25例新生儿先天性乳糜胸及乳糜腹的临床特征及结局分析

Clinical feature and outcomes analysis in 25 cases of newborns with congenital chylothorax and chyloperitoneum

目的探讨新生儿先天性乳糜胸及乳糜腹的临床特征和住院结局。方法回顾性分析2011年1月至2018年12月于中国医科大学附属盛京医院住院并诊断先天性乳糜胸及乳糜腹的新生儿临床资料,按照结局分为存活组和死亡组,比较两组新生儿的临床特点。结果全部患儿25例,男女比例3.2∶1,胎龄30~39周,出生体重1620~4770 g,产前发现胸(腹)腔积液者20例(80.0%),胎儿水肿5例(20.0%)。乳糜胸21例(84.0%,5例合并乳糜腹),双侧乳糜胸14例(66.7%),单侧乳糜胸7例,其中右侧6例(85.7%),单纯乳糜腹4例(16.0%)。存活组15例,其中乳糜胸11例(73.3%),乳糜腹3例(20.0%),1例乳糜胸合并乳糜腹(6.7%)。死亡组共10例,均为早产儿,其中乳糜胸9例,7例为双侧乳糜胸(70.0%)。死亡组中位胎龄(33周)及出生体重(2486 g)明显低于存活组(38周和3342 g),产前诊断时平均胎龄[(30±1)周]明显低于存活组[(34±1)周],两组比较差异有统计学意义(P<0.05)。死亡组机械通气的比例明显高于存活组(P<0.05)。结论新生儿的出生胎龄、体重、产前诊断时胎龄等因素影响先天性乳糜胸及乳糜腹的生存结局,早产、宫内诊断时胎龄小及双侧乳糜胸者病死率高。

Objective To investigate the clinical features and outcome of congenital chylothorax and chyloperitoneum ascites in infants.Methods The clinical data of infants admitted to the Neonatal Department of Shengjing Hospital of China Medical University and diagnosed with congenital chylothorax and chyloperitoneum from January 2011 to December 2018 were analyzed retrospectively.According to outcome,the infants were assigned into survival group and death group.The clinical characteristics between the two groups were compared.Results The total cases were 25(the ratio of male to female is 3.2).The gestational age ranged from 30 to 39 weeks,and the birth weight was 1620 to 4770 g.There were twenty infants were diagnosed before delivery accounted for 80%.Five infants(20%)presented with fetal edema.There were twenty-one infants were diagnosed with congenital chylothorax(84.0%,5 with chyloperitoneum).Fourteen cases of congenital chylothorax were bilateral(66.7%),seven infants were unilateral,six infants(85.7%)were right-sided chylothorax.There four infants(16.0%)were diagnosed with chyloperitoneum.There were fifteen cases in the survival group,including eleven cases of chylothorax(73.3%),three cases of chyloperitoneum(20.0%),and one case of chylothorax combined with chyloperitoneum(6.7%).There were ten cases in the death group,all of which were premature infants,including nine cases of chylothorax and seven cases of bilateral chylothorax(70.0%).The median gestational age(33w)and birth weight(2486 g)of the death group was significantly lower than the survival group(38w and 3342 g),and the median gestational age when prenatal diagnosis[(30±1)weeks]was significantly lower than the survival group[(34±1)weeks].The difference between the two groups was statistically significant(P<0.05).The proportion of mechanical ventilation in the death group was significantly higher than the survival group(P<0.05).Conclusion The gestational age,birth weight,and the time of intrauterine diagnosis affect the outcome of congenital chylothorax and chyloperitoneum.The mortality rate is higher in premature,lower gestational age at the time of intrauterine diagnosis and bilateral chylothorax.