新生儿期颈部肿物14例临床分析

Clinical analysis of 14 newborns with neck masses

目的探讨新生儿颈部肿物的临床特点、诊断思路与治疗方案。方法总结2016年1月至2018年2月我院NICU收治的以颈部肿物为主要表现的新生儿病例,对其临床特点、辅助检查、治疗及术后诊断符合情况进行分析。结果共收治颈部肿物新生儿14例,其中生后即发病8例,新生儿早期发病1例,晚期发病5例;以呼吸困难为主诉入院7例;合并局部感染10例;14例均行颈部B超检查,2例行颈部增强CT,10例行颈部MRI检查;入院后予气管插管接人工鼻5例,气管插管机械通气3例,经鼻持续气道正压通气3例;予抗感染治疗13例;肿物穿刺4例;手术切除6例。诊断2例为局部原发感染,6例为手术确诊,其中鳃裂囊肿4例,食管重复畸形1例,淋巴管瘤1例。结论新生儿期颈部肿物易致上气道梗阻,部分需气管插管开放气道,可合并感染,术前影像学检查存在一定误诊率,根据肿物性质不同,治疗方案亦不同。

Objective To investigate the clinical features, diagnosis and treatment of neck masses in newborns. Methods All cases of neck masses in newborns admitted to NICU of Beijing Children′s Hospital form January 2016 to Febrary 2018 were included, and the clinical manifestations, examinations, treatments and outcomes were evaluated. Results Fourteen cases of newborn′s neck masses were collected.The time of onset was 8 cases at birth, 1 case earlier than 7 days, 5 cases after 7 days.Seven cases were admitted with dyspnea, 10 cases combined with neck infections.Neck ultrasound examinations were performed in all 14 cases, CT scan in 2 cases, MRI in 10 cases.Five cases were given endotracheal intubation after admission, among them 3 cases needed mechanical ventilation.Nasal continuous positive airway pressure was used in 3 cases.Thirteen cases received anti-infective treatment.Punctures were performed in 4 cases.Surgical resections were taken in 6 cases.Two cases were diagnosed as local primary infection.Six cases were confirmed by surgery, including 4 cases of branchial cleft cyst, 1 case of esophageal duplication and 1 case of lymphangioma. Conclusion The neck masses of the newborn is prone to upper airway obstruction.Part of them need endotracheal intubation to open the airway.And the infection can be combined.There is a certain rate of misdiagnosis before operation, and the treatment plan is different according to the nature of the mass.