新生儿腹腔囊性肿块108例病理与临床结果

The pathology and outcome of 108 cases of neonatal abdominal cystic masses

目的分析新生儿期腹腔囊性肿块患儿的病因、病理、预后及转归。方法收集2008年8月至2013年7月我院新生儿外科术前诊断腹腔囊性肿块的病例,分析其性别、入院日龄、病因、治疗效果、病理及随访,总结预后及转归。结果 108例患儿中男女比例为40∶68;入院日龄3 h至28天,平均12天;住院日8～23天,平均11.2天;105例为足月儿,3例为早产儿。产前检查发现腹腔肿块42例（36例择期剖宫产）,新生儿期发现66例（27例剖宫产分娩）。91例患儿在新生儿期完成手术,15例患儿在生后1～3个月实施手术,均痊愈出院,另2例未行手术治疗。术后病理证实：胆总管囊肿51例,卵巢囊肿25例,肠源性囊肿16例,肠系膜淋巴管瘤6例,其他8例。2例开腹胆总管囊肿根治术患儿术后因粘连性肠梗阻再次行肠粘连松解术,恢复良好,其余手术患儿均健康成长。结论新生儿腹腔囊性肿块以女性稍多见,胆总管囊肿和卵巢囊肿占大部分,肠源性囊肿和肠系膜淋巴管瘤也是常见原因。新生儿腹腔囊性肿块患儿绝大多数预后良好,转归满意。

Objective To study the etiology,pathology and prognosis of neonates with abdominal cystic masses. Methods From August 2008 to July 2013,108 neonates were diagnosed with cystic abdominal mass in the Department. Their clinical data（ including etiology,age at diagnosis, gender,efficacy of surgical procedure,pathology and follow-up） were retrospectively studied. Results Total of 108 neonates included 40 males and 68 females. Age at admission ranged from 3 h to 28 d with an average of 12 d. The duration of hospital stay ranged from 8 d to 23 d,an average of 11. 2 d. 105 cases were full term babies and 3,preterms. 42 cases were diagnosed antenatally（ 36 cases chose cesarean sections）, and 66 cases were diagnosed during neonatal period（ 27 cases chose cesarean sections）. 91 neonates had surgery during neonatal period,and 15 during 1- 3 months. All improved and recovered. The other 2 cases received no surgery. Postoperative pathology showed： 51 cases of choledochocyst,25 cases of ovarian cyst,16 cases of enterogenous cyst,6 cases of mesenteric lymphagioma,and 7 undetermined cases. Postoperative follow-up revealed 2 cases receiving open common bile duct cystectomy complicated with adhesive intestinal obstruction. The patients recovered well after enterolysis. All other patients who had surgery recovered well. Conclusions Abdominal cystic masses in neonates were more frequently found in females than males. Bile duct cyst and ovarian cyst comprised the largest proportion of neonatal abdominal cystic masses. Enterogenous cyst and mesenteric lymphangioma were common. The prognosis of the majority of neonates with abdominal cystic masses was good.