Wu Ying,Ren Hongxi,Wu Xiaoxia,et al.Outcomes of integrated prenatal diagnosis and postpartum treatment of meconium peritonitis[J].Journal of Clinical Pediatric Surgery,2025,(04):351-355.[doi:10.3760/cma.j.cn101785-202409065-009]
胎粪性腹膜炎产前产后一体化诊治的结局探讨
- Title:
- Outcomes of integrated prenatal diagnosis and postpartum treatment of meconium peritonitis
- Keywords:
- Meconium Peritonitis; Peripartum Period; Disease Management; Pathological Conditions; Signs and Symptoms; Treatment Outcome; Root Cause Analysis
- 摘要:
- 目的 探讨胎粪性腹膜炎 (meconium peritonitis,MP) 产前产后一体化诊治的结局及临床意义。方法 回顾性分析2011年10月至2024年7月在山西省儿童医院新生儿外科接受手术治疗的81例MP患儿临床资料。根据是否接受产前产后一体化诊治分为产前产后一体化诊治组(27例)和产前产后非一体化诊治组(54例),比较两组患儿术前及术中一般资料、住院时间、病理类型、手术方式以及术后并发症的差异。将所有MP患儿按照临床结局分为放弃/死亡组(21例)和存活组(60例),将一体化诊治作为自变量进行影响因素分析,并通过多因素Logistic回归确定产前产后一体化诊治对MP预后的影响。结果 产前产后一体化诊治组术前C反应蛋白水平、放弃/死亡人数分别为0.50(0.50,2.37)g/L、2例(7.04%),低于非一体化诊治组的9.91(2.07,25.84)g/L、19例(35.2%),差异有统计学意义(P<0.001、P=0.007)。放弃/死亡组和存活组在是否接受产前产后一体化诊治(P=0.007)、病理分型(P=0.022)、术后并发短肠综合征(P=0.018)方面比较,差异有统计学意义(P＜0.05)。接受产前产后一体化诊治(OR=5.951,95%CI:1.175~30.144,P=0.031)为MP患儿预后较好的保护因素;合并短肠综合征(OR=0.199,95%CI:0.053~0.744,P=0.016)为MP患儿预后不良的危险因素。结论 产前产后一体化诊治可有效控制MP的病情进展,降低放弃/死亡的发生率,对改善预后有积极意义。
- Abstract:
- Objective To explore the clinical outcomes and significance of integrated prenatal diagnosis and postpartum treatment of meconium peritonitis (MP).Methods A retrospective analysis was conducted for the relevant clinical data of 81 neonates born with MP operated at Department of Neonatal Surgery,Children’s Hospital of Shanxi Province,from October 2011 to July 2024.According to whether the neonates received integrated prenatal diagnosis and postpartum treatment,they were assigned into two groups of integrated prenatal diagnosis and postpartum treatment (n=27) and non-integrated prenatal diagnosis and postpartum treatment (n=54).The inter-group differences in general perioperative profiles,length of hospitalization stay,pathological type,surgical approach and presence of postoperative complications were compared.Based upon clinical outcomes,they were also divided into two groups of abandonment/death (n=21) and survival (n=60).Integrated prenatal diagnosis and postpartum treatment was employed as an important influencing factor for comparing the inter-group differences in general profiles,pathological types and surgical approaches.Furthermore the prognostic impact of integrated prenatal diagnosis and postpartum treatment was examined through multifactorial Logistic regression analysis.Results Preoperative level of C-reactive protein (CRP) and case number of abandonment/death were lower in integrated prenatal diagnosis and postpartum treatment group than those in non-integrated prenatal diagnosis and postpartum treatment group .There were statistically significant differences (P<0.001,P=0.007).In clinical outcome groups,statistically significant differences existed in whether or not adopting integrated prenatal diagnosis and postpartum treatment,pathological typing and postoperative complications of short bowel syndrome (SBS) (P=0.007,P=0.022,P=0.018).Integrated prenatal diagnosis and postpartum treatment (OR=5.951,95%CI:1.175~30.144,P=0.031) was a protective factor for the prognosis of MP patients.And the presence of SBS was a risk factor for the prognosis of MP children (OR=0.199,95%CI:0.053~0.744,P=0.016).Conclusions Integrated prenatal diagnosis and postpartum treatment may effectively control the progression of MP,lower the rate of abandonment/mortality and have a positive significance for prognosis.
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备注/Memo
收稿日期:2024-3-25。
基金项目:山西省儿童医院院内课题(2023002)
通讯作者:任红霞,Email:renhongxia100@sina.com