胎儿及新生儿先天性胸腔积液6例报告并文献复习

Congenital pleural effusion in fetuses and neonates：cases report and literature review of 6 cases

目的：探讨胎儿及新生儿先天性胸腔积液的病因、临床特点及诊断和治疗，以提高临床医师对该病的认识。方法回顾性分析郑州大学第一附属医院新生儿科的6例先天性胸腔积液患儿的临床资料，结合文献复习分析其病因、临床特点及相关诊断和治疗过程。结果6例先天性胸腔积液患儿中，乳糜胸3例，其中1例同时合并乳糜腹、21-三体综合征、先天性甲状腺功能低下，病因不明者3例。确诊主要靠影像学和实验室检查。胸、腹水体液有核细胞数（1588~13057）×106/ L，以淋巴细胞为主；蛋白定性均阳性（＋~＋＋＋）；乳糜定性实验阳性3例；肝功能示均有不同程度的总蛋白及清蛋白降低。根据患儿情况采取内科保守治疗或外科治疗，其中3例治疗好转后出院，另外3例最终放弃治疗。结论先天性胸腔积液病因很多，常合并染色体异常或其他畸形，超声检查是产前诊断的主要手段，对产前即发现胸腔积液的患儿可动态观察，必要时于产前或产时行宫内治疗，故早期诊断与治疗十分重要。

Objective To discuss the etiology,clinical features,diagnosis and treatment of congenital pleural effusion in fetuses and neonates in order to improve the understanding of this disease. Methods Six neonate cases with congenital pleural effusion were retrospectively analyzed in neonates who were admitted to the Department of Neonatolo-gy of the First Affiliated Hospital of Zhengzhou University after birth and the etiology,clinical features,diagnosis and re-lated treatment were analyzed based on literature review. Results Among 6 patients with congenital pleural effusion, chylothorax was found in 3 cases,one of whom had chylothorax,chylous abdominal,21 trisomy syndrome and congenital hypothyroidism,and the etiology of the other 3 cases were unknown. Diagnosis mainly was depended on imaging and la-boratory tests. The number of nucleated cells of hydrothorax or ascites were（1 588 - 13 057）× 106 / L,mainly lympho-cytes. Protein qualitative was（ ＋ - ＋ ＋ ＋ ）,the chylothorax qualitative test was positive in 3 cases. The liver function showed that the total protein and albumin were decreased in varyig degrees. Conservative or surgical treatment was taken according to the situation of the patients. Among 6 patients,3 cases were cured after treatment,the others gave up treat-ment finally. Conclusions The etiology of congenital pleural effusion was different,and often associated with chromo-somal abnormalities or other malformations,ultrasonography was the main method to diagnose congenital pleural effusion and the patients should be dynamically observed or treated during the antepartum or intrapartum period. If the neonates are found to have pleural effusion in prenatal period early diagnosis and treatment is a best choice.