Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.009
Minzhong Zhang, W. Cai, Jun Wang, Jiefeng Chen, Weihua Pan, Xiangru Wu, Ming Zhu, W. Guan, Lifeng Wang, Yeming Wu
Objective To assess the practicability of a pathological grading system for ganglion cells in frozen sections for determining surgical margin of Hirschsprung's disease (HSCR) and predicting bowel function. Methods A total of 205 HSCR children were hospitalized from January 2014 to August 2018. There were 158 boys (77.1%) and 47 girls (22.9%). The clinical types of HSCR included short-segment (S-HSCR) (n=155, 75.6%), long-segment (L-HSCR) (n=30, 14.6%) and total colonic aganglionosis (TCA) (n=20, 9.8%). Medical records and detailed pathologic results of intraoperative frozen sections were reviewed. Based upon the histopathological features of ganglion cells in frozen sections, ganglion cells were divided into six degrees. The identification of grades I-III ganglion cells was regarded as a symbol of an acceptable surgical margin and vice versa. Follow-up data were collected for evaluating the clinical outcomes. And a validated pediatric incontinence and constipation scoring system (PICSS) was utilized for predicting bowel function. Results The final pathologic results of proximal resected bowel were presented as follows: grade I (n=6, 2.9%), grade II (n=102, 49.8%), grade III (n=85, 41.5%) and grade IV (n=12, 5.8%). Thirty-three HSCR children (16.1%) required further resection of proximal bowel since initial specimens submitted for pathologic evaluation showed an unacceptable surgical margin. The median follow-up period was 24.8(3.0-54.4) months. A marked correlation was observed between the pathologic grade of proximal resected margin and postoperative constipation (P=0.011) and soiling (P<0.001). The results of PICSS hinted at a positive correlation between postoperative bowel function and better pathologic grade. Conclusions A pathological grading system of ganglion cells in frozen sections guides pediatric surgeons in precisely determining surgical margin during surgery and an excellent pathologic grade is correlated with satisfactory clinical outcomes. This pathologic grade system may provide a new method for intraoperative histopathologic consultations for preventing insufficient resection of affected colon. Key words: Hirschsprung disease; Pathologic diagnosis; Histopathology; Intraoperative frozen section analysis
{"title":"Guidance of a pathological grading system of ganglion cells for intraoperative rapid biopsy of Hirschsprung disease for determining surgical margin and predicting bowel function","authors":"Minzhong Zhang, W. Cai, Jun Wang, Jiefeng Chen, Weihua Pan, Xiangru Wu, Ming Zhu, W. Guan, Lifeng Wang, Yeming Wu","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.009","url":null,"abstract":"Objective \u0000To assess the practicability of a pathological grading system for ganglion cells in frozen sections for determining surgical margin of Hirschsprung's disease (HSCR) and predicting bowel function. \u0000 \u0000 \u0000Methods \u0000A total of 205 HSCR children were hospitalized from January 2014 to August 2018. There were 158 boys (77.1%) and 47 girls (22.9%). The clinical types of HSCR included short-segment (S-HSCR) (n=155, 75.6%), long-segment (L-HSCR) (n=30, 14.6%) and total colonic aganglionosis (TCA) (n=20, 9.8%). Medical records and detailed pathologic results of intraoperative frozen sections were reviewed. Based upon the histopathological features of ganglion cells in frozen sections, ganglion cells were divided into six degrees. The identification of grades I-III ganglion cells was regarded as a symbol of an acceptable surgical margin and vice versa. Follow-up data were collected for evaluating the clinical outcomes. And a validated pediatric incontinence and constipation scoring system (PICSS) was utilized for predicting bowel function. \u0000 \u0000 \u0000Results \u0000The final pathologic results of proximal resected bowel were presented as follows: grade I (n=6, 2.9%), grade II (n=102, 49.8%), grade III (n=85, 41.5%) and grade IV (n=12, 5.8%). Thirty-three HSCR children (16.1%) required further resection of proximal bowel since initial specimens submitted for pathologic evaluation showed an unacceptable surgical margin. The median follow-up period was 24.8(3.0-54.4) months. A marked correlation was observed between the pathologic grade of proximal resected margin and postoperative constipation (P=0.011) and soiling (P<0.001). The results of PICSS hinted at a positive correlation between postoperative bowel function and better pathologic grade. \u0000 \u0000 \u0000Conclusions \u0000A pathological grading system of ganglion cells in frozen sections guides pediatric surgeons in precisely determining surgical margin during surgery and an excellent pathologic grade is correlated with satisfactory clinical outcomes. This pathologic grade system may provide a new method for intraoperative histopathologic consultations for preventing insufficient resection of affected colon. \u0000 \u0000 \u0000Key words: \u0000Hirschsprung disease; Pathologic diagnosis; Histopathology; Intraoperative frozen section analysis","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"37 1","pages":"230-237"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74117379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.001
T. Tao, Huixia Zhou, Pin Li, H. Cao, Tao Guo, Weiwei Zhu, Yang Zhao, Xiaoguang Zhou, Li-fei Ma
Objective To summarize the experience and efficacy of robot-assisted bilateral laparoscopic pyeloplasty for children with bilateral ureteropelvic junction obstruction (UPJO). Methods Robot-assisted bilateral laparoscopic pyeloplasty was performed for 6 children with bilateral severe hydronephrosis from June 2017 to May 2019. There were 4 boys and 2 girls with an average age of (65.8±34.2) months. Ultrasound, magnetic resonance urography (MRU), diuretic renal dynamic imaging and voiding cystourethrogram (VCUG) were performed. The left/right-side preoperative anterioposterior diameter (APD) was (3.07±0.67) and (3.22±0.51) cm respectively. Then robotic-assisted bilateral laparoscopic pyeloplasty was performed. Results All operations were successful. There was no intraoperative complication. The mean operative duration was (246.17±23.02) min and the mean volume of estimated blood loss was(29.17±6.07) ml. No complications of Clavien-Dindo grade Ⅲ/Ⅳ occurred. The mean follow-up period was (16.5±8.92) months. The left/right-side postoperative APD was (1.37±0.25) and (1.47±0.19) cm respectively. The statistical difference was significant. All renal functions were normal. Conclusions Robotic-assisted bilateral laparoscopy pyeloplasty is both feasible and safe. It provides an effective method of managing patients with bilateral UPJO. Key words: Child; Ureteropelvic junction obstruction; Robot assisted laparoscopic surgery
{"title":"Preliminary experience of applying robotic-assisted laparoscopic pyeloplasty for bilateral ureteropelvic junction obstructions in children","authors":"T. Tao, Huixia Zhou, Pin Li, H. Cao, Tao Guo, Weiwei Zhu, Yang Zhao, Xiaoguang Zhou, Li-fei Ma","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.001","url":null,"abstract":"Objective \u0000To summarize the experience and efficacy of robot-assisted bilateral laparoscopic pyeloplasty for children with bilateral ureteropelvic junction obstruction (UPJO). \u0000 \u0000 \u0000Methods \u0000Robot-assisted bilateral laparoscopic pyeloplasty was performed for 6 children with bilateral severe hydronephrosis from June 2017 to May 2019. There were 4 boys and 2 girls with an average age of (65.8±34.2) months. Ultrasound, magnetic resonance urography (MRU), diuretic renal dynamic imaging and voiding cystourethrogram (VCUG) were performed. The left/right-side preoperative anterioposterior diameter (APD) was (3.07±0.67) and (3.22±0.51) cm respectively. Then robotic-assisted bilateral laparoscopic pyeloplasty was performed. \u0000 \u0000 \u0000Results \u0000All operations were successful. There was no intraoperative complication. The mean operative duration was (246.17±23.02) min and the mean volume of estimated blood loss was(29.17±6.07) ml. No complications of Clavien-Dindo grade Ⅲ/Ⅳ occurred. The mean follow-up period was (16.5±8.92) months. The left/right-side postoperative APD was (1.37±0.25) and (1.47±0.19) cm respectively. The statistical difference was significant. All renal functions were normal. \u0000 \u0000 \u0000Conclusions \u0000Robotic-assisted bilateral laparoscopy pyeloplasty is both feasible and safe. It provides an effective method of managing patients with bilateral UPJO. \u0000 \u0000 \u0000Key words: \u0000Child; Ureteropelvic junction obstruction; Robot assisted laparoscopic surgery","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"5 1","pages":"193-196"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78549433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.010
Z. Zhao, Jian-Feng Wang, Hong-wei Xi, Zhengfeng Shi
Objective To explore the feasibility, diagnosis and treatment of colonic stricture in children. Methods Three children of sigmoid stenosis were hospitalized from July 2008 to July 2018. Their clinical data were retrospectively analyzed. There were 2 boys and 1 girl with an age range of 9 to 25 months. The literatures of clinical characteristics and surgical treatments of pediatric colonic stenosis were retrieved from the databases of PubMed, Wanfang and application document delivery. The key words included colonic stenosis, colonic stricture and child. The literature cutoff period started from January 1968 to November 2018. Results One case with a previous history of neonatal necrotizing enterocolitis (NEC) had sigmoid stenosis and terminal ileum stenosis. Among another two cases of congenital sigmoid stenosis, one was associated with coagulation abnormalities. All 3 cases were operated for acute intestinal obstruction. One case underwent colonic stenosis resection with end-to-end anastomosis while the remainder were operated in stages. The first stage was stenotomy plus proximal enterostomy and the second stage closure of fistula. All children recovered well postoperatively and no complication occurred during follow-ups. The retrieved literatures were divided into congenital and acquired colonic stenosis groups. In congenital colonic stenosis group, 19 articles were retrieved and 22 cases were reported. The operative stages were I (9/22, 41%) and II (4/22, 18%). The remainder was not described. A total of 31 literatures were retrieved in pediatric acquired colonic stenosis group (n=180) and NEC acquired colonic stenosis group (n=158). Conclusions Colonic stenosis is clinically rare and its etiology is due to congenital and acquired causes. The acquired cause is predominantly NEC. The clinical presentation depends upon the severity of stenosis. The selection of treatments is dependent upon age of onset, degree of stenosis, location and presence/absence of complications. Sigmoid stricture resection may be completed by one-stage end-to-end anastomosis or staged enterostomy. And staged operation is reserved for multiple colonic stenoses. Key words: Colonic diseases; Stenosis; Child
{"title":"Diagnosis and treatment of colonic stenosis in children: a report of 3 cases and literature review","authors":"Z. Zhao, Jian-Feng Wang, Hong-wei Xi, Zhengfeng Shi","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.010","url":null,"abstract":"Objective \u0000To explore the feasibility, diagnosis and treatment of colonic stricture in children. \u0000 \u0000 \u0000Methods \u0000Three children of sigmoid stenosis were hospitalized from July 2008 to July 2018. Their clinical data were retrospectively analyzed. There were 2 boys and 1 girl with an age range of 9 to 25 months. The literatures of clinical characteristics and surgical treatments of pediatric colonic stenosis were retrieved from the databases of PubMed, Wanfang and application document delivery. The key words included colonic stenosis, colonic stricture and child. The literature cutoff period started from January 1968 to November 2018. \u0000 \u0000 \u0000Results \u0000One case with a previous history of neonatal necrotizing enterocolitis (NEC) had sigmoid stenosis and terminal ileum stenosis. Among another two cases of congenital sigmoid stenosis, one was associated with coagulation abnormalities. All 3 cases were operated for acute intestinal obstruction. One case underwent colonic stenosis resection with end-to-end anastomosis while the remainder were operated in stages. The first stage was stenotomy plus proximal enterostomy and the second stage closure of fistula. All children recovered well postoperatively and no complication occurred during follow-ups. The retrieved literatures were divided into congenital and acquired colonic stenosis groups. In congenital colonic stenosis group, 19 articles were retrieved and 22 cases were reported. The operative stages were I (9/22, 41%) and II (4/22, 18%). The remainder was not described. A total of 31 literatures were retrieved in pediatric acquired colonic stenosis group (n=180) and NEC acquired colonic stenosis group (n=158). \u0000 \u0000 \u0000Conclusions \u0000Colonic stenosis is clinically rare and its etiology is due to congenital and acquired causes. The acquired cause is predominantly NEC. The clinical presentation depends upon the severity of stenosis. The selection of treatments is dependent upon age of onset, degree of stenosis, location and presence/absence of complications. Sigmoid stricture resection may be completed by one-stage end-to-end anastomosis or staged enterostomy. And staged operation is reserved for multiple colonic stenoses. \u0000 \u0000 \u0000Key words: \u0000Colonic diseases; Stenosis; Child","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"28 1","pages":"238-242"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90485617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.011
Zhe Wang, Qiu-ming He, Yong Wang, Yonglan Li, Siyuan Zhang, Xiaoli Xie, Yan Bin, Jia-kang Yu, W. Zhong
Objective To explore the individualized preoperative evaluations of cloacal malformations and to examine its guiding significance for surgical approaches. Methods A retrospective analysis was conducted for clinical data from 31 girls with cloaca malformations from March 2011 to November 2017. During the first and second assessments prior to palliative and radical operations, clinical significance was analyzed for urinary and reproductive system malformations, rectal position and common channel length by ultrasonography type B, common channel angiography, magnetic resonance (MR) and endoscopy, abnormality type and selecting surgical approaches. Initial visit was (280.25±731.01) days with an age range of (0-9) years (median: 25 days); the follow-up period (51.91±44.13) months with a median range of 41(11-192) months. Results Ten patients (type I) with a common canal 1 cm and 3 cm high malformation (n=7). The procedures of type I malformation included posterior sagittal anorectoplasty (PSARP)(n=3) and PSARP plus post-vaginal wall mobilization (n=7); all cases with low malformation had PSARP plus urogenital sinus mobilization (n=14). One patient underwent PSARP with untreated urogenital sinus while another 6 girls had rectal vaginal replacement plus angioplasty. During a follow-up period of 38.46(9-84) months, there were perineal wound rupture (n=1) and vaginal/anal stenosis (n=4). The overall prognosis was good after corresponding treatments. Conclusions With the guidance of the first and second evaluation strategies, individualized assessment based upon common canal angiography, CT, MR and endoscopy can identify the associated malformations, complete the individualized assessments of common channels and effectively guide the choice of surgical approaches. Key words: Individualized medicine; Congenital ano-rectal malformation; Cloaca deformity
{"title":"Individualized evaluations and surgical options of cloacal malformations","authors":"Zhe Wang, Qiu-ming He, Yong Wang, Yonglan Li, Siyuan Zhang, Xiaoli Xie, Yan Bin, Jia-kang Yu, W. Zhong","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.011","url":null,"abstract":"Objective \u0000To explore the individualized preoperative evaluations of cloacal malformations and to examine its guiding significance for surgical approaches. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted for clinical data from 31 girls with cloaca malformations from March 2011 to November 2017. During the first and second assessments prior to palliative and radical operations, clinical significance was analyzed for urinary and reproductive system malformations, rectal position and common channel length by ultrasonography type B, common channel angiography, magnetic resonance (MR) and endoscopy, abnormality type and selecting surgical approaches. Initial visit was (280.25±731.01) days with an age range of (0-9) years (median: 25 days); the follow-up period (51.91±44.13) months with a median range of 41(11-192) months. \u0000 \u0000 \u0000Results \u0000Ten patients (type I) with a common canal 1 cm and 3 cm high malformation (n=7). The procedures of type I malformation included posterior sagittal anorectoplasty (PSARP)(n=3) and PSARP plus post-vaginal wall mobilization (n=7); all cases with low malformation had PSARP plus urogenital sinus mobilization (n=14). One patient underwent PSARP with untreated urogenital sinus while another 6 girls had rectal vaginal replacement plus angioplasty. During a follow-up period of 38.46(9-84) months, there were perineal wound rupture (n=1) and vaginal/anal stenosis (n=4). The overall prognosis was good after corresponding treatments. \u0000 \u0000 \u0000Conclusions \u0000With the guidance of the first and second evaluation strategies, individualized assessment based upon common canal angiography, CT, MR and endoscopy can identify the associated malformations, complete the individualized assessments of common channels and effectively guide the choice of surgical approaches. \u0000 \u0000 \u0000Key words: \u0000Individualized medicine; Congenital ano-rectal malformation; Cloaca deformity","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"121 1","pages":"243-247"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88687368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.016
Hui Wang, Hua Xie, Lijun Zhou, Fang Chen
{"title":"Robot-assisted laparoscopic ureteroplasty for retrocaval ureter in children: one case report","authors":"Hui Wang, Hua Xie, Lijun Zhou, Fang Chen","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.016","url":null,"abstract":"","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"4 1","pages":"268-270"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90913916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.003
Lijun Zhou, Hua Xie, Fang Chen, Yi-Chen Huang, Yiqing Lyu, Yan Chen, Linhui Wang, Yinghao Sun
Objective To explore the value of hidden incision for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy. Methods The clinical data of robotic-assisted laparoscopic radical nephrectomy were retrospectively analyzed. Six patients undergoing robot-assisted laparoscopic radical nephrectomy were recruited from August 2015 to February 2019. There were 4 boys and 2 girls with a mean age of 47 months. There were Wilms' tumor (n=3), Xp11.2 translocation renal cell carcinoma (n=2) and metanephric adenoma (n=1). The involved side was left (n=3) and right (n=3). With a 60° lateral position, eyepiece Trocar was located at umbilical contralateral margin. The operation hole 1 was located at 6-7 cm above anterior median line (depending upon abdominal wall space) and operation hole 2 at the intersection of anterior median line and lower transverse Pfannenstiel incision. Trocar was sneaked under skin and then inserted into abdominal cavity (1.5 cm above operation hole 2) if auxiliary hole was needed. Auxiliary hole Trocar was placed on the affected side of lower abdominal transverse line. All children underwent radical resection. After removal, specimen was placed into a specimen bag. Then lower abdominal transverse incision (length of incision equal to the minimal renal diameter) was extended. The specimen bag was extracted through the Pfannenstiel incision. Results Auxiliary hole was applied in 3 cases with an average length of incision at 6.5(5-8) cm. All specimens were intactly extracted. The average postoperative hospital stay was 4.5(4-7) days. No active bleeding, splitting or infection of wounds occurred postoperatively. During an average follow-up period of 25(4-46) months, postoperative wound recovery was excellent and there was no scar hyperplasia. Conclusions The hidden Pfannenstiel incision may be safely and effectively applied for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy. Key words: Kidney neoplasms; Hidden incision; Robot assisted laparoscopic surgery; Child
{"title":"Application of hidden incision for specimen extraction during robot-assisted laparoscopic pediatric radical nephrectomy","authors":"Lijun Zhou, Hua Xie, Fang Chen, Yi-Chen Huang, Yiqing Lyu, Yan Chen, Linhui Wang, Yinghao Sun","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.003","url":null,"abstract":"Objective \u0000To explore the value of hidden incision for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy. \u0000 \u0000 \u0000Methods \u0000The clinical data of robotic-assisted laparoscopic radical nephrectomy were retrospectively analyzed. Six patients undergoing robot-assisted laparoscopic radical nephrectomy were recruited from August 2015 to February 2019. There were 4 boys and 2 girls with a mean age of 47 months. There were Wilms' tumor (n=3), Xp11.2 translocation renal cell carcinoma (n=2) and metanephric adenoma (n=1). The involved side was left (n=3) and right (n=3). With a 60° lateral position, eyepiece Trocar was located at umbilical contralateral margin. The operation hole 1 was located at 6-7 cm above anterior median line (depending upon abdominal wall space) and operation hole 2 at the intersection of anterior median line and lower transverse Pfannenstiel incision. Trocar was sneaked under skin and then inserted into abdominal cavity (1.5 cm above operation hole 2) if auxiliary hole was needed. Auxiliary hole Trocar was placed on the affected side of lower abdominal transverse line. All children underwent radical resection. After removal, specimen was placed into a specimen bag. Then lower abdominal transverse incision (length of incision equal to the minimal renal diameter) was extended. The specimen bag was extracted through the Pfannenstiel incision. \u0000 \u0000 \u0000Results \u0000Auxiliary hole was applied in 3 cases with an average length of incision at 6.5(5-8) cm. All specimens were intactly extracted. The average postoperative hospital stay was 4.5(4-7) days. No active bleeding, splitting or infection of wounds occurred postoperatively. During an average follow-up period of 25(4-46) months, postoperative wound recovery was excellent and there was no scar hyperplasia. \u0000 \u0000 \u0000Conclusions \u0000The hidden Pfannenstiel incision may be safely and effectively applied for specimen extraction during pediatric robot-assisted laparoscopic radical nephrectomy. \u0000 \u0000 \u0000Key words: \u0000Kidney neoplasms; Hidden incision; Robot assisted laparoscopic surgery; Child","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"2012 1","pages":"201-204"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88153634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.017
Junjie Xu, Xing Liu, Feng Liu, De-wen Zhang, P. Lu, Shengde Wu, Sheng Wen, Yi Hua
{"title":"Diagnosis and treatment of blind-ending bifid ureter with comorbid systemic multi-organ malformations: one case report","authors":"Junjie Xu, Xing Liu, Feng Liu, De-wen Zhang, P. Lu, Shengde Wu, Sheng Wen, Yi Hua","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.017","url":null,"abstract":"","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"10 1","pages":"270-273"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84102143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To summarize the clinical experiences of removing prostatic utricle cyst and seminal reconstruction with robotic-assisted laparoscopy. Methods From July 2019 to September 2019, five children with recurrent epididymitis and urinary tract infection after hypospadias repair were analyzed retrospectively. The average age was (47.2±42.2) months. Urinary ultrasound and voiding cystourethrogram (VCUG) were performed for confirming the presence of prostatic utricle cyst. And removing prostatic utricle cyst and seminal reconstruction were performed simultaneously. After operation, ultrasonography of urinary system and routine urinalysis were performed. Results The follow-up period was (4-6) months. All procedures were successful without any intraoperative complication or any conversion into open surgery. The average operative duration was (133.0±77.1) min. There was no onset of such postoperative complications as recurrent epididymitis or urinary tract infection. Conclusions It is both safe and effective to resect prostatic utricle cyst and reconstruct seminal tract simultaneously with robotic-assisted laparoscopy. However, the patency of seminal tract and fertility rate in adulthood should be verified by longer term of follow-ups and data supports. Key words: Hypospadias; Prostatic utricle; Robot assisted laparoscopic surgery
{"title":"Role of robotic-assisted laparoscopy in removing prostatic utricle cyst and seminal reconstruction","authors":"Yu Mao, Daorui Qin, M. Xia, Xue-jun Wang, Shaoji Chen, Yunman Tang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.002","url":null,"abstract":"Objective \u0000To summarize the clinical experiences of removing prostatic utricle cyst and seminal reconstruction with robotic-assisted laparoscopy. \u0000 \u0000 \u0000Methods \u0000From July 2019 to September 2019, five children with recurrent epididymitis and urinary tract infection after hypospadias repair were analyzed retrospectively. The average age was (47.2±42.2) months. Urinary ultrasound and voiding cystourethrogram (VCUG) were performed for confirming the presence of prostatic utricle cyst. And removing prostatic utricle cyst and seminal reconstruction were performed simultaneously. After operation, ultrasonography of urinary system and routine urinalysis were performed. \u0000 \u0000 \u0000Results \u0000The follow-up period was (4-6) months. All procedures were successful without any intraoperative complication or any conversion into open surgery. The average operative duration was (133.0±77.1) min. There was no onset of such postoperative complications as recurrent epididymitis or urinary tract infection. \u0000 \u0000 \u0000Conclusions \u0000It is both safe and effective to resect prostatic utricle cyst and reconstruct seminal tract simultaneously with robotic-assisted laparoscopy. However, the patency of seminal tract and fertility rate in adulthood should be verified by longer term of follow-ups and data supports. \u0000 \u0000 \u0000Key words: \u0000Hypospadias; Prostatic utricle; Robot assisted laparoscopic surgery","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"2 1","pages":"197-200"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79309489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.021
Guijie Ge, Zhibao Lyu
As a severe gastrointestinal disease with multiple causative factors, necrotizing enterocolitis (NEC) is one of the most common devastating necro-inflammatory intestinal injuries in neonates, particularly among preterm or very-low-birth-weight infants. Prematurity, formula feeding, bacterial colonization and proliferation are the major risk factors. The incidence of NEC is 5-10% among very-low-birth-weight neonates and the mortality 20-30%. Recent studies suggest that NEC results from gut bacteria dysbiosis activating an uncontrolled proinflammatory response. In gut microbiota composition of preterm infants, there are more potential pathogens of Enterobacteriaceae, Staphylococcus, Enterococcus and Clostridium. And there is a paucity of beneficial commensal organisms such as strict anaerobic bacteria (esp. Negativicutes), Bifidobacterium and Propionibacterium. Also the diversity of microbiota declines. To date, there is no consensus on which specific bacterial strains are causally correlated with NEC development. Several prospective studies have shown a marked dysbiosis with phylum Proteobacteria before NEC onset. Lipopolysaccharide (LPS), a product of Gram-negative Proteobacteria, activates TLR4 signaling pathway of mediating an exaggerated inflammatory response. In addition, an interaction between gut bacteria dysbiosis and an immature intestine has also been implicated in the pathogenesis of NEC. Thus some researchers hypothesized that inappropriate colonization of premature intestine may be a major predisposing factor for NEC. The administration of probiotics such as Bifidobacterium and Propionibacterium may mitigate the damage caused by gut bacteria dysbiosis through activating NOD2 signaling pathway or regulating lymphocyte balance. Thus it may help devise a new strategy for early protection of NEC. Key words: Neonate; Necrotizing enterocolitis; Gut bacteria dysbiosis
{"title":"Research advances in gut bacteria dysbiosis and neonatal necrotizing enterocolitis","authors":"Guijie Ge, Zhibao Lyu","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.021","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.021","url":null,"abstract":"As a severe gastrointestinal disease with multiple causative factors, necrotizing enterocolitis (NEC) is one of the most common devastating necro-inflammatory intestinal injuries in neonates, particularly among preterm or very-low-birth-weight infants. Prematurity, formula feeding, bacterial colonization and proliferation are the major risk factors. The incidence of NEC is 5-10% among very-low-birth-weight neonates and the mortality 20-30%. Recent studies suggest that NEC results from gut bacteria dysbiosis activating an uncontrolled proinflammatory response. In gut microbiota composition of preterm infants, there are more potential pathogens of Enterobacteriaceae, Staphylococcus, Enterococcus and Clostridium. And there is a paucity of beneficial commensal organisms such as strict anaerobic bacteria (esp. Negativicutes), Bifidobacterium and Propionibacterium. Also the diversity of microbiota declines. To date, there is no consensus on which specific bacterial strains are causally correlated with NEC development. Several prospective studies have shown a marked dysbiosis with phylum Proteobacteria before NEC onset. Lipopolysaccharide (LPS), a product of Gram-negative Proteobacteria, activates TLR4 signaling pathway of mediating an exaggerated inflammatory response. In addition, an interaction between gut bacteria dysbiosis and an immature intestine has also been implicated in the pathogenesis of NEC. Thus some researchers hypothesized that inappropriate colonization of premature intestine may be a major predisposing factor for NEC. The administration of probiotics such as Bifidobacterium and Propionibacterium may mitigate the damage caused by gut bacteria dysbiosis through activating NOD2 signaling pathway or regulating lymphocyte balance. Thus it may help devise a new strategy for early protection of NEC. \u0000 \u0000Key words: \u0000Neonate; Necrotizing enterocolitis; Gut bacteria dysbiosis","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"9 1","pages":"285-288"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86743253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.03.013
Wei Liu, Xiangyu Wu, R. Wu
Objective To evaluate the efficacy of foreskin reconstruction for distal hypospadias during tubularized incised plate (TIP) repairing. Methods From November 2017 to April 2018, 64 children with distal hypospadias underwent stented TIP urethroplasty. Foreskin reconstruction (n=28) and circumcision (n=36) were performed and compared with regards to operative duration and postoperative complications. Results The operative duration was [(109.9±2.2) vs. (143.8±3.0)] min in foreskin reconstruction and circumcision groups respectively (P<0.0001). Urethroplasty complications occurred in 4(11.1%) circumcision children (fistula, n=1; glans dehiscences, n=2; meatal stenosis, n=1) versus 2(7.1%) after prepucioplasty (fistula, n=1; meatal stenosis, n=1) (P=0.688). Skin complications included preputial dehiscences (n=2, 7.1%) in foreskin reconstruction group and penile torsion (n=1, 2.8%) in circumcision group (P=0.577). The reoperative rate was 10.7% (3/28) in foreskin reconstruction group including fistula repair (n=1) and circumcision (n=2) for foreskin dehiscence versus 8.3% (3/36) in circumcision group including fistula repair (n=1) and glansplasty (n=2) (P=0.746). No significant inter-group differences existed in urethroplasty and skin complications or reoperative rate. Conclusions During TIP repairing, foreskin reconstruction is a time-saving procedure with similar complication and reoperative rate to traditional technique. Prepuce preservation may hide most penile malformations and provide valuable local tissues for dealing with potential complications. Foreskin reconstruction is a surgical alternative for distal hypospadias using TIP repair based upon prepuce appearance and parental preference. Key words: Hypospadias; Foreskin; Postoperative complications
{"title":"Distal hypospadias repairing with foreskin reconstruction","authors":"Wei Liu, Xiangyu Wu, R. Wu","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.03.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.03.013","url":null,"abstract":"Objective \u0000To evaluate the efficacy of foreskin reconstruction for distal hypospadias during tubularized incised plate (TIP) repairing. \u0000 \u0000 \u0000Methods \u0000From November 2017 to April 2018, 64 children with distal hypospadias underwent stented TIP urethroplasty. Foreskin reconstruction (n=28) and circumcision (n=36) were performed and compared with regards to operative duration and postoperative complications. \u0000 \u0000 \u0000Results \u0000The operative duration was [(109.9±2.2) vs. (143.8±3.0)] min in foreskin reconstruction and circumcision groups respectively (P<0.0001). Urethroplasty complications occurred in 4(11.1%) circumcision children (fistula, n=1; glans dehiscences, n=2; meatal stenosis, n=1) versus 2(7.1%) after prepucioplasty (fistula, n=1; meatal stenosis, n=1) (P=0.688). Skin complications included preputial dehiscences (n=2, 7.1%) in foreskin reconstruction group and penile torsion (n=1, 2.8%) in circumcision group (P=0.577). The reoperative rate was 10.7% (3/28) in foreskin reconstruction group including fistula repair (n=1) and circumcision (n=2) for foreskin dehiscence versus 8.3% (3/36) in circumcision group including fistula repair (n=1) and glansplasty (n=2) (P=0.746). No significant inter-group differences existed in urethroplasty and skin complications or reoperative rate. \u0000 \u0000 \u0000Conclusions \u0000During TIP repairing, foreskin reconstruction is a time-saving procedure with similar complication and reoperative rate to traditional technique. Prepuce preservation may hide most penile malformations and provide valuable local tissues for dealing with potential complications. Foreskin reconstruction is a surgical alternative for distal hypospadias using TIP repair based upon prepuce appearance and parental preference. \u0000 \u0000 \u0000Key words: \u0000Hypospadias; Foreskin; Postoperative complications","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"19 1","pages":"252-256"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89354122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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