新生儿腹部急症救治体会:附37例报告

Clinical experience on the emergency treatment of the newborn infants with abdominal emergency: Attached with 37 cases report

为探讨新生儿腹部急症的诊断和治疗,对1999年6月～2001年12月收治的37例患儿进行回顾性分析,其中男24例,女13例;入院年龄为生后1～27天,平均10天;发病时间为出生当天～20天。根据临床表现、腹部直立位平片及有关影像学检查分为消化道梗阻19例,消化道穿孔3例,腹腔脏器外露4例,外科性呼吸窘迫2例,腹部巨大肿块1例,消化道功能紊乱8例。其中11例经综合对症治疗症状缓解,21例进行手术治疗,3例放弃手术探查,2例暂缓手术回家随访。经临床、手术及病理提示,25例为先天性畸形。资料显示:新生儿腹部急症大多有胚胎发育异常造成先天性畸形的基础,肠梗阻发生率高,常伴多发性畸形;需对临床病情动态观察,及时予以辅助检查,重视把握保守治疗和手术指征及手术原则,予以综合对症治疗。提示了解新生儿腹部急症的特点、早期诊断和及时治疗是提高生存率的关键。

In order to explore the diagnosis and treatment for the newborn infants with abdominal emergency, the clinical data of 37 cases admitted to the Shanghai Children's Medical Center from June 1999 to December 2001 was reviewed. Of them, 24 boys, 13 girls, the age on admission was from 1-27 days . Mean value was ten days after birth. The day for initial presentation appeared from just on the day after birth to the 20 days later. According to the clinical presentation, abdominal upright position X-ray film and related imaging examination, these patients could be divided into the following: 19 cases with gastro-intestinal obstruction, 3 cases with digestive tract perforation, 4 cases with extroversion of the organs, 2 cases with surgical respiratory distress, 1 case with huge mass in abdomen and 8 cases with digestive tract dysfunction. Of them 11 cases got improvement with comprehensive symptomatic treatment,21 cases received operation, 3 cases abandoned to have laparotomy,2 cases delayed to receive operation for the time-being and went home for following-up. With the clinical observation, operation and pathological examination, 25 cases were confirmed to have congenital malformation indicating most of the newborn infants with abdominal emergencies had congenital malformation based on the abnormality of the embryonic growth and development with high incidence of intestinal obstruction and potentiality of multiple deformations. So, it is important to make careful clinical dynamic observation and supplementary examinations. Much attention should be paid to control the principles for conservative treatment and operation as well as the indication for operation, also it is ne cessary to give them the comprehensive treatment. After all, the key point for improving the survival rate is to realize the characteristics of the newborn infants with abdominal emergencies and make early diagnosis as well as the time intervention.