摘要
目的分析新生儿消化道畸形的主要临床特点,探讨有效的早期检查方法,以促进消化道畸形的早期诊断与早期干预,改善患儿预后。方法收集2019年1月至2021年12月经南京医科大学附属儿童医院手术证实为消化道畸形的新生儿资料(包括性别、入院日龄、首发症状时间、出生体重、住院天数),消化道畸形疾病构成及主要临床特点,术前相关检查及诊断准确率。本研究共收集到资料完整病例507例,包括肛门直肠畸形(166例)、肠闭锁和肠狭窄(93例)、先天性肥厚性幽门狭窄(84例)、肠旋转不良(72例)、环状胰腺(43例)、胃肠重复畸形(11例)、肠神经发育异常症(11例)、先天性胃壁肌层缺损(9例)、脐肠瘘(7例)、胎粪性腹膜炎(7例)、梅克尔憩室(2例)、先天性肠系膜畸形(2例),其中男376例,女131例,足月儿433例,出生体重为(3157.53±596.50)g。肛门直肠畸形病例共166例,其中27例因原始影像结果测量数据缺失未纳入统计,其余139例肛门直肠畸形患儿按照手术方式分为会阴肛门成形术组(76例)和结肠造口术组(63例)。比较两组腹部倒立侧位X线检查直肠盲端至肛隐窝的距离,并通过受试者工作特征曲线(receiver operating characteristic curve,ROC)评估直肠盲端至肛隐窝距离对手术方式选择的指导价值。结果消化道畸形患儿总体入院日龄为生后2.0(1.0,8.0)d,首发症状时间为生后1.0(1.0,4.5)d,住院时间为13.0(8.0,19.0)d。新生儿消化道畸形以肛门直肠畸形、肠闭锁和肠狭窄、先天性肥厚性幽门狭窄常见,临床表现主要为呕吐(311/507,61.34%)、腹胀(239/507,47.14%)及胎便异常(159/507,31.36%)。术前X线检查阳性479例,总体阳性率达94.48%;腹部超声检查阳性186例,阳性率36.69%;产前超声检查异常116例,阳性率22.88%。ROC分析结果表明,直肠盲端至肛隐窝距离对手术方式的选择具有指导意义,准确率为73.2%,最佳阈值20.5 mm,敏感性为74.6%,特�
Objective To explore effective early detection methods,promote the early diagnosis and intervention of gastrointestinal malformations and improve the prognosis through examining the major clinical features of gastrointestinal malformations during neonatal period.Methods From January 2019 to December 2021,complete clinical data were retrospectively reviewed for 507 neonates with surgically confirmed gastrointestinal malformations.Gender,age at admission,time of symptom onset,birth weight,length of hospital stay,composition and major symptoms and accuracy of preoperative examinations were recorded.There were anorectal malformation(n=166),intestinal atresia&stricture(n=93),congenital hypertrophic pyloric stenosis(n=84),intestinal malrotation(n=72),annular pancreas(43 cases),gastrointestinal tract duplication(n=11),enteric neuropathies(n=11),congenital gastric wall muscle defect(n=9),umbilical intestinal fistula(n=7),meconium peritonitis(n=7),Meckel s diverticulum(n=2),and congenital mesenteric malformation(n=2).There were 376 boys and 131 girls with a birth weight of(3157.53±596.50)g.And 433 of them were full-term.A total of 139 cases were collected by measuring the distance from blind rectal end to anal recess on abdominal upside down lateral radiograph.The other 27 cases were not included in the statistics due to the lack of measurement data of the original imaging results.Receiver operating characteristic curve(ROC)analysis of perineal anoplasty(n=76)and colostomy groups(n=63)was performed.Results The median age of admission was 2.0(1.0,8.0)days after birth,the median time to first symptoms 1.0(1.0,4.5)days after birth and the median length of hospital stay 13.0(8.0,19.0)days.Anorectal malformation,intestinal atresia&strictureand congenital hypertrophic pyloric stenosis were the most common digestive tract malformations in the neonatal period.The major clinical manifestations were vomiting(311/507,61.34%),abdominal distension(239/507,47.14%)and abnormal meconium(159/507,31.36%).Preoperative radiographic examinat
作者
李红星
唐维兵
Li Hongxing;Tang Weibing(Department of Neonatal Surgery,Affiliated Children s Hospital,Nanjing Medical University,Nanjing 210008,China)
出处
《临床小儿外科杂志》
CAS
CSCD
2022年第9期820-826,共7页
Journal of Clinical Pediatric Surgery
基金
国家自然科学基金面上项目(81870372)。
