36例先天性消化道畸形的临床分析

Clinical analysis on 36 cases of congenital malformation of digestive tract

目的:分析先天性消化道畸形患儿的临床特征和预后影响因素。方法:选择36例先天性消化道畸形患儿作为研究对象,对患儿的性别、胎龄、受孕方式、分娩方式、是否多胎妊娠、临床症状、并发症情况进行观察和分析,对患儿母亲年龄、是否存在羊水过多、是否胎膜早破、妊娠期并发症情况、妊娠期感染史、妊娠期叶酸应用史、妊娠期吸烟史、妊娠期药物应用史、是否居住新房及父亲的吸烟史进行观察和分析,对患儿的预后转归情况进行观察,并分析其相关因素。结果:在36例纳入患儿中,畸形种类以肛门直肠闭锁、小肠闭锁最为常见,分别占41. 67%和13. 89%;较多患儿的母亲在妊娠期有感染史和吸烟史,剖宫产和胎膜早破的比例也较高,患儿的临床表现以呕吐、腹胀为主;有4例患儿于术后或转院后死亡,5例患儿因放弃治疗死亡;死亡患儿与存活患儿的母亲羊水过多、呼吸衰竭、腹膜炎、消化道穿孔的发生率的差异有统计学意义(P <0. 05)。结论:先天性消化道畸形以肛门直肠畸形最为常见,患儿母亲在妊娠期多有感染史和吸烟史,胎膜早破的发生率也较高,患儿以呕吐、腹胀为主要临床表现,术后并发症是影响患儿预后的主要因素。

Objective:To analyze the clinical characteristics and the prognostic factors of children with congenital malformations of digestive tract.Methods:36 cases of children with congenital malformations of digestive tract were selected as the research subjects.The gender,gestational period,the mode of conception,the mode of delivery,whether multiple pregnancy,clinical symptoms and the complications of the children were observed and analyzed.The mother′s age,the presence of excessive amniotic fluid,the presence of premature rupture of membranes,the complications during pregnancy,the conditions of folic acid application during pregnancy,the infection history during pregnancy,the smoking during pregnancy,the drug application during pregnancy,whether to live in a new house and the father′s smoking history were observed and analyzed.The prognosis of the children was observed and the related factors were analyzed.Results:Among the 36 cases,the anorectal atresia and the intestinal atresia were the most common malformations,accounting for 41.67%and 13.89%,respectively.Most mothers had a history of infection and smoking during pregnancy and a higher proportion of cesarean section and premature rupture of membranes.The main clinical manifestations of the children were vomiting and abdominal distention.4 cases died after operation or after transfer,and 5 died due to abandonment of treatment.There were statistically significant differences of the incidences of amniotic fluid hyperhydramnios in the mother and respiratory failure,peritonitis and digestive tract perforation in the children were between the dead children and the surviving children(P<0.05).Conclusion:Anorectal malformation is the most common congenital malformations of digestive tract.Most mothers of the children have a history of infections and smoking during pregnancy.The incidence of premature rupture of membranes is high.The main clinical manifestations of the children are vomiting and abdominal distention.Postoperative complications are the main factors affecting the prognosis of the children.