新生儿头颈部占位40例分析

Clinical analysis of 40 newborns with head and neck occupying lesions

目的探讨新生儿头颈部占位的临床特点、诊断与治疗。方法总结2014年1月至2019年11月郑州大学第一附属医院新生儿重症监护室收治的40例头颈部占位的新生儿病例,其中男23例,女17例,年龄2~28 d,对其临床特点、辅助检查、治疗情况进行分析。结果40例患儿中22例以呼吸困难入院,15例因发现口腔或头颈部肿物入院,2例以发热为首发症状,1例以声音嘶哑为首发症状。合并局部感染者5例。所有患儿均行局部超声及CT或MRI检查;9例出现严重呼吸困难者给予有创通气,其中有创通气超过48 h者6例次,需气管插管接人工鼻者4例次。治疗上行囊肿穿刺2例;行手术切除者31例;保守治疗7例。25例经病理检查确诊,包括软腭成熟畸胎瘤3例,硬腭畸胎瘤1例,(口腔下牙龈)颗粒细胞瘤1例,舌根间叶源性梭形细胞肿瘤1例,(右侧声门)息肉1例,(食管入口)息肉1例,舌根囊肿4例,喉囊肿1例,甲状舌管囊肿2例,淋巴管瘤2例,淋巴管瘤合并冬眠瘤1例,气管囊肿1例,食管囊肿1例,左侧颈部脓肿3例,枕部血管瘤1例,左侧颞顶部脓肿1例。结论新生儿期头颈部占位易致气道梗阻,影像学检查可辅助诊断,根据肿物性质不同,治疗方案不尽相同。

Objective To investigate the clinical features,diagnoses and treatments of head and neck occupying lesions in newborns.Methods All newborns with head and neck occupying lesions admitted to Neonatel Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University form January 2014 to November 2019 were included.There were 23 males and 17 females,admission age was from 2 d-28 d,and the clinical manifestations,examinations,treatments and outcomes were evaluated.Results Among 40 newborns with head and neck occupying lesions,22 cases were admitted with dyspnea,15 cases with masses in oral cavity or head and neck,2 cases with fever as the first symptom,and 1 case with hoarseness as the first symptom.There were 5 cases with local infection.All cases were examined with local ultrasound and CT or MRI.Nine cases with severe dyspnea were treated with invasive ventilationm,of them 6 cases underwent invasive ventilation for more than 48 hours,4 cases received tracheal intubation and artificial nose.Diagnostic punctures were performed in 2 cases.Seven cases received conservative treatments.Surgeries were performed in 31 cases,and 25 cases obtained pathologic diagnoses,including 3 cases of soft palate mature teratomas,1 case of hard palate teratoma,1 case of granulosa cell tumor,1 case of lobulated spindle cell tumor in tongue base,1 case of polyp in right glottis,1 case of polyp at esophageal entrance,4 cases of lingual root cysts,1 case of laryngeal cyst,2 cases of thyroglossal duct cysts,2 cases of lymphangiomas,1 case of lymphangioma with hibernoma,1 case of tracheal cyst,1 case of esophageal cyst,3 cases of left neck abscesses,1 case of occipital hemangioma,and 1 case of left temporoparietal abscess.Conclusions The head and neck occupying lesions in the newborn is prone to upper airway obstruction.Imaging examination can assist the diagnosis.Different treatments can be selected according to the natures of occupying lesions.