He Weijing,Sun Song,Zheng Shan,et al.Clinical characteristics and outcomes of children of meconium peritonitis in perinatal integrated management model[J].Journal of Clinical Pediatric Surgery,2024,(12):1138-1143.[doi:10.3760/cma.j.cn101785-202410001-006]
围产期一体化管理模式下胎粪性腹膜炎患儿临床特征与结局探讨
- Title:
- Clinical characteristics and outcomes of children of meconium peritonitis in perinatal integrated management model
- Keywords:
- Meconium Peritonitis; Perinatal Care; Disease Management; Prenatal Diagnosis; Ultrasonography; Prenatal; Postnatal Diagnosis; Interdisciplinary Communication
- 摘要:
- 目的 胎粪性腹膜炎(meconium peritonitis,MP)是新生儿常见急腹症之一。本文旨在探讨经围产期一体化管理获得产前诊断的MP患儿临床特点以及围产期一体化管理模式对于MP患儿结局的影响。方法 本研究为回顾性研究,收集2014年1月至2023年12月复旦大学附属儿科医院收治的MP患儿临床资料,根据是否获得产前诊断及接受围产期一体化管理分为产前诊断组和生后诊断组。产前诊断组采取围产期一体化管理模式,生后由新生儿专业团队转运至本中心进一步诊治。生后诊断组以腹胀或呕吐就诊,经腹部X线检查诊断为MP。对比两组患儿基本信息、临床分型、手术方式、术后治疗情况及临床结局。结果 本研究纳入MP患儿共120例,产前诊断组101例,生后诊断组19例;男69例,女51例;出生胎龄(36.07±2.68)周,出生体重(2.93±0.69)kg。5例术前放弃治疗;13例无明显肠梗阻表现,经保守治疗后好转出院;其余102例接受手术治疗,包括48例肠造瘘术、53例一期肠吻合术、1例腹腔引流术。产前诊断组诊断孕周(29.85±4.81)周,产前超声发现异常包括肠管扩张36例(36/101,35.64%),腹腔囊肿27例(27/101,26.73%),腹腔积液21例(21/101,20.79%),腹腔钙化灶17例(17/101,16.83%);分型为腹膜炎型56例(55.45%),肠梗阻型35例(34.65%),无症状型10例(9.9%)。生后诊断组中,腹膜炎型10例(52.63%),无症状型6例(31.58%),肠梗阻型3例(15.79%)。两组MP分型差异有统计学意义(χ2=7.456,P=0.024)。产前诊断组接受手术人数占比90.10%(91/101),均为腹膜炎型和肠梗阻型;生后诊断组手术人数占比57.89%(11/19),较产前诊断组低,差异有统计学意义(χ2=10.605,P=0.001),其中5例术前家长放弃治疗。产前诊断组和生后诊断组首次手术时长、一期肠吻合率(53.85%比36.36%,χ2=1.285,P=0.257)、关瘘时间[(94.34±40.54)d 比 (99.60±44.54)d,t=-0.264,P=0.793)、最终剩余小肠长度、术后抗生素使用天数、肠外营养使用天数、住院天数以及住院费用比较,差异均无统计学意义(P＞0.05)。产前诊断组放弃治疗或死亡 13例,生后诊断组放弃治疗或死亡7例,产前诊断组存活率(88/101,87.13%)高于生后诊断组(12/19,63.16%),差异有统计学意义(χ2=5.003,P=0.025)。产前诊断组并发症发生率低于生后诊断组(6.59%比18.18%),但差异无统计学意义(χ2=3.148,P=0.206)。结论 经产前诊断并采取围产期一体化管理模式的MP以腹膜炎型和肠梗阻型为主要类型,需在生后尽早手术。围产期一体化管理模式可使MP患儿得到及时的个性化治疗,家长治疗意愿和依从性较高,总体存活率较生后诊断的MP更高,疗效良好。
- Abstract:
- Objective Meconium peritonitis (MP) is a common neonatal surgical emergency.This study explores the clinical characteristics of MP diagnosed prenatally under a perinatal integrated management model and the model’s impact on outcomes for MP patients. Methods A retrospective study was conducted on MP cases treated at the Children’s Hospital of Fudan University from January 2014 to December 2023.Patients were divided into a prenatal diagnosis group (n=101) and a postnatal diagnosis group (n=19) based on the timing of diagnosis and whether they received perinatal integrated management.The prenatal diagnosis group received integrated perinatal care and was transferred postnatally to a specialized neonatal team for further treatment.The postnatal diagnosis group presented with symptoms such as abdominal distension or vomiting and was diagnosed with MP via abdominal X-rays.Basic information,clinical classifications,surgical methods,postoperative treatments,and clinical outcomes were compared between the two groups. Results A total of 120 MP cases were included:101 in the prenatal diagnosis group.Male-to-female ratio was 69:51; mean gestational age was 36.07±2.68 weeks,and mean birth weight was 2.93±0.69 kg.Five cases discontinued treatment before surgery,and 13 were treated conservatively and discharged after improvement.Among the remaining 102 cases,surgical interventions included 48 stoma surgeries,53 primary anastomoses,and 1 peritoneal drainage procedure.Prenatal diagnosis was made at 29.85±4.81 weeks of gestation,with abnormal ultrasound findings such as intestinal dilation (36/101,35.64%),abdominal cysts (27/101,26.73%),ascites (21/101,20.79%),and intra-abdominal calcification (17/101,16.83%).The predominant types were peritonitis (55.45%),intestinal obstruction (34.65%),and asymptomatic (9.9%).In the postnatal group,the distribution was peritonitis (52.63%),asymptomatic (31.58%),and intestinal obstruction (15.79%),with a statistically significant difference in MP types between the groups (χ2=7.456,P=0.024).Surgerical rates were significantly higher in the prenatal group (90.10% vs.57.89%,χ2=10.605,P=0.001).No significant differences were observed between groups in initial surgery duration ,primary anastomosis rate (53.85% vs.36.36%,χ2=1.285,P=0.257),time to stoma closure[(94.34±40.54) d vs.(99.60±44.54) d,t=-0.264,P=0.793),residual small intestinal length [(110.00±29.94) cm vs.(94.29±13.97) cm,t=1.369,P=0.175)],duration of postoperative antibiotics ,parenteral nutrition [(25.26±19.17) d vs.(30.33±22.98) d,t=-0.927,P=0.356)],hospitalization days,or hospitalization costs.In the prenatal diagnosis group,13 cases resulted in treatment withdrawal or death,compared to 7 cases in the postnatal diagnosis group.The survival rate in the prenatal diagnosis group (88/101,87.13%) was significantly higher than that in the postnatal diagnosis group (12/19,63.16%)(χ2=5.003,P=0.025).The complication rate in the prenatal diagnosis group (6.59%) was lower than that in the postnatal diagnosis group (18.18%),but the difference was not statistically significant (χ2=3.148,P=0.206). Conclusions MP cases diagnosed prenatally under a perinatal integrated management model are primarily of the peritonitis and intestinal obstruction types,necessitating early surgical intervention.This model enables personalized treatment,improves parental compliance,and results in higher survival rates and better outcomes compared to postnatally diagnosed cases.
参考文献/References:
[1] 沈淳.胎粪性腹膜炎与胎儿腹腔钙化[J].临床外科杂志,2011,19(8):513-514.DOI:10.3969/j.issn.1005-6483.2011.08.002. Shen C.Meconium peritonitis and fetal intra-abdominal calcification[J].J Clin Surg,2011,19(8):513-514.DOI:10.3969/j.issn.1005-6483.2011.08.002.
[2] 何炜婧,朱海涛,董岿然,等.产前多学科会诊模式优化对结构畸形胎儿结局的影响[J].中华围产医学杂志,2024,27(6):477-483.DOI:10.3760/cma.j.cn113903-20230721-00025. He WJ,Zhu HT,Dong KR,et al.Effects of prenatal multidisciplinary consultation on outcomes of fetuses with structural anomalies[J].Chin J Perinat Med,2024,27(6):477-483.DOI:10.3760/cma.j.cn113903-20230721-00025.
[3] 倪鑫,孙宁,张潍平.中华医学百科全书·小儿外科学[M].北京:中国协和医科大学出版社,2023:415-416. Ni X,Sun N,Zhang WP.Chinese medical encyclopedia clinical medicine pediatric surgery[M].Beijing:Peking Union Medical College Press,2023:415-416.
[4] Chan KL,Tang MHY,Tse HY,et al.Meconium peritonitis:prenatal diagnosis,postnatal management and outcome[J].Prenat Diagn,2005,25(8):676-682.DOI:10.1002/pd.1221.
[5] 黄轩,方群.胎粪性腹膜炎的产前诊断和处理[J].国际妇产科学杂志,2006,33(6):395-398.DOI:10.3969/j.issn.1674-1870.2006.06.006. Huang X,Fang Q.Prenatal diagnosis and management of meconium peritonitis[J].J Int Obstet Gynecol,2006,33(6):395-398.DOI:10.3969/j.issn.1674-1870.2006.06.006.
[6] Wong CWY,Wong KKY.Meconium peritonitis:a 22-year review in a tertiary referral center[J].J Pediatr Surg,2022,57(8):1504-1508.DOI:10.1016/j.jpedsurg.2021.10.006.
[7] Li MM,Lu CX,Wang Q,et al.Does prenatal diagnosis of meconium peritonitis have the better recovery? A single-center over 10 years of experience[J].Pediatr Surg Int,2024,40(1):94.DOI:10.1007/s00383-024-05682-4.
[8] Lu YT,Ai B,Zhang WJ,et al.Fetal magnetic resonance imaging contributes to the diagnosis and treatment of meconium peritonitis[J].BMC Med Imaging,2020,20(1):55.DOI:10.1186/s12880-020-00453-8.
[9] Zheng XQ,Wu DM,Chen X,et al.Analysis of the clinical diagnosis and treatment of fetal meconium peritonitis[J].J Matern Fetal Neonatal Med,2024,37(1):2250045.DOI:10.1080/14767058.2023.2250045.
[10] Ping LM,Rajadurai VS,Saffari SE,et al.Meconium peritonitis:correlation of antenatal diagnosis and postnatal outcome-an institutional experience over 10 years[J].Fetal Diagn Ther,2017,42(1):57-62.DOI:10.1159/000449380.
[11] 谈蕴璞,何秋明,钟微,等.产前诊断与产后序贯治疗对胎粪性腹膜炎患儿临床结局的影响[J].临床小儿外科杂志,2019,18(8):670-674.DOI:10.3969/j.issn.1671-6353.2019.08.011. Tan YP,He QM,Zhong W,et al.Effects of prenatal diagnosis and postnatal sequential therapy for meconium peritonitis[J].DOI:10.3969/j.issn.1671-6353.2019.08.011.
[12] 王莹,马立霜,刘超,等.产前诊断先天性膈疝的转运救治机制与临床实证分析[J].临床小儿外科杂志,2022,21(1):58-62.DOI:10.3760/cma.j.cn.101785-202107031-011. Wang Y,Ma LS,Liu C,et al.Transfer and treatment mechanism and practical effect analysis of prenatally diagnosed congenital diaphragmatic hernia[J].J Clin Ped Sur,2022,21(1):58-62.DOI:10.3760/cma.j.cn.101785-202107031-011.
[13] Sato M,Hamada Y,Kohno M,et al.Neonatal gastrointestinal perforation in Japan:a nationwide survey[J].Pediatr Surg Int,2017,33(1):33-41.DOI:10.1007/s00383-016-3985-z.
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备注/Memo
收稿日期:2024-10-3。
基金项目:国家临床重点专科建设项目(10000015Z155080000004)
通讯作者:沈淳,Email:chshen0521@126.com