摘要
目的 总结先天性乳糜胸的临床特点和预后,为合理诊疗提供依据.方法 回顾性分析2020年1月至2022年12月浙江大学医学院附属妇产科医院新生儿科救治的11例先天性乳糜胸患儿的临床资料,总结宫内干预、临床表现、辅助检查、治疗方法、转归和随访.采用描述性统计分析.结果 11例患儿均为剖宫产娩出,出生胎龄(35.7±2.2)周(32+1～39周+0),男女比例4∶7,合并胎儿水肿4例.9例行宫内干预(胸腔穿刺术6例、胸腔-羊膜腔分流术1例、胸腔穿刺术+胸腔-羊膜腔分流术2例).6例生后有轻度窒息.生后24h内均出现呼吸窘迫;胸部X射线片及超声均提示胸腔积液.经胸腔引流、呼吸支持、序贯式营养治疗、奥曲肱等治疗后,9例治愈出院,2例因肺萎陷(均合并胎儿水肿)放弃治疗后死亡.9例出院患儿随访至生后3～22个月,均未复发,生长发育均未见异常.结论 先天性乳糜胸患儿易发生产时窒息并出现呼吸窘迫.经宫内干预和生后综合治疗,存活率高且预后良好.
Abstract
Objective To summarize the clinical features and prognosis of congenital chylothorax and provide a basis for rational diagnosis and treatment.Methods Clinical data of 11 cases of congenital chylothorax treated in the Department of Neonatology of Women's Hospital,School of Medicine,Zhejiang University from January 2020 to December 2022 were retrospectively collected and analyzed.Intrauterine intervention,clinical manifestations,auxiliary examinations,management strategies,outcomes,and postnatal follow-up were summarized using descriptive statistical analysis.Results All the patients were born by cesarean section at the gestational age of(35.7±2.2)weeks(32+1-39+0 weeks).The male-to-female ratio was 4∶7.Four cases were complicated by fetal edema.Nine cases received intrauterine treatment,including thoracentesis in six cases,thoraco-amniotic shunting in one case,and thoracentesis combined with thoraco-amniotic shunting in two cases.Six patients had mild asphyxia.All 11 patients developed respiratory distress within 24 h after birth and were found with pleural effusion by chest X-ray and ultrasound.After a series of treatments,including chest drainage,respiratory support,sequential nutritional therapy,and octreotide,nine cases were cured and discharged from the hospital,while two cases died of pulmonary collapse after withdrawing treatment(both complicated by fetal edema).No recurrence of chylothorax was reported in the nine patients and their growth and development were normal during a follow-up to 3-22 months after birth.Conclusions Patients with congenital chylothorax are prone to intrapartum asphyxia and respiratory distress after birth.Most patients can survive and have good outcomes after intrauterine intervention and postnatal comprehensive treatment.
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