胎粪性腹膜炎的产前诊断与新生儿结局的探讨

Relationship of prenatal diagnosis and neonatal outcomes in meconium peritonitis

目的探讨胎粪性腹膜炎产前超声诊断与新生儿结局的相关性。方法对2010年1月至2013年12月,在广州市妇女儿童医疗中心产前超声诊断、出生后经影像学检查或手术证实的胎粪性腹膜炎43例病例进行回顾性分析。产前动态B超监测,并且对分娩前末次超声表现进行评分分级:0级为单纯腹腔钙化灶(6例);1级包括腹腔内钙化灶伴腹水(9例)或伴假性囊肿(1例)或伴肠管扩张(4例);2级为腹腔钙化灶伴2种相关异常声像(19例);3级为存在以上所有的相关异常声像(4例)。新生儿出生后再次评估,有肠梗阻或腹膜炎者,行手术治疗。比较手术及非手术组产前超声声像的差异及不同分级的胎儿出生后的临床结局。结果 0级者无需手术,分级≥1者共37例,其中33例行手术治疗,新生儿病死率为4.7%。手术组的产前超声表现:腹腔钙化100%、腹水78.8%、肠管扩张63.6%、假性囊肿39.4%、羊水过多39.4%。非手术组10例中无1例有肠管扩张及假性囊肿的表现。结论早期诊断对MP的预后至关重要,产前超声声像能预测新生儿预后及手术风险。三级医院产检分娩、出生后再次评估病情、对有手术指征者尽早手术可有效降低MP新生儿病死率。

Objective To study the relationship between prenatal ultrasound findings and postnatal course of neonates with meconium pefitonitis（MP）. Methods 43 cases of neonates who were diagnosed as meconium peritonitis by prenatal ultrasound and confirmed surgically or by image studies after birth from January 2010 to December 2013 in the Guangzhou Women and Children＇s Center were enrolled. All neonates were monitored by ultrasound prenatally. All the cases were divided into 4 groups according to the prenatal sonographic findings：grade 0, isolated intra-abdominal calcification （n=6）; grade 1, intra-abdominal calcification and ascites （n=9） or pseudoeyst （n= 1 ） or bowel dilation （n=4） ; grade 2, two associated findings （n=19）; and grade 3, all sonographic features （n=4）. Postnatal evaluation was taken again and symptomatic newborns who were suspected with intestinal obstruction or peritonitis received surgery.The difference of prenatal ultrasound findings in surgical and non-surgical groups and postnatal outcomes according to the score of MP were analyzed. Results Neonatal surgical intervention was required in none of the newborns with grade 0 MP and most cases with the score of ≥ 1 had undergone surgery （33/37）. Neonatal mortality rate was 4.7%. Prenatal ultrasound findings in surgical group were intra-abdominal calcification （100%）, fetal ascites （78.8%）, bowel dilatation （63.6%）, meconium pseudocyst（39.4% ）and polyhydramnios （39.4%）, but none of bowel dilatation and meeonium pseudoeyst was found in non-surgical group. Conclusions Early diagnosis of MP is crucial to improve the prognosis.The prenatal ultrasound findings can predict the risk of surgery and postnatal outcomes.Delivery is recommended in a tertiary hospital when intra- abdominal calcification associated with other ultrasound findings was found in MP patients. Moreover, postnatal evaluation and early operation when indicated can reduce the mortality rate.