原因是异常分娩史（剖宫产、胎儿窘迫、产程延长、胎头吸引、急产等）和产伤，分别占65．2％（15／23）和47．8％（11／23）。肝出血14例，脾出血6例，肝脾同时出血3例。早期主要临床表现包括反应差、嗜睡、拒乳者21例（91．3％），早期出现黄疸者18例（78．3％），苍白、贫血貌者17例（73．9％），腹胀者15例（65．2％），其他临床表现包括易激惹、呼吸困难、腹壁发紫、阴囊血肿等。保守治疗15例；手术治疗8例，其中死亡3例，病死率13．0％。结论新生儿围产期肝脾出血与巨大儿、早产儿及异常分娩史有关，以产伤为主要原因，临床表现与出血量有关，早期表现具有非特异性，超声是最好的诊断手段。血流动力学稳定的患儿保守治疗成功率高，出血不止者应尽早手术。

Objective To summarize the clinical characteristics, diagnosis and management methods and prognosis of hepatorrhagla and splenorrhagia of newborns. Methods A retrospective review of clinical data of neonates with hepatorrhagia and splenorrhagia in perinatal period was performed from June 1, 1992 to June 1, 2009 in Nanjing Childrenrs Hospital. Results There were twenty-three neonates suffered from hepatorrhagia and splenorrhagia in the perinatal period. There were 12 macrosomias and 6 preterm newborns. Abnormal birth history （65.2%,15/23）, including caesarean section, fetal distress, application of vacuum extractor, prolonged labour and precipitate labor, were most commom reasons of hepatorrhagia and splenorrhagia,and birth injuries [47.8 % （11/ 23）]was subsequent. In all cases, 14 cases were hepatorrhagia, six were splenorrhagia, three were hepatorrhagia and splenorrhagia simultaneously. Primary early symtoms included low response, sleepiness （91.3%, 21/23）; jaundice 78.3% （18/23） ; pallor and anemia 73.9% （17/23） ; abdominal distension （65.2%, 15/23） and so on. Ultrasonography and computed torrlography may make a definite diagnosis. Fifteen newborns underwent non operative treatment and 8 received hemostatic laparotomy. The general mortality was 13.0% （3/23）. Conclusions Hepatorrhagia and splenorrhagia of neonates in perinatal period is associated with macrosomias, abnormal birth history and preterm birth, and birth injuries were the major etiological factors. Clinical presentations are nonspecific which maybe asociated with the degree of blood loss. Abdominal ultrasonography is an optimal diagnostic method. Nonoperative management may be successful in hemodynamically stable patients, while immediate intervention, such as laparotomy, is required to control persist bleeding.