围生儿死亡108例临床病理分析

Clinicopathologic analysis of 108 cases with perinatal death

目的探讨围生儿的死亡原因及其与胎盘病理改变的关系。方法选择2000年1月～2012年12月北京天坛医院及佑安医院围生期死亡的尸检标本108例作为研究对象,其中包括胎死宫内76例及新生儿死亡32例,分析各器官及胎盘脐带的HE切片,观察胎盘脐带的病理改变。结果先天性宫内缺氧窒息和先天畸形均为胎死宫内及新生儿死亡的主要原因,其中在胎死宫内及新生儿死亡中先天性宫内缺氧窒息分别占63.2%和78.1%,先天畸形分别占36.8%和21.9%。绒毛间质纤维化、细胞滋养细胞明显、干绒毛血管硬化、干绒毛闭塞性动脉内膜炎、绒毛膜羊膜炎及羊膜胎粪污染多见于胎死宫内的胎盘,与新生儿死亡胎盘情况的差异有统计学意义(P<0.05);在胎死宫内的胎盘中,绒毛合体细胞结节增多、细胞滋养细胞明显、干绒毛血管硬化及干绒毛闭塞性动脉内膜炎在因宫内缺氧窒息死亡胎盘和因畸形死亡胎盘间,差异有统计学意义(P<0.05);绒毛膜羊膜炎多见于因畸形死亡胎盘中,镜下可见到脐血管病变。结论围生儿尸检对于明确死因有重要价值,胎盘脐带的病理检查可为寻找死因提供证据。

Objective To study the causes of perinatal death and the relation to the placental pathologic changes. Methods 108 cases of perinatal death autopsy specimens from January 2000 to December 2012 in Beijing Tiantan Hospital and Beijing You＇an Hospital were selelcted as study objects,there were 76 cases of intrauterine death and 32 cases of neonatal death. The tissue slices stained by HE of every organ,placentas and cords were reviewed. The causes of perinatal death were analyzed according to the pathological changes of placentas and cords. Results In the 108 cases,asphyxia and congenital malformation were mainly dead causes both in intrauterine death and neonatal death,the asphyxia in intrauterine death and neonatal death were 63.2% and 78.1% respectively,the congenital malformatio in intrauterine death and neonatal death were 36.8% and 21.9% respectively. Stromal fibrosis of villi,excessive number of villous cytotrophoblastic cells,fibromuscular sclerosis of villous stem arteries,obliterative endarteritis,meconium-stained amniotic fluid,chorioamnionitis and funic augiitis were more in the placentas of intrauterine fetal death than in the placentas of neonatal death,and their difference was statistically significant（P〈 0.05）. In the placentas of intrauterine fetal death,excessive number of syncytial knots,excessive number of villous cytotrophoblastic cells,fibromuscular sclerosis of villous stem arteries,obliterative endarteritis were statistically different between the placentas of intrauterine asphyxia and congenital malformation（P 0.05）. Vascular lesions of cords could also be responsible for perinatal death. Conclusion Perinatal autopsy was valuable for identifying the causes of perinatal death,and detail examination of placenta and cord could also provide evidence for the finding of dead cause.