[1]邹婵娟,李波,董洁,等.新生儿肠闭锁合并胎粪性腹膜炎患儿并发短肠综合征的临床特征分析[J].临床小儿外科杂志,2024,(12):1144-1148.[doi:10.3760/cma.j.cn101785-202308020-007]
　Zou Chanjuan,Li Bo,Dong Jie,et al.Analysis of clinical features of neonatal intestinal atresia complicated with meconium peritonitis in children of short bowel syndrome[J].Journal of Clinical Pediatric Surgery,2024,(12):1144-1148.[doi:10.3760/cma.j.cn101785-202308020-007]
点击复制

新生儿肠闭锁合并胎粪性腹膜炎患儿并发短肠综合征的临床特征分析

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 期数: 2024年12 页码: 1144-1148 栏目: 专题·出生缺陷的产前产后一体化诊治 出版日期: 2024-12-01
Title:
Analysis of clinical features of neonatal intestinal atresia complicated with meconium peritonitis in children of short bowel syndrome
作者:
邹婵娟1;  李波1;  董洁2;  李明1;  冯勇1;  夏仁鹏1;  周崇高1
1. 中南大学湘雅医学院附属儿童医院(湖南省儿童医院)胎儿与新生儿外科, 长沙 410007;
2. 中南大学湘雅医学院附属儿童医院(湖南省儿童医院)儿科医学研究所, 长沙 410007
Author(s):
Zou Chanjuan1;  Li Bo1;  Dong Jie2;  Li Ming1;  Feng Yong1;  Xia Renpeng1;  Zhou Chonggao1
1. Department of Fetal & Neonatal Surgery,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China;
2. Institute of Pediatric Medicine,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China
关键词:
胎粪性腹膜炎; 肠闭锁; 短肠综合征; 外科手术; 儿童
Keywords:
Meconium Peritonitis; Intestinal Atresia; Short Bowel Syndrome; Surgical Procedures; Operative; Child
DOI:
10.3760/cma.j.cn101785-202308020-007
摘要:
目的 探讨新生儿肠闭锁(intestinal atresia,IA)合并胎粪性腹膜炎(meconium peritonitis,MP)患儿并发短肠综合征(short bowel syndrome,SBS)的临床特征。方法 回顾性分析2019年1月至2023年5月湖南省儿童医院收治的33例诊断为肠闭锁合并胎粪性腹膜炎患儿的临床资料。将其中肠切除术后42 d不能脱离静脉营养者纳入短肠综合征组(SBS组),共14例,男7例、女7例,年龄2~30 d;术后42 d内完全恢复肠内营养者纳入非短肠综合征组(non-short bowel syndrome,non-SBS组),共19例,男12例、女7例,年龄4~33 d。对比分析两组患儿产前超声检查结果、性别、胎龄、出生体重、临床表现、手术资料、初次喂养时间、初次排便时间(经瘘口或肛门)、肠外营养时间、住院时间以及存活率。结果 本研究中SBS发生率为42.4%(14/33)。两组性别、胎龄、出生体重、入院年龄差异均无统计学意义(P>0.05);SBS组和Non-SBS组产前超声异常发生率分别为85.7%(12/14) 和42.1%(8/19),行高位肠造瘘术人数占比分别为78.6%(11/14)和31.6%(4/19),肠外营养时间分别为79(64,120)d和17(12,21)d,住院时间分别为87(48,125)d和24(17,30)d,差异均具有统计学意义(P＜0.05)。SBS组和Non-SBS组腹胀、呕吐、术前肠管扩张情况、手术后初次排便时间差异均无统计学意义(P>0.05),存活率分别为85.7%(12/14)和94.7%(18/19),差异无统计学意义(P>0.05)。结论 新生儿肠闭锁合并胎粪性腹膜炎患儿的胎儿期超声异常提示手术后出现SBS的机率更高,此类SBS经过规范治疗可以获得痊愈。
Abstract:
Objective To explore the clinical characteristics of intestinal atresia (IA) complicated by meconium peritonitis (MP) in neonatorum with short bowel syndrome (SBS). Methods From January 2019 to May 2023,the relevant clinical data were retrospectively reviewed for 33 IA children with MP.A total of 14 patients failing to disintegrate from intravenous nutrition at Day 4 post-operation were included in short bowel syndrome (SBS) group.There were 7 boys and 7 girls with an age range of (2-30) day.Another 19 children with a complete bowel recovery within 42d were included in non-short bowel syndrome (Non-SBS) group.There were 12 boys and 7 girls with an age range of (4-33) day.Prenatal ultrasonography,gender,gestational age,birth weight,clinical manifestations,surgical findings,initial feeding time,initial defecation time (through fistula or anus),parenteral nutrition time,hospitalization stay and survival rate were compared between two groups. Results The incidence of SBS was 42.4%(14/33).No significant inter-group differences existed in gender,gestational age,birth weight or age at admission (P>0.05).Abnormal rate of prenatal ultrasonography in SBS and non-SBS groups were 85.7%(12/14) and 42.1%(8/19),respectively.Proportion of children undergoing high enterostomy was 78.6%(11/14) and 31.6%(4/19),duration of parenteral nutrition 79(64,120) and 17(12,21) day and duration of hospitalization 87(48,125) and 24(17,30) day with statistical significance (P<0.05).No significant inter-group differences existed in abdominal distension,vomiting,preoperative intestinal dilation or initial defecation time (P>0.05).Survival rate of SBS and non-SBS groups was 85.7%(12/14) and 94.7%(18/19) with no statistical significance (P>0.05). Conclusions Abnormal fetal ultrasonography of neonatal intestinal atresia complicated with MP hints at a higher postoperative probability of SBS.This type of SBS may be cured conventionally.

参考文献/References:

[1] Pan EY,Chen LY,Yang JZ,et al.Radiographic diagnosis of meconium peritonitis.A report of 200 cases including six fetal cases[J].Pediatr Radiol,1983,13(4):199-205.DOI:10.1007/BF00973156.
[2] 祝菁,杨祖菁,王磊,等.胎粪性腹膜炎的产前诊断特点和预后[J].中华围产医学杂志,2016,19(6):432-435.DOI:10.3760/cma.j.issn.1007-94082016.06.008. Zhu J,Yang ZJ,Wang L,et al.Prenatal diagnoses and fetal outcomes of meconium peritonitis[J].Chin J Perinat Med,2016,19(6):432-435.DOI:10.3760/cma.j.issn.1007-94082016.06.008.
[3] 伍颖恒,王海玉,樊绮云,等.胎儿胎粪性腹膜炎的产前超声诊断及预后分析[J].中华围产医学杂志,2020,23(1):25-28.DOI:10.3760/cma.j.issn.1007-948.2020.01.005. Wu YH,Wang HY,Fan QY,et al.Prenatal ultrasonographic diagnosis and prognosis of fetal meconium peritonitis[J].Chin J Perinat Med,2020,23(1):25-28.DOI:10.3760/cma.j.issn.1007-948.2020.01.005.
[4] Olieman JF,Penning C,Ijsselstijn H,et al.Enteral nutrition in children with short-bowel syndrome:current evidence and recommendations for the clinician[J].J Am Diet Assoc,2010,110(3):420-426.DOI:10.1016/j.jada.2009.12.001.
[5] Nam SH,Kim SC,Kim DY,et al.Experience with meconium peritonitis[J].J Pediatr Surg,2007,42(11):1822-1825.DOI:10.1016/j.jpedsurg.2007.07.006.
[6] 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.
[7] He F,Yin Y,Huang L,et al.Using prenatal MRI to define features of meconium peritonitis:an overall outcome[J].Clin Radiol,2018,73(2):135-140.DOI:10.1016/j.crad.2017.08.006.
[8] Tseng JJ,Chou MM,Ho ESC.Meconium peritonitis in utero:prenatal sonographic findings and clinical implications[J].J Chin Med Assoc,2003,66(6):355-359.
[9] 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.
[10] Shinar S,Agrawal S,Ryu M,et al.Fetal meconium peritonitis-prenatal findings and postnatal outcome:a case series,systematic review,and meta-analysis[J].Ultraschall Med,2022,43(2):194-203.DOI:10.1055/a-1194-4363.
[11] Caro-Domínguez P,Zani A,Chitayat D,et al.Meconium peritonitis:the role of postnatal radiographic and sonographic findings in predicting the need for surgery[J].Pediatr Radiol,2018,48(12):1755-1762.DOI:10.1007/s00247-018-4198-5.
[12] Wang CN,Chang SD,Chao AS,et al.Meconium peritonitis in utero-the value of prenatal diagnosis in determining neonatal outcome[J].Taiwan J Obstet Gynecol,2008,47(4):391-396.DOI:10.1016/S1028-4559(09)60004-8.
[13] Kamata S,Nose K,Ishikawa S,et al.Meconium peritonitis in utero[J].Pediatr Surg Int,2000,16(5/6):377-379.DOI:10.1007/s003830000354.
[14] 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.
[15] Shyu MK,Shih JC,Lee CN,et al.Correlation of prenatal ultrasound and postnatal outcome in meconium peritonitis[J].Fetal Diagn Ther,2003,18(4):255-261.DOI:10.1159/000070806.
[16] Gupta P,Sharma R,Kumar S,et al.Role of MRI in fetal abdominal cystic masses detected on prenatal sonography[J].Arch Gynecol Obstet,2010,281(3):519-526.DOI:10.1007/s00404-009-1190-1.
[17] Miyake H,Urushihara N,Fukumoto K,et al.Primary anastomosis for meconium peritonitis:first choice of treatment[J].J Pediatr Surg,2011,46(12):2327-2331.DOI:10.1016/j.jpedsurg.2011.09.031.
[18] Jiang Y,Pan WH,Wu WJ,et al.Can early surgery improve the outcome of patients with meconium peritonitis? A single-center experience over 16 years[J].BMC Pediatr,2019,19(1):473.DOI:10.1186/s12887-019-1844-5.

相似文献/References:

[1]张生 金先庆 李晓庆 周德凯 向丽 刘伟. 先天性肠闭锁、肠狭窄120例临床分析[J].临床小儿外科杂志,2011,10(04):273.
　[J].Journal of Clinical Pediatric Surgery,2011,10(12):273.
[2]李光源 李婉冰 高梅玲. 肠闭锁产前诊断与产后诊疗21例体会[J].临床小儿外科杂志,2012,11(03):234.
　[J].Journal of Clinical Pediatric Surgery,2012,11(12):234.
[3]夏仁鹏 李碧香 周崇高. 先天性结肠闭锁18例诊治分析[J].临床小儿外科杂志,2014,13(05):412.
[4]吴典明 崔旭 林宇. 先天性肠闭锁113例预后分析[J].临床小儿外科杂志,2014,13(06):492.
[5]王娟,丁敏,印其友. PICC在新生儿先天性肠闭锁围手术期的应用[J].临床小儿外科杂志,2015,14(06):555.
[6]李艳云,刘雪来,崔钊,等.TLR4/TRIF信号参与Ⅰ型小肠闭锁隔膜组织黏膜免疫应答的组织学研究[J].临床小儿外科杂志,2023,22(02):180.[doi:10.3760/cma.j.cn101785-202202018-015]
　Li Yanyun,Liu Xuelai,Cui Zhao,et al.Histological observation of TLR4/MyD88 signaling pathway in septum arisen from type Ⅰ intestinal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(12):180.[doi:10.3760/cma.j.cn101785-202202018-015]
[7]蒋维维,唐维兵.肠闭锁的快速康复策略[J].临床小儿外科杂志,2023,22(09):801.[doi:10.3760/cma.j.cn101785-202306012-001]
　Jiang Weiwei,Tang Weibing.Enhanced recovery after surgery for intestinal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(12):801.[doi:10.3760/cma.j.cn101785-202306012-001]
[8]赖登明,钭金法.难治型肠闭锁的手术治疗策略[J].临床小儿外科杂志,2023,22(09):807.[doi:10.3760/cma.j.cn101785-202307011-002]
　Lai Dengming,Tou Jinfa.Surgical treatment strategies of refractory intestinal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(12):807.[doi:10.3760/cma.j.cn101785-202307011-002]
[9]李嘉骅,彭艳芬,吕俊健,等.早期肠内营养支持在难治型空回肠闭锁术后加速康复中的应用研究[J].临床小儿外科杂志,2023,22(09):813.[doi:10.3760/cma.j.cn101785-202305043-003]
　Li Jiahua,Peng Yanfen,Lyu Junjian,et al.Effect of early enteral nutrition on enhanced recovery after surgery for severe jejunoileal atresia[J].Journal of Clinical Pediatric Surgery,2023,22(12):813.[doi:10.3760/cma.j.cn101785-202305043-003]
[10]吴晓霞,刘文跃,张晖,等.新生儿肠闭锁术后短期预后不良危险因素分析[J].临床小儿外科杂志,2023,22(09):818.[doi:10.3760/cma.j.cn101785-202306009-004]
　Wu Xiaoxia,Liu Wenyue,Zhang Hui,et al.Risk factors of poor short-term prognosis in neonatal intestinal atresia children[J].Journal of Clinical Pediatric Surgery,2023,22(12):818.[doi:10.3760/cma.j.cn101785-202306009-004]

备注/Memo

收稿日期:2023-8-17。
基金项目:湖南省出生缺陷协同防治科技重大专项(2019SK1015)
通讯作者:周崇高,Email:zhoucg_hnch@163.com

更新日期/Last Update: 2024-12-28