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目的探讨复杂性胎粪性腹膜炎胎儿产前超声征象与新生儿结局的关系。方法20例产前超声诊断复杂性胎粪性腹膜炎,出生后经影像学检查或开腹手术确诊的胎儿。产前行动态B超监测,大量腹水胎儿行腹水减量。新生儿怀疑肠梗阻或穿孔者,行剖腹探查术。结果复杂性胎粪性腹膜炎产前超声声像包括腹腔内钙化17/20(85%)、羊水过多13/20(65%)、腹水11/20(55%)、肠管扩张8/20(40%)、胎粪性假性囊肿3/20(15%)。新生儿手术率为10/20(50%),新生儿术后病死率2/10(20%)。KamataⅠ型和Ⅱ型较Ⅲ型手术率更高,分别为71.4%和41.7%,但差异无统计学意义(P=0.22)。KamataⅠ型和Ⅱ型较Ⅲ型生后病死率稍高,分别为14.3%和8.3%,但差异无统计学意义(P=0.61)。结论产前超声能预测胎儿复杂性胎粪性腹膜炎新生儿期手术风险。三级医院分娩、生后禁食、对有手术指征者及早手术有助于降低新生儿病死率。
Objective To investigate the relationship between fetal prenatal ultrasound signs and neonatal outcome in complicated meconium peritonitis. Methods 20 cases of prenatal ultrasound diagnosis of complicated meconium peritonitis, after birth by imaging or open surgery confirmed fetus. Prenatal dynamic B-monitoring, a large number of ascites fetal ascites reduction. Neonatal suspected intestinal obstruction or perforation who underwent exploratory laparotomy. Results Complications Prenatal ultrasonography of meconium peritonitis included intraperitoneal calcification 17/20 (85%), polyhydramnios 13/20 (65%), ascites 11/20 (55%), bowel dilation 8/20 (85% 40%), meconium pseudocyst 3/20 (15%). Neonatal surgery rate was 10/20 (50%), neonatal mortality after 2/10 (20%). Kamata type I and type II had a higher rate of operation than type III with 71.4% and 41.7% respectively, but the difference was not statistically significant (P = 0.22). The mortality rates of Kamata typeⅠand typeⅡ were slightly higher than those of type Ⅲ, which were 14.3% and 8.3% respectively, but the difference was not statistically significant (P = 0.61). Conclusion Prenatal ultrasound can predict the neonatal surgical risk of fetal complicated meconium peritonitis. Third-class hospital childbirth, fasting after birth, early indications of surgical indications help to reduce neonatal mortality.