临床小儿外科杂志2024，Vol.23Issue(12)：1138-1143,6.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
Clinical characteristics and outcomes of children of meconium peritonitis in perinatal integrated man-agement model
摘要
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 treat-ments,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.Prena-tal 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-ab-dominal calcification(17/101,16.83％).The predominant types were peritonitis(55.45％),intestinal ob-struction(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(x2=7.456,P=0.024).Surgerical rates were significantly higher in the prenatal group(90.10％vs.57.89％x2=10.605,P=0.001).No significant differences were observed between groups in initial surgery duration[(120.62±39.80)min vs.(110.10±14.59)min,t=1.691,P=0.102)],primary anastomosis rate(53.85％vs.36.36％,x2=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[(13.44±12.75)d vs.(24.88±28.01)d,t=-1.606,P=0.128)],parenteral nutrition[(25.26±19.17)d vs.(30.33±22.98)d,t=-0.927,P=0.356)],hospitalization days[(37.35±28.3)d vs.(30.6±27.75)d,t=0.944,P=0.347)],or hospitalization costs[(86,400±65,300 yuan vs.68,000±54,100 yuan,t=1.126,P=0.263)].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％)(x2=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(x2=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.关键词
胎粪性腹膜炎/围产期/疾病管理/产前诊断/超声检查,产前/产后期,诊断/学科间信息交流Key words
Meconium Peritonitis/Perinatal Care,Disease Management/Prenatal Diagnosis/Ultra-sonography,Prenatal/Postnatal Diagnosis/Interdisciplinary Communication引用本文复制引用
何炜婧,孙松,郑珊,董岿然,沈淳..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[J].临床小儿外科杂志,2024,23(12):1138-1143,6.基金项目
国家临床重点专科建设项目(10000015Z155080000004) National Clinical Key Specialty Construction(10000015Z155080000004) （10000015Z155080000004）
