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目的:探讨新生儿先天性乳糜胸的诊断及治疗。方法:对我院2008年9月—2013年5月收治11例新生儿先天性乳糜胸患儿的临床资料进行分析。结果:11例患儿中男7例,女4例;足月儿6例,早产儿5例;11例均有出生窒息史;9例我院产前检查发现,2例生后发现;产前超声发现胎儿胸腔积液9例;孕周(22~26)周者2例;(32~37)周5例,>37周2例,母亲合并羊水过多5例;出生孕周(30~32)周2例,(35~37)周3例;>37周6例。11例临床主要表现为气促、发绀、呼吸困难,伴全身水肿。1例染色体核型分析为21-三体综合征。经引流乳糜胸水,呼吸支持,补充丢失的体液和胃肠外营养等非手术治疗8例治愈,2例死亡,1例放弃治疗;6例患儿自出生后1个月至1年于门诊随访,生长发育正常,2例失访。结论:乳糜胸出现的孕周,持续时间和程度是决定肺发育情况和出生后呼吸窘迫的主要因素;超声检查是产前诊断胎儿胸腔积液的主要方法;肺发育不全和感染是乳糜胸患儿死亡的主要原因;早期诊断和及时治疗决定预后,非手术治疗为首选措施,严格掌握手术指征。
Objective: To investigate the diagnosis and treatment of congenital chylothorax in neonates. Methods: The clinical data of 11 neonates with congenital chylothorax in our hospital from September 2008 to May 2013 were analyzed. Results: There were 7 males and 4 females in 11 cases, 6 full-term infants, 5 preterm infants, 11 cases of birth asphyxia, 9 cases of prenatal examination in our hospital and 2 cases of postnatal birth. There were 9 cases of fetal pleural effusion before pregnancy, 2 weeks of gestational weeks (22-26 weeks), 5 cases of (32-37) weeks, 2 cases of> 37 weeks and 5 cases of mothers with polyhydramnios. ~ 32) weeks in 2 cases, (35 ~ 37) weeks in 3 cases;> 37 weeks in 6 cases. 11 cases of clinical manifestations of shortness of breath, cyanosis, dyspnea, with systemic edema. One case of karyotype analysis of chromosome 21-trisomy. 8 cases were cured by non-surgical treatment of drainage chylothorax, respiratory support, replacement of lost body fluids and parenteral nutrition, 2 cases died and 1 case abandoned treatment; 6 cases were followed up from outpatient clinic 1 month to 1 year after birth , Normal growth and development, 2 cases were lost. CONCLUSIONS: The gestational age, duration and extent of chylothorax are the major determinants of lung development and postnatal respiratory distress. Ultrasonography is the primary method of prenatal diagnosis of fetal pleural effusion. Lung hypoplasia and infection are chylothorax The main cause of death of children; early diagnosis and timely treatment of prognosis, non-surgical treatment is the preferred measure, strict surgical indications.