Li Yuan,Li Tianyu,Su Pengjun,et al.Clinical characteristics of infants with meconium peritonitis diagnosed prenatally versus postnatally and analysis of factors affecting postoperative intestinal function recovery[J].Journal of Clinical Pediatric Surgery,2025,(12):1134-1139.[doi:10.3760/cma.j.cn101785-20251215-00118-008]
产前与出生后诊断胎粪性腹膜炎的临床特征差异及术后肠功能恢复影响因素分析
- Title:
- Clinical characteristics of infants with meconium peritonitis diagnosed prenatally versus postnatally and analysis of factors affecting postoperative intestinal function recovery
- Keywords:
- Prenatal Diagnosis; Meconium Peritonitis; Surgical Procedures; Operative; Intestinal Rehabilitation; Root Cause Analysis
- 摘要:
- 目的 探讨产前与出生后诊断的胎粪性腹膜炎(meconium peritonitis,MP)患儿在临床特征上的差异,并分析影响MP术后肠功能恢复的相关因素。方法 回顾性分析2015年1月至2025年1月中国医科大学附属盛京医院收治的MP患儿临床资料,按照诊断时间分为产前诊断组和出生后诊断组,比较两组患儿一般资料、早产情况、临床特征、呼吸机使用情况、手术方式、回盲瓣保留情况、术后禁食时间、术后肠外营养时间以及住院时间,并探讨上述因素对MP患儿术后肠功能恢复的影响。结果 73例规范治疗的MP患儿中，产前诊断56例，出生后诊断17例。产前诊断组患儿临床分型以肠梗阻型为主（38例，67.81%），出生后诊断组患儿以腹膜炎型为主（10例，56.25%），3例无症状型病例均为产前诊断；产前诊断组与出生后诊断组患儿临床分型差异具有统计学意义（P<0.05）。产前诊断组患儿住院天数为16.0（11.0,22.5）d，出生后诊断组患儿住院天数为12.5（10.0,15.0）d，差异具有统计学意义（P<0.05）。70例接受手术治疗的患儿术后禁食时间、术后肠外营养时间分别为9.0（8.0,12.0）d、11.0（9.0,15.0）d。接受一期肠吻合手术患儿的术后禁食天数短于接受肠造瘘手术患儿［6.5(8.0,11.0)d比9.0(8.0,13.0)d］，术中保留回盲瓣患儿的术后肠外营养天数短于未保留回盲瓣的患儿［10.0(8.5,13.5)d比12.0(10.0,16.5)d］，差异均有统计学意义（P<0.05）。与出生后诊断组相比，产前诊断组术后禁食天数延长［10.0(8.0,13.0)d比8.0(10.0,16.5)d］，术后肠外营养天数也延长［13.0(9.5,17.0)d比10.0(8.5,10.5)d］，差异均有统计学意义（P<0.05）。多因素分析表明，产前诊断是MP患儿术后肠功能恢复延迟的危险因素（OR=0.105,95%CI:0.012~0.897,P<0.05）。结论 多数MP患儿可获得产前诊断,产前诊断患儿的临床分型以肠梗阻型为主,部分产前诊断患儿可表现为无症状型MP;产前诊断患儿术后肠功能障碍持续时间长于出生后诊断患儿;产前诊断是MP患儿术后肠功能延迟恢复的危险因素。
- Abstract:
- Objective To investigate differences in clinical characteristics between infants with meconium peritonitis (MP) diagnosed prenatally and those diagnosed postnatally,and to analyze the impact of prenatal diagnosis and other related factors on postoperative intestinal function recovery in infants with MP. Methods Clinical data of infants with MP treated at Shengjing Hospital of China Medical University from January 2015 to January 2025 were retrospectively analyzed.According to the timing of diagnosis,patients were divided into a prenatal diagnosis group and a postnatal diagnosis group.General characteristics,prematurity,clinical features,ventilator use,surgical procedures,preservation of the ileocecal valve,duration of postoperative fasting,duration of postoperative parenteral nutrition,and length of hospital stay were compared between the two groups.The effects of the above factors on postoperative intestinal function recovery were analyzed. Results Among 73 infants with MP who received standardized treatment,56 were diagnosed prenatally and 17 postnatally.In the prenatal diagnosis group,the predominant clinical subtype was the intestinal obstruction type (38 cases,67.81%),whereas in the postnatal diagnosis group,the peritonitis type predominated (10 cases,56.25%).All three asymptomatic cases were diagnosed prenatally.The distribution of clinical subtypes differed significantly between the two groups (P<0.05).The length of hospital stay was 16.0(11.0,22.5) days in the prenatal diagnosis group and 12.5(10.0,15.0) days in the postnatal diagnosis group,with a statistically significant difference (P<0.05).Among 70 infants who underwent surgery,the postoperative fasting duration and postoperative parenteral nutrition duration were 9.0 (8.0,12.0) days and 11.0(9.0,15.0) days,respectively.Infants who underwent primary intestinal anastomosis had a significantly shorter postoperative fasting duration than those who underwent enterostomy ［6.5(8.0,11.0) days vs.9.0(8.0,13.0) days,P<0.05］.Infants in whom the ileocecal valve was preserved intraoperatively had a significantly shorter duration of postoperative parenteral nutrition than those without preservation ［10.0(8.5,13.5) days vs.12.0(10.0,16.5) days,P<0.05］.Compared with the postnatal diagnosis group,the prenatal diagnosis group had a significantly longer postoperative fasting duration ［10.0(8.0,13.0) days vs.8.0 (10.0,16.5) days,P<0.05］ and a significantly longer duration of postoperative parenteral nutrition ［13.0(9.5,17.0) days vs.10.0(8.5,10.5) days,P<0.01］.Multivariate analysis showed that prenatal diagnosis was a risk factor for delayed postoperative intestinal function recovery in infants with MP (OR=0.105,95%CI:0.012-0.897,P<0.05). Conclusions Most infants with MP can be diagnosed prenatally.In prenatally diagnosed infants,the intestinal obstruction type is the predominant clinical subtype,and some prenatally diagnosed infants may present with asymptomatic MP.Prenatally diagnosed infants experience a longer duration of postoperative intestinal dysfunction than those diagnosed postnatally.Prenatal diagnosis is a risk factor for delayed postoperative intestinal function recovery in infants with MP.
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备注/Memo
收稿日期:2025-12-15。
基金项目:辽宁省科技计划联合计划项目(辽科办发[2024]41号)
通讯作者:张志波,Email:zhangzb@sj-hospital.org