新生儿无脾综合征八例分析与转归

来源 :中国新生儿科杂志 | 被引量 : 0次 | 上传用户:lsj9
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目的:探讨新生儿无脾综合征的临床特点,提高对该病的认识。方法收集2008年6月至2015年7月我院新生儿科收治的无脾综合征患儿资料,回顾性分析患儿的一般特征、临床表现、影像学及实验室检查、治疗及预后。结果共收治8例无脾综合征患儿。8例生后均有不同程度的发绀,5例听诊有心脏杂音,3例心尖搏动位于右侧,2例产前超声检查心脏结构异常,2例合并先天性肛门闭锁伴皮肤瘘;8例心脏彩超检查均提示复杂的先天性心脏病,3例右位心,1例心腔位置异常;8例腹部 B 超均提示无脾、水平肝,1例合并右肾缺如;1例行外周血涂片检查,见豪-周小体。明确诊断后8例均自动出院。随访发现2例存活(1例现19月龄,1例4周岁),失访2例,其余4例死于新生儿期。结论无脾综合征具有脾缺如、内脏反位、严重心血管畸形、易合并其他脏器畸形等特点;临床上若发现持续发绀、心脏杂音、心尖搏动位置异常患儿,应考虑无脾综合征可能,积极完善影像学检查,如胸部 X 线片、B 超、内脏血管造影等。“,”Objective To summarize the clinical characteristics of neonatal asplenia syndrome to improve the understanding of the disorder. Methods Newborns with neonatal asplenia syndrome admitted to the neonatal department of our Hospital from June 2008 to July 2015 were recruited and their gender, birth weight, gestational age, clinical manifestations, imaging features, laboratory examinations, treatments and prognosis were analyzed. Results A total of 8 newborns with asplenia syndrome were studied. All the patients presented with cyanosis at birth, 5 of them with heart murmur, 3 with apical impulse in the right ( dextrocardia) thorax and complex congenital heart diseases were found in all of them by echocardiogram examinations. 2 of them were diagnosed congenital heart diseases before birth by the fetal ultrasound. 2 cases combined with congenital imperforate anus and cutaneous fistulas. 1 case was found right renal agenesis and Howell-Jolly was seen in another case. All the 8 patientsˊ parents refused medical advices about continuing treatments and left hospital. Among them, 4 patients died in the neonatal period, 2 lost in follow-up and only 2 survived, one for 19 months and the other for 4 years. Conclusions Patients with asplenia syndrome presented absence of spleen, visceral inversion, severe cardiovascular malformations and other malformations. When the cyanosis, heart murmur and abnormal position of apical impulse were found in the newborns, asplenia syndrome should be considered and imaging examinations such as chest X-ray, ultrasound, visceral angiography and more should be ordered immediately, in order to make an early diagnosis of the disease.
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