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頁籤選單縮合
題名 | Clinical Observation of Meconium Peritonitis=胎便性腹膜炎臨床觀察 |
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作者 | 許瓊心; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 31:4 民79.07-08 |
頁次 | 頁214-220 |
分類號 | 417.509 |
關鍵詞 | 胎便性腹膜炎; |
語文 | 英文(English) |
中文摘要 | 馬偕紀念醫院小兒科自民國69年9月至77年3月,共經歷20例經開刀及病理證實為胎便性腹膜炎之病例。男與女的比例為1.5:1。6例為早產兒。18例在出生後5天內出現症狀。3例在出生前,因母親羊水過多作腹部超音波檢查而診斷。1例延遲至13個月大,因機械性腸阻塞,開刀證實為纖維沾黏性腹膜炎引起之沾黏性腸阻塞。臨床上,20例皆有腹脹現象,9例(45%)吐膽汁。在12例男嬰中,8例(66%)有陰囊水腫現象。追溯其母親懷孕史,6例(30%)有羊水過多之症狀。放射線學檢查,7例(35%)有明顯之腹部鈣化,4例(20%)有假性囊腫,1例有氣腹。細菌學培養上,6例死亡病例,皆培養出革蘭氏陰性細菌於血液中。開刀後證實9例為纖維沾黏性胎便性腹膜炎,7例為囊性,而4例為泛性胎便性腹膜炎。機械性腸阻塞可見於9例(45%),5例為腸閉鎖,2例為腸扭結,1例腸橫隔膜,餘1例為巨腸症。13例有腸穿孔,且皆位於迴腸。預後,於民國75年之前,住院之14例中有6例死於敗血症,而75年之後之6例則全數存活。我們相信,早期診斷,緊急手術,良好的新生兒加護照顧,包括抗生素之投與,呼吸治療,及全脈營養,是增加存活率之重要原因。 |
英文摘要 | Twenty cases of meconium peritonitis were found between September 1980 and March 1988 at Mackay Memorial Hospital. The male to female ratio was 1.5 to 1. Six of the 20 cases involved premature babies. The great majority presented symptoms and signs before 5 days old, but one case was not diagnosed until 13 months of age. Polyhydramnios of the mother was found in six cases (30%). Abdominal distension was the universal symptom in all 20 cases. Hydrocele was noticed in 8 of the 12 male babies. In seven cases (35%) radiological examination showed abdominal calcifications. All patients underwent surgical intervention. Peritonitis was of cystic type in seven cases (35%); fibroadhesive in nine cases (45%); generalized in four cases (20%). Evident intestinal perforation was noted in 13 patients, and a mechanical obstructive lesion was found in 9 cases (45%) including intestinal diaphragm, atresia, volvulus, and Hirschsprung's disease. In only two patients (10%).was neither evident perforation nor obstructive lesion. The overall mortality rate was 30% (6/20), with no mortality after 1986 (0/6). The mortality seemed increased in those associated with perforation (4/13) and midgut volvulus (2/2) in particular, compared with non-perforation cases (1/7). It appears that early aggressive operation, and meticulous postoperative care, have contributed to the higher survival rate in recent years. |
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