新生儿胃肠道穿孔

由于早产儿及围产期窘迫的新生儿存活者增加,以往罕见的新生儿胃肠道穿孔也逐渐增多。作者分析1978～1986年间经手术和尸检确诊的此症患儿48例,男女婴各26及22例,低体重儿38例,早产儿36例。产妇有流产史者11例,胎膜早破及多产各7例,前置胎盘6例,妊高征4例,羊膜炎、羊水过多及胎盘早剥各2例。20例剖腹产及4例胎头吸引或产钳分娩。新生儿窒息21例,动脉导管未闭18例(13例使用消炎痛),肺透明膜病15例,颅内出血3例。穿孔发生前24例婴儿需机械通气,6例经脐动脉输血。21例早产儿因呼吸暂停曾用氨茶硷。30例婴儿在出生后第一周发病,10例在第二周,出生后第5天发病最多。体征以腹胀、呕吐、胃内容物残留、便血、呼吸窘迫,腹壁褪色等多见。亦可有体温过低、呼吸暂停伴心动过缓、低血压、腹泻     

新生儿继发性血小板增多症临床分析

目的分析继发性血小板增多症新生儿的发病情况、有无脏器损伤及治疗与预后。方法对1 500例住院患儿采用全自动血细胞计数仪检测,其中52例2次血小板计数≥500×109/L,诊断为血小板增多症。同期随机选取血小板正常的患儿100例作为对照组。结合临床资料进行分析比较。结果血小板增多症患儿中新生儿肺炎19例(36.5%),新生儿高胆红素血症25例(48.0%),新生儿败血症3例(5.7%),其他5例(9.6%)。血小板增多症患儿住院时间较非血小板增高症患儿住院时间延长,差异有统计学意义(P0.05)。血小板计数在3d至2个月恢复正常,平均(15.6±13.3)d。病程中未发生出血、血栓形成及心脏病等并发症。结论血小板增多症是新生儿肺炎、新生儿高胆红素血症等疾病的常见并发症。血小板增高新生儿无肝功及心肌酶异常表现。血小板增高症患儿住院时间延长。新生儿血小板增多症为良性疾病,预后良好。     

早产儿颅内出血的头颅CT筛查与预后分析

目的　了解早产儿颅内出血 (ICH)的发病情况、CT表现及预后。　方法　对 896例早产儿进行头颅 CT筛查 (生后 5～ 7d) ,随访 16 0例 ICH患儿 ,定期复查头颅 CT及进行智能发育检查 ,分析随访结果。　结果　 896例早产儿中发现 ICH2 38例 ,ICH检出率 2 6 .6 % ,有围产期缺氧史及临床症状者 189例 (79.4% ) ,无明显临床症状 49例 (2 0 .6 % )。 ICH部位依次为蛛网膜下腔出血(SAH) 16 8例 (70 .6 % ) ,脑室周围 -脑室内出血 (SEH/IVH ) 4 8例 (2 0 .2 % )其中 45例为胎龄 <32周者 ,脑实质出血 (IPH ) 16例 (6 .7% ) ,小脑出血 (ICEH ) 6例 (2 .5 % )。 2 38例中死亡 5 2例 ,病死率 2 1.8%。随访 16 0例 ,正常 111例 (6 9.4% ) ,后遗症 49例 (30 .6 % ) ,主要表现为智能落后、脑瘫、癫。SAH预后较好 ,后遗症发生率 12 .8% (16 /12 5例 ) ,SEH/IVH、IPH、ICEH预后均差 ,后遗症发生率分别为 92 .6 % (2 5 /2 7例 )、5 /5例、3/3例。　结论　早产儿 ICH易漏诊 ,头颅 CT筛查是必要的 ,预后与ICH部位关系密切 ,后遗症发生率高 ,应以预防为主。     

先天性膈疝的子宫外产时处理与预后探讨

目的探讨先天性膈疝孕妇及新生儿临床特点,建立先天性膈疝产时处理流程规范,提高先天性膈疝患儿围产期生存率。方法回顾性分析中国医科大学附属盛京医院2008年1月至2016年12月收治的23例先天性膈疝患者临床资料。结果 23例患儿均接受子宫外产时处理(EXIT)手术,20例患儿出生后行膈肌修补术,2例患儿放弃治疗,1例患儿暂未手术。远期随访19例患儿生存,2例失访。结论轻中度先天性膈疝患儿孕期通过超声诊断后应转入产前诊断中心,密切监测并完善相关检查,分娩时多学科合作行EXIT手术,并在新生儿呼吸、循环系统功能稳定后行膈疝修补手术,能够得到良好的预后结局。     

双胎妊娠一胎胎死宫内90例妊娠结局分析

目的:探讨双胎妊娠一胎胎死宫内(sIUFD)的临床特点及妊娠结局。方法:回顾性分析2016年9月至2021年1月昆明医科大学第一附属医院收治的90例sIUFD的临床资料,其中单绒毛膜(MC)双胎(31例),双绒毛膜(DC)双胎(59例)。分析不同绒毛膜性sIUFD存活胎儿的预后,sIUFD存活胎儿终止妊娠的时间、分娩方式等。结果:(1)sIUFD孕妇存活胎儿妊娠丢失14例(15.6%),其中流产6例,引产8例(胎死宫内5例,胎儿异常3例)。MC双胎存活胎儿胎死宫内、早产发生率高于DC双胎(P<0.05);两组间存活胎儿活产、新生儿窒息、转NICU、新生儿脑损伤、新生儿死亡的发生率差异均无统计学意义(P>0.05)。(2)发现sIUFD后24小时内终止妊娠7例,其中2例双胎输血综合征(TTTS)存活胎死亡。MC双胎与DC双胎相比,发生sIUFD距分娩间隔时间较短(P<0.05),分娩孕周较早(P<0.05)。(3)新生儿窒息率、转NICU率、新生儿死亡率在阴道分娩与剖宫产中比较,差异无统计学意义(P>0.05)。结论:MC双胎发生sIUFD存活胎儿发生胎死宫内及早产的不良妊娠结局风险明显增加,应加强监测。sIUFD不是剖宫产术终止妊娠的指征,阴道分娩并不增加新生儿不良预后的发生率。     

产时手术在治疗出生缺陷儿及改善其预后中的价值

目的 探讨产时手术在治疗出生缺陷儿及改善其预后中的价值.方法 2008年8月至2009年11月,在中国医科大学附属盛京医院母胎医学中心通过彩色三维多普勒超声(彩超)筛查出有胎儿出生缺陷(淋巴管瘤和脐膨出各3例,膈疝和腹裂各2例,骶尾部畸胎瘤1例)的11例病例,通过MRI检查和胎儿染色体核型分析,明确为可行外科手术治疗的先天性疾病.11例产妇均行子宫下段剖宫产术及产时手术治疗出生缺陷儿,其中将胎儿取出宫外不断脐带的产时胎儿手术3例(膈疝修补术2例、骶尾部畸胎瘤切除术1例);子宫外产时处理(EXIT)后行产房外科手术6例(腹裂和巨型脐膨出修补术各2例、颈部和面部淋巴管瘤切除术各1例);分娩后立即行产房外科手术2例(脐膨出修补术和胸壁淋巴管瘤切除术各1例).对产妇进行常规的产后复查.随访出生缺陷儿手术后的生长发育及营养状态.结果 (1)手术结果:11例产妇均行剖宫产术娩出胎儿行产时手术治疗.其中3例实施产时胎儿手术治疗,手术时间平均为89 min;6例先对胎儿实施EXIT,在保持胎儿胎盘循环的情况下完成气管插管,EXIT平均时间为5.5 min,然后切断脐带,实施新生儿产房外科手术治疗;2例实施单纯产房外科手术,平均时间为37 min.除重度膈疝新生儿术后3.5 h死亡外,其他10例出生缺陷儿术后均存活至今.11例产妇剖宫产术及出生缺陷儿手术的母体平均失血量为275 ml,11例产妇术后均无发热及感染征象,子宫复旧良好,手术切口愈合良好.所有病例均未输血治疗,术后3～5 d出院.(2)随访结果:10例出生缺陷儿术后分别于1～18个月到我院儿科发育门诊随访,患儿体质量及身长等发育正常.其中,1例腹裂患儿术后1个月由于肠管旋转不良,喂养不耐受,体质量小于同龄婴儿,给予体位疗法治疗后,现喂养良好,体质量增加,术后4个月发育至正常水平.轻度膈疝患儿于术后2个月发生肺部感染,住院治疗2周后好转,患侧胸部X线片提示肺气胸比约1/4,术后6个月发现动脉导管未闭,复查胸部X线片,患侧肺叶几近全部扩张正常.1例巨型脐膨出患儿术前诊断为先天性轻度室间隔缺损,1年后复查心功能未受影响.骶尾部畸胎瘤患儿术后无自主排尿,10 d后排尿基本正常,1个月后排尿完全正常.结论 产时手术治疗可迅速终止疾病进一步发展,并明显改善出生缺陷儿的预后.     

妊娠合并急性主动脉夹层4例临床资料分析

目的:探讨妊娠合并急性主动脉夹层(AAD)的预防、诊断、治疗及预后。方法:回顾分析上海长海医院妇产科收治的4例妊娠合并主动脉夹层患者的临床资料。结果:4例患者均主诉胸背痛就诊,孕前及孕期均未发现心脏疾病。3例A型主动脉夹层(TAAD),1例B型主动脉夹层(TBAD)(Stanford分型标准)。1例TAAD患者先行心外科手术,术后11天行剖宫产术;2例TAAD患者行剖宫产术+次全子宫切除+心外科手术;1例TBAD患者药物保守治疗失败后行剖宫产术,术后10天行胸主动脉夹层腔内隔绝术。1例TBAD患者新生儿死亡,母亲存活,其余3例母儿均存活。结论:妊娠期建议常规行心脏超声筛查,预防主动脉夹层应以控制血压为主。一旦发病,诊治需多学科综合治疗,综合考虑孕周、母体心功能等情况,选择适宜治疗方案。若为有生机儿,推荐先行剖宫产再行心外科手术。     

完全性子宫纵隔31例临床诊治经验分享

目的:探讨完全性子宫纵隔宫腹腔镜联合手术的临床疗效。方法:回顾性分析2011年1月1日—2014年6月30日行腹腔镜监护下宫腔镜手术切除完全性子宫纵隔31例患者的临床资料。结果:31例患者均一次手术成功,平均手术时间(35.2±6.4)min,平均出血量(16.5±3.8)m L;除1例子宫穿孔外无其他并发症发生。自然流产率由术前87.1%(27/31)明显下降至术后5.0%(1/20),足月妊娠率由术前0上升为术后79.2%(19/24)。结论:完全性子宫纵隔通过宫腹腔镜联合手术切除能显著改善患者的生殖预后结局,安全可靠。     

宫颈绒毛管状腺癌36例临床分析

目的:探讨宫颈绒毛管状腺癌(VGA)的临床特点、治疗及预后。方法:收集2013年1月-2018年4月郑州大学第一附属医院诊治的VGA患者36例,回顾性分析其年龄分布、临床表现、人乳头瘤病毒(HPV)检测与新柏氏液基细胞学检测(TCT)结果、治疗方法及预后等。结果:同期323例宫颈腺癌中,VGA占11.15%(36/323)。36例VGA患者年龄25~67岁,平均(44.61±7.93)岁。主要的临床症状为接触性出血与阴道不规则出血(均为12例,分别占33.33%);ⅠB1期26例,ⅠB2期5例,ⅡA1期3例,ⅡB期2例;26例患者治疗前行HPV检测,21例患者阳性(80.77%),5例HPV阴性(19.23%);35例患者接受根治性子宫切除术+盆腔淋巴结清扫术,其中6例年轻ⅠB期患者术中保留卵巢;1例患者未手术,接受同步放化疗。36例患者随访4~59个月,2例死亡,余34例(包括6例保留卵巢患者)均存活且无肿瘤复发。结论:VGA发病率较低,其发生与高危型HPV感染密切相关。确诊时大多数患者处于临床早期,肿瘤分化程度高,浸润表浅,卵巢转移、淋巴脉管间隙浸润及淋巴结转移少见,预后较好。年轻早期患者排除卵巢转移高危因素后可考虑保留卵巢。     

盆底重建术后合成材料相关阴道侵蚀9例临床分析

目的:探讨盆底重建术后并发合成材料相关阴道侵蚀的临床特点和防治方法.方法:回顾性分析290例盆底重建术后出现的9例合成材料相关阴道侵蚀患者的临床资料.结果:盆底重建术后合成材料相关阴道侵蚀发生率为3.1%(9/290),其中阴道无张力尿道悬吊术(TVT),术后阴道侵蚀2例(1.5%,2/136);经闭孔尿道悬吊术(TOT),术后阴道侵蚀2例(10.5%,2/19);补片修补术后阴道侵蚀5例(3.7%,5/135).8例阴道侵蚀位于阴道前壁正中,1例位于阴道左后壁.术后病理检查提示慢性炎症8例,单纯增生1例.9例均行阴道侵蚀修补术后痊愈.结论:盆底重建术后并发合成材料相关阴道侵蚀,需积极手术治疗,预后良好.     

Impact of prenatal diagnosis on outcome of pulmonary atresia and intact ventricular septum

Objectives: To determine the impact of fetal echocardiography on the management of pregnancy and of newborns affected by pulmonary atresia and intact ventricular septum (PAIVS) and to evaluate the outcome of infants with and without prenatal diagnosis of PAIVS. Methods: We searched our database for cases of PAIVS prenatally and postnatally diagnosed during the period January 1993–December 2009. Postnatal follow-up was available in all cases included in the study. Karyotyping and fluorescent in situ hybridization analysis for the DiGeorge critical region (22q11.2) were performed in all but one case. Results: The study comprised 60 cases of PAIVS: 36 with (Group A) and 24 without (Group B) prenatal diagnosis. In Group A, there were two intrauterine deaths, six postnatal deaths (five early after birth) and one termination of pregnancy. In this group, radiofrequency (RF) perforation was successfully performed in 25 cases; 20/25 infants had a biventricular (BV) repair, without further operation in 13 of them. No patient of Group B died. In this group, RF perforation was successfully performed in 22 cases; 20/22 had a BV repair without further procedure in 15 of them. Conclusions: Prenatal diagnosis of PAIVS allows a reliable prognosis of severity and planning of proper surgical repair strategies. Fetuses that are prenatally diagnosed present a more severe spectrum of the disease; for the cases capable of getting through the neonatal period, the mortality rate and the need for further intervention were not significantly different when compared with babies with only postnatal diagnosis.     

Omphalocele: clinical outcomes in cases with normal karyotypes

OBJECTIVE: This study was undertaken to examine neonatal outcomes in karyotypically normal cases of omphalocele with respect to mode of delivery, presence of associated anomalies, presence of extracorporeal liver, and method of abdominal wall closure. STUDY DESIGN: We reviewed 36 cases of omphalocele with delivery at University of North Carolina Hospitals between 1988 and 2001. Elective terminations and pregnancies resulting in miscarriage before 20 weeks' gestation were excluded. RESULTS: Perinatal mortality rate was 19%. Rate of composite neonatal morbidity was 25%. Associated major anomalies were present in 11 (31%) cases and were associated with increased neonatal mortality. Cesarean deliveries were performed in 21 (58%) cases and were not associated with increased primary closure rates or decreased neonatal morbidity and mortality. Extracorporeal liver was present in 27 (75%) cases and was associated with decreased rates of primary closure but did not affect neonatal outcome. CONCLUSION: In cases of ongoing omphalocele, perinatal mortality rates are low in the absence of associated anomalies or genetic defects. Intracorporeal liver was not associated with increased rates of associated anomalies or was it associated with increased neonatal morbidity or mortality.     

Stercoral perforation of the colon during pregnancy

A 39-year-old Japanese woman was referred to our hospital for severe abdominal pain at 22 weeks and 2 days of gestation. Abdominal computed tomography (CT) suggested perforation of the gastrointestinal tract and emergency surgery was conducted. There was a fibrous adhesion between an enlarged uterus and the sigmoid colon. There was a 5.0-cm perforation near the adhesion in the posterior wall of the sigmoid colon. We performed a partial resection of the sigmoid colon and Hartmann's procedure with copious intraperitoneal lavage. Five hours following the laparotomy, uterine contractions could not be controlled and the patient delivered vaginally. The neonate died almost immediately after delivery. We conclude that although stercoral bowel perforation is rare, poor prognosis after perforation emphasizes the need to carry out a CT scan for patients who present with undiagnosed severe abdominal pain and compatible medical history, even if the patient is pregnant.     

The sonographic diagnosis of Dandy-Walker and Dandy-Walker variant: associated findings and outcomes

Outcomes of pregnancies with sonographically diagnosed Dandy-Walker (DW) or Dandy-Walker variant (DWV) syndromes vary widely. We examined our own experience with these diagnoses in an effort to identify those sonographic features that best predicted neonatal outcome. We identified 50 fetuses with DW and 49 with DWV diagnosed sonographically. Eighty-six per cent of fetuses with DW and 85% of fetuses with DWV had other sonographically identifiable anomalies, the most common being ventriculomegaly (DW: 32%; DWV: 27%) and cardiac defects (DW:38%; DWV: 41%). Forty-six per cent and 36% of available karyotypes in cases of DW and DWV, respectively, were abnormal. 50 out of 99 women in our series elected pregnancy termination. Only three pregnancies with DW resulted in a living infant, and only one of these had a normal paediatric examination at six-week follow-up. Thirteen out of 49 infants with DWV survived the neonatal period and 7 of 13 were reported initially as normal infants, including six with an isolated finding of DWV. We conclude that overall, the prognosis for these posterior fossa defects is grim but not uniformly fatal. The presence of other anomalies is associated with the worst prognosis. Isolated Dandy-Walker variant has the highest chance of leading to a normal neonate.     

Isolated abdominal wall defect with complete liver herniation without a covering or remnant membrane: an ominous sign: case report and review of literature

Abstract

Complete liver herniation in abdominal wall defects without a membrane is rare and its prognosis is not well documented. We present a case diagnosed at 12 weeks of gestation. At 27 weeks, a C-section was performed for fetal distress. The infant proved impossible to ventilate and died. In literature, 16 similar cases are described of whom 14 died in the neonatal period and two in infancy. This suggests that herniation of the complete liver in isolated abdominal wall defects without a remnant membrane is lethal and counselling should be provided accordingly.     

妊娠并发HELLP综合征66例临床分析

目的探讨妊娠并发HELLP综合征的临床特点及孕产妇和围产儿的预后。方法回顾性分析2005年1月至2009年12月在广州医学院附属第三医院妊娠合并HELLP综合征66例,比较完全性和部分性HELLP患者的实验室指标、入院孕周、终止妊娠时机、围产儿缺氧、出生体重及死亡率等。结果实验室指标:完全性HELLP组血小板计数明显低于部分性HELLP组(P<0.05),乳酸脱氢酶(1651.8±1058.9)U/L则显著高于部分性HELLP组(478.3±266.6)U/L(P<0.05);天冬氨酸转氨酶及总胆红素两组间亦存在显著统计学差异(P<0.05)。完全性HELLP组的分娩孕周为(33.7±4.0)周,新生儿体重(1723.8±546.1)g,死亡率为14.3%;部分性HELLP组的分娩孕周为(34.2±4.2)周,新生儿体重(1831.2±949.3)g,死亡率为14.3%,两组间无统计学差异(P>0.05)。结论完全性HELLP综合征和部分性HELLP综合征在实验室指标、临床表现方面均有显著不同。如能早期诊断、早期支持治疗并应用糖皮质激素,依据病情的严重程度及孕周,及时终止妊娠,新生儿的预后无显著差异。     

脑脊液细菌16S rRNA荧光定量PCR快速诊断儿童化脓性脑膜炎

目的探讨儿童化脓性脑膜炎(化脑)新的快速诊断方法。 方法2003 08—2005 12采用16SrRNA荧光定量法对浙江大学儿童医院49例临床疑似化脑患儿脑脊液(CSF)的细菌DNA进行测定；监测化脑患儿脑脊液细菌DNA拷贝数，同期进行CSF细菌培养的对照。 结果(1)荧光定量PCR(FQ PCR)检测49份脑脊液标本发现17份阳性，阳性率为34.7%(17/49)，明显高于脑脊液培养的阳性率10.2%(5/49)，差异具有显著性(P<0.01)。(2)对17份FQ PCR阳性标本进一步测定细菌DNA的拷贝数，发现患儿病情与其DNA拷贝数呈正相关，与其Ct值(指每个反应管内的荧光信号到达设定的阈值时所经历的循环数)呈负相关，Ct值越低，脑脊液细菌DNA拷贝数越高，患儿的预后越差。(3)FQ PCR、CSF细菌培养同时阳性的仅为5例。(4)对2例脑脊液FQ PCR的产物测序，Ct值17.9的测序提示为大肠埃希菌，符合CSF细菌培养结果；Ct值31.8的，测序未果。 结论荧光定量PCR特异性强、敏感性高，需标本量少，是早期快速诊断儿童化脑的可靠方法，具有较大的应用价值。     

病灶局限在盆腔的静脉平滑肌瘤病81例临床分析

目的:探讨病灶局限在盆腔的静脉内平滑肌瘤病（IVL）的临床特征、治疗方法,并分析IVL术后复发的影响因素。方法:收集2014年1月至2021年3月在浙江大学医学院附属妇产科医院接受手术治疗且术后病理检查证实病灶局限在盆腔的81例IVL患者的临床病理资料及随访资料,回顾性分析IVL患者的临床特征、治疗方法,并探讨IVL术...     

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001–2013

Objective: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries.

Methods: A retrospective analysis of 26?416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography.

Results: Of the 26?416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed.

Conclusions: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.