Tan Yunpu,He Qiuming,Zhong Wei,et al.Effects of prenatal diagnosis and postnatal sequential therapy for meconium peritonitis[J].Journal of Clinical Pediatric Surgery,2019,18(08):670-674.[doi:10.3969/j.issn.1671-6353.2019.08.011]
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
- Title:
- Effects of prenatal diagnosis and postnatal sequential therapy for meconium peritonitis
- Keywords:
- Peritonitis/DI; Peritonitis/TH; Prenatal Diagnosis
- 分类号:
- R656.4+1;R714.5;R714.7
- 摘要:
- 目的 探讨产前诊断与产后序贯治疗对胎粪性腹膜炎的治疗意义。方法 收集2014年4月至2018年4月在广州市妇女儿童医院新生儿外科住院，确诊为胎粪性腹膜炎（meconium peritonitits，MP）的患儿（n=46）作为研究对象，按是否行产前诊断及产后序贯治疗，分为产前诊断组（n=27）和产后诊断组（n=19）。产前诊断组均接受产前诊断及产后序贯治疗，产后诊断组为产后才诊断此病并进行治疗。比较两组在早产儿比例、出生体重、性别、MP病理类型、术前C反应蛋白（C-reactive protein，CRP）水平、入院时年龄、住院时间、住院费用、肠造瘘率、肠功能恢复时间、病死率和术后并发症等方面的差异。结果 两组在早产儿比例、性别、出生体重和MP病理类型方面差异无统计学意义（P>0.05）。产前诊断组入院年龄为（0.38±0.43）d，较产后诊断组[（6.89±10.74）d]更小，差异有统计学意义（t=-2.64，P=0.017）。产前诊断组术前CRP水平为（6.6±22.0）mg/L，较产后诊断组[（36.6±29.6）mg/L]低，差异有统计学意义（t=-2.43，P=0.019）。产前诊断组术后肠功能恢复时间为（13.85±8.84）d，较产后诊断组[（21.11±14.87）d]短，差异有统计学意义（t=-2.031，P=0.049）。两组手术患儿进一步比较，产前诊断组手术者造瘘率（61.54%）较产后诊断组手术者（100%）低（P=0.01）；术后肠功能恢复时间[（20.38±5.53）d]较产后诊断组手术者[（30.93±15.47）d]短，差异有统计学意义（t=-2.390，P=0.04）；住院时间[（23.69±6.15）d]较产后诊断组手术者[（33.71±16.21）d]短，差异有统计学意义（t=-2.152，P=0.046）。结论 产前诊断及产后序贯治疗有利于加快MP手术患儿的肠功能恢复，缩短住院时间，降低肠造瘘率，对于MP患儿的诊疗有积极的临床意义。
- Abstract:
- Objective To evaluate the effects of prenatal diagnosis and postnatal sequential therapy for meconium peritonitis (MP).Methods Retrospective review was conducted for the clinical data of 46 inpatients with a final diagnosis of MP from April 2015 to April 2018.According to whether or not adopting prenatal diagnosis and postnatal sequential therapy,they were divided into prenatal diagnosis group (n=27) (adopt prenatal and postnatal sequential therapy) and postnatal diagnosis group (n=19) (not adopt sequential therapy as control).The parameters of preterm neonate rate,birth weight,gender ratio,preoperative value of C-reactive protein (CRP),age at admission,length of hospital stay,total hospitalization cost,MP pathological type,operative ratio,enterostomy ratio,intestinal function recovery time,mortality and complications were reviewed.Results No significant inter-group differences existed in preterm neonate rate,gender ratio,MP pathological type and birth weight.The age at admission was significantly younger in prenatal diagnosis group than that of control group[(0.38±0.43) vs.(6.89±10.74) days,t=-2.64,P=0.017]; The preoperative CRP value was significantly lower in prenatal diagnosis group than that in control group[(6.6±22.0) vs.(36.6±29.6) mg/L,t=-2.43,P=0.019]; The intestinal function recovery time was significantly shorter in prenatal diagnosis group than that of control group[(13.85±8.84) vs.(21.11±14.87) days,P=0.049].For operated neonates in two groups,enterostomy ratio was significantly lower in operated children of prenatal diagnosis group than those of control group (61.54% vs.100%,P=0.01).In prenatal diagnosis group,intestinal function recovery time after surgery was faster than control group[(20.38±5.53) vs.(30.93±15.47) days,P=0.04); The length of hospital stay was shorter than control group[(23.69±6.15) vs. (33.71±16.21) days,P=0.046].Conclusion Prenatal and postnatal sequential therapy can shorten intestinal function recovery time,reduce the length of hospital stay and lower the enterostomy ratio for operated MP children.
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备注/Memo
收稿日期:2018-10-08。
基金项目:国家临床重点专科建设项目（编号：GJLCZD1301）
通讯作者:钟微,Email:manr68@126.com