Objective To introduce pneumovesicoscopic orthotopic modified nipple ureteral reimplantation for megaureter and to compare its safety, feasibility and application with open or pneumovesicoscopic Cohen cross-trigonal ureteral reimplantation. Methods From January 2010 to March 2019, retrospective analysis was performed for clinical data of retrograde cystography and complications during pneumovesicoscopic orthotopic modified nipple ureteral reimplantation.The potential advantages and disadvantages were compared with open or pneumovesicoscopic Cohen cross-trigonal ureteral reimplantation.One hundred and seventy-nine cases were reviewed and analyzed in 3 groups.In open group, there were 44 boys and 19 girls.The age was under 6 months (n=32), 6 months to 1 year (n=23) and older than 1 year (n=8). The sideness was left (n=30), right (n=17) and bilateral (n=16). There were primary obstructive megaureter (POM, n=58), vesicoureteral reflux (VUR, n=4) and POM & VUR (n=1). And the outcomes were hydronephrosis (n=53), infection (n=33), ectopic ureteral orifice (n=7) and ureter cyst (n=3); In pneumovesicoscopic Cohen group, there were 38 boys and 17 girls.The age was under 6 months (n=10), 6 months to 1 year (n=5) and above 1 year (n=40). The sideness was left (n=27), right (n=13) and bilateral (n=15). There were POM (n=50), VUR (n=3) and POM & VUR (n=2). And the outcomes were hydronephrosis (n=44), infection (n=38), ectopic ureteral orifice (n=2) and ureter cyst (n=3); In pneumovesicoscopic modified nipple group, there were 36 boys and 25 girls.The age was under 6 months (n=22), 6 months to 1 year (n=28) and older than 1 year (n=11). The sideness was left (n=33), right (n=19) and bilateral (n=9). There were POM (n=50), VUR (n=7) and POM & VUR (n=4). And the outcomes were hydronephrosis (n=61), infection (n=56), ectopic ureteral orifice (n=3) and ureteral caecum (n=1). Results All cases of ureteral reimplantation were performed successfully.Pneumovesicoscopic operations were performed with only 2 cases of Cohen procedure converting into open surgery.No significant differences existed between pneumovesicoscopic Cohen procedure and pneumovesicoscopic orthotopic modified nipple procedure in operative duration (97.2±49.4 vs 77.4±37.0 min, P>0.05), volume of blood loss (3.7±1.5 vs 2.9±1.8 ml, P>0.05) and hospitalization stay (6.8±2.3 vs 6.2±1.3 days, P>0.05) with an equivalent postoperative antireflux efficacy and without severe complications.As compared with open surgery, pneumovesicoscopy offered longer operative duration (P<0.05), less volume of blood loss (P<0.05), shorter hospitalization stay (P<0.05) and fewer complications. Conclusions Pneumovesicoscopic orthotopic modified nipple ureteral reimplantation is an anatomic orthotopic ureteral reimplantation with remarkable antireflux and clinical efficacies.It is an alternative treatment for refluxing and obstructed megaureter. Key words: Child; Ureteral obstruction; Laparoscopes; Urete
目的介绍腹腔镜下原位改良乳头输尿管重建术，并比较其与开放输尿管重建术、腹腔镜下Cohen输尿管重建术的安全性、可行性及应用价值。方法回顾性分析2010年1月至2019年3月我院气管镜下原位改良乳头输尿管再植术逆行膀胱造影及并发症的临床资料。比较开放输尿管再植术与腹腔镜下输尿管再植术的优缺点。将179例病例分为3组进行回顾性分析。公开组男生44人，女生19人。年龄6月龄以下32例，6月龄~ 1岁23例，1岁以上8例。侧边为左侧(n=30)、右侧(n=17)和双侧(n=16)。原发性梗阻性脉管炎(POM, n=58)、膀胱输尿管反流(VUR, n=4)和POM + VUR (n=1)。结果:肾积水53例，感染33例，输尿管口异位7例，输尿管囊肿3例;腹腔镜Cohen组男38例，女17例。年龄6月龄以下(n=10)、6月龄~ 1岁(n=5)、1岁以上(n=40)。侧边为左侧(n=27)、右侧(n=13)和双侧(n=15)。有POM (n=50)、VUR (n=3)和POM & VUR (n=2)。结果为肾积水(44例)、感染(38例)、输尿管口异位(2例)、输尿管囊肿(3例);气管内镜下改良乳头组男36例，女25例。年龄为6月龄以下22例，6月龄~ 1岁28例，1岁以上11例。左侧(n=33)、右侧(n=19)和双侧(n=9)。其中POM (n=50)， VUR (n=7)， POM & VUR (n=4)。结果为肾积水61例，感染56例，输尿管口异位3例，输尿管盲肠1例。结果所有输尿管再植术均成功。经腹腔镜手术，科恩手术转为开放手术仅2例。两组手术时间(97.2±49.4 min vs 77.4±37.0 min, P>0.05)、出血量(3.7±1.5 ml vs 2.9±1.8 ml, P>0.05)、住院时间(6.8±2.3 d vs 6.2±1.3 d, P>0.05)差异无统计学意义，术后抗反流效果相当，无严重并发症。与开放手术相比，肺内镜手术时间更长(P<0.05)，出血量更少(P<0.05)，住院时间更短(P<0.05)，并发症更少。结论气管镜下原位改良乳头输尿管再植术是一种解剖式原位输尿管再植术，具有显著的抗反流效果和临床疗效。这是一种治疗反流和阻塞的方法。关键词:儿童;输尿管梗阻;镜头辅助;输尿管再植术
{"title":"Pneumovesicoscopic modified orthotopic nipple ureteral reimplantation","authors":"Aiwu Li, X. Cui, Jian Wang, Qiangye Zhang, Feng-yin Sun, Weijing Mu, Peimin Hou, Jiawei Chen, Guowei Li","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.02.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.02.004","url":null,"abstract":"Objective \u0000To introduce pneumovesicoscopic orthotopic modified nipple ureteral reimplantation for megaureter and to compare its safety, feasibility and application with open or pneumovesicoscopic Cohen cross-trigonal ureteral reimplantation. \u0000 \u0000 \u0000Methods \u0000From January 2010 to March 2019, retrospective analysis was performed for clinical data of retrograde cystography and complications during pneumovesicoscopic orthotopic modified nipple ureteral reimplantation.The potential advantages and disadvantages were compared with open or pneumovesicoscopic Cohen cross-trigonal ureteral reimplantation.One hundred and seventy-nine cases were reviewed and analyzed in 3 groups.In open group, there were 44 boys and 19 girls.The age was under 6 months (n=32), 6 months to 1 year (n=23) and older than 1 year (n=8). The sideness was left (n=30), right (n=17) and bilateral (n=16). There were primary obstructive megaureter (POM, n=58), vesicoureteral reflux (VUR, n=4) and POM & VUR (n=1). And the outcomes were hydronephrosis (n=53), infection (n=33), ectopic ureteral orifice (n=7) and ureter cyst (n=3); In pneumovesicoscopic Cohen group, there were 38 boys and 17 girls.The age was under 6 months (n=10), 6 months to 1 year (n=5) and above 1 year (n=40). The sideness was left (n=27), right (n=13) and bilateral (n=15). There were POM (n=50), VUR (n=3) and POM & VUR (n=2). And the outcomes were hydronephrosis (n=44), infection (n=38), ectopic ureteral orifice (n=2) and ureter cyst (n=3); In pneumovesicoscopic modified nipple group, there were 36 boys and 25 girls.The age was under 6 months (n=22), 6 months to 1 year (n=28) and older than 1 year (n=11). The sideness was left (n=33), right (n=19) and bilateral (n=9). There were POM (n=50), VUR (n=7) and POM & VUR (n=4). And the outcomes were hydronephrosis (n=61), infection (n=56), ectopic ureteral orifice (n=3) and ureteral caecum (n=1). \u0000 \u0000 \u0000Results \u0000All cases of ureteral reimplantation were performed successfully.Pneumovesicoscopic operations were performed with only 2 cases of Cohen procedure converting into open surgery.No significant differences existed between pneumovesicoscopic Cohen procedure and pneumovesicoscopic orthotopic modified nipple procedure in operative duration (97.2±49.4 vs 77.4±37.0 min, P>0.05), volume of blood loss (3.7±1.5 vs 2.9±1.8 ml, P>0.05) and hospitalization stay (6.8±2.3 vs 6.2±1.3 days, P>0.05) with an equivalent postoperative antireflux efficacy and without severe complications.As compared with open surgery, pneumovesicoscopy offered longer operative duration (P<0.05), less volume of blood loss (P<0.05), shorter hospitalization stay (P<0.05) and fewer complications. \u0000 \u0000 \u0000Conclusions \u0000Pneumovesicoscopic orthotopic modified nipple ureteral reimplantation is an anatomic orthotopic ureteral reimplantation with remarkable antireflux and clinical efficacies.It is an alternative treatment for refluxing and obstructed megaureter. \u0000 \u0000 \u0000Key words: \u0000Child; Ureteral obstruction; Laparoscopes; Urete","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"65 1","pages":"112-117"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74824291","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 : 2020-02-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.02.007
Yusheng Liu, Yuhe Duan, Jie Mi, Xianjun Zhou, Hong-ting Lu, Zhong Jiang, B. Wei, Q. Dong
Objective To explore the application value of Hisense computer-assisted surgical system for resecting retroperitoneal tumors. Methods A retrospective analysis was performed for 48 children with retroperitoneal tumors between March 2012 and September 2018.The data of 64-slice spiral computer tomography (CT) scans were analyzed.And 38 CT scans were constructed three-dimensionally (3D). Another 10 patients receiving abdominal enhanced CT were treated as control group.The inter-group differences in operative duration; intraoperative blood loss, length of hospitalization and other aspects were compared. Results All operations were successfully operated without perioperative mortality.Reconstruction group had significantly shorter operative duration, less intraoperative blood loss and length of hospitalization than those in control group.Tumor anatomical locations and adjacent relationship with surrounding organs and blood vessels were basically consistent with intraoperative findings. Conclusions Hisense computer-assisted surgical system provides accurate preoperative evaluations of retroperitoneal tumors so that it has application value for guiding surgery. Key words: Surgery, computer-assisted; Retroperitoneal neoplasms; Child
{"title":"Application of Hisense computer-assisted surgical system for resecting retroperitoneal tumors","authors":"Yusheng Liu, Yuhe Duan, Jie Mi, Xianjun Zhou, Hong-ting Lu, Zhong Jiang, B. Wei, Q. Dong","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.02.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.02.007","url":null,"abstract":"Objective \u0000To explore the application value of Hisense computer-assisted surgical system for resecting retroperitoneal tumors. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed for 48 children with retroperitoneal tumors between March 2012 and September 2018.The data of 64-slice spiral computer tomography (CT) scans were analyzed.And 38 CT scans were constructed three-dimensionally (3D). Another 10 patients receiving abdominal enhanced CT were treated as control group.The inter-group differences in operative duration; intraoperative blood loss, length of hospitalization and other aspects were compared. \u0000 \u0000 \u0000Results \u0000All operations were successfully operated without perioperative mortality.Reconstruction group had significantly shorter operative duration, less intraoperative blood loss and length of hospitalization than those in control group.Tumor anatomical locations and adjacent relationship with surrounding organs and blood vessels were basically consistent with intraoperative findings. \u0000 \u0000 \u0000Conclusions \u0000Hisense computer-assisted surgical system provides accurate preoperative evaluations of retroperitoneal tumors so that it has application value for guiding surgery. \u0000 \u0000 \u0000Key words: \u0000Surgery, computer-assisted; Retroperitoneal neoplasms; Child","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"81 1","pages":"128-132"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83249140","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 : 2020-02-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.02.016
Dapeng Jiang, Zhengzhou Shi, F. Tian, Haiteng Zhao
Objective To explore the prevalence and clinical characteristics of congenital anomalies of kidney and urinary tract (CAKUT) with cryptorchidism in children. Methods A total of 21 children of CAKUT with cryptorchidism were recruited from January 2017 to August 2018.Their complete clinical and imaging data were collected and clinical symptoms and imaging abnormalities were summarized. Results The total number of genitourinary abnormalities was 26.The major CAKUT diseases included hydronephrosis, renal hypoplasia and duplex collecting system.No association existed between CAKUT and parity or paternal age.However, the incidence of CAKUT was correlated with type of cryptorchidism.Children with unilateral testicular agenesis and intraperitoneal testis were more susceptible to concurrent CAKUT than other types of cryptorchidism. Conclusions Urinary tract ultrasonography is routinely recommended for children with cryptorchidism.The incidence of CAKUT is higher in children with unilateral testicular agenesis and intraperitoneal testis.Clinical alert should be raised and necessary imaging examinations conducted.It is necessary to diagnose this disorder early, avoid a misdiagnosis and made treatment properly. Key words: Cryptorchidism; Congenital anomalies of the kidney and urinary tract; Incidence
{"title":"Clinical characteristics of congenital anomalies of kidney and urinary tract with cryptorchidism","authors":"Dapeng Jiang, Zhengzhou Shi, F. Tian, Haiteng Zhao","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.02.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.02.016","url":null,"abstract":"Objective \u0000To explore the prevalence and clinical characteristics of congenital anomalies of kidney and urinary tract (CAKUT) with cryptorchidism in children. \u0000 \u0000 \u0000Methods \u0000A total of 21 children of CAKUT with cryptorchidism were recruited from January 2017 to August 2018.Their complete clinical and imaging data were collected and clinical symptoms and imaging abnormalities were summarized. \u0000 \u0000 \u0000Results \u0000The total number of genitourinary abnormalities was 26.The major CAKUT diseases included hydronephrosis, renal hypoplasia and duplex collecting system.No association existed between CAKUT and parity or paternal age.However, the incidence of CAKUT was correlated with type of cryptorchidism.Children with unilateral testicular agenesis and intraperitoneal testis were more susceptible to concurrent CAKUT than other types of cryptorchidism. \u0000 \u0000 \u0000Conclusions \u0000Urinary tract ultrasonography is routinely recommended for children with cryptorchidism.The incidence of CAKUT is higher in children with unilateral testicular agenesis and intraperitoneal testis.Clinical alert should be raised and necessary imaging examinations conducted.It is necessary to diagnose this disorder early, avoid a misdiagnosis and made treatment properly. \u0000 \u0000 \u0000Key words: \u0000Cryptorchidism; Congenital anomalies of the kidney and urinary tract; Incidence","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"1 1","pages":"176-179"},"PeriodicalIF":0.0,"publicationDate":"2020-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88650030","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 : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.017
Guoqiang Jia, E. Wang, Jun Sun, Tianjing Liu, Li-jun Zhang, Jihong Fang, Ran Gu
Objective To explore the influence of preoperative magnetic resonance imaging (MRI) on the choice of operative methods in children aged under 2 years with developmental dislocation of hip. Methods Retrospective analysis was performed for children with developmental dislocation of hip from July 2013 to February 2017. According to the Bowen's radiographic standards, they were divided into 3 groups of closed reduction (A, n=26), failure of closed reduction (B, n=24) and impossibility of reduction (C, n=7). On standard MRI, the preoperative measurement of MRI in joint sacs were anterior access angle, inferior access angle, maximal coronal entrance diameter, maximal axial entrance diameter, axial diameter of femoral head, coronal diameter of femoral head, coronal diameter ratio (CMAD/AFHD) and axial diameter ratio (AMAD/CFHD). And the significant differences of data were compared among three groups. Logistic regression analysis was performed for the correlations of gender, age, degree of dislocation, weight bearing time and final treatment. And receiver operating characteristic (ROC) curve was used for assessing the sensitivity and specificity of closed reduction group and determine the cutoff point. Results No significant difference existed in AAA/CFHD/AFHD among 3 groups (P>0.05). IAA angle (108.2±9.8)° was significantly higher in group A than that in group B (98.8±11.2)° and group C (91.7±6.9)°(P 0.05). Logistic regression analysis revealed that, except for age, no correlation existed in gender, measurement, degree of dislocation, weight bearing time or final treatment (P>0.05). The maximal area of ROC curve was 0.515 (AMAD/CFHD), its specificity (92.3%) and inflection point (0.515). Conclusions Preoperative measurements of MRI of IAA, CMAD, AMAD, CMAD/AFHD, AMAD/CFHD offer certain guiding values for treatment. When AMAD/CFHD ratio is >0.515, closed reduction is recommended. Key words: Magnetic resonance imaging; Developmental dislocation of the hip; Closed reduction; Articular sacs
{"title":"Analysis of preoperative predictive factors of MRI for closed reduction of developmental dislocation of the hip","authors":"Guoqiang Jia, E. Wang, Jun Sun, Tianjing Liu, Li-jun Zhang, Jihong Fang, Ran Gu","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.017","url":null,"abstract":"Objective \u0000To explore the influence of preoperative magnetic resonance imaging (MRI) on the choice of operative methods in children aged under 2 years with developmental dislocation of hip. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for children with developmental dislocation of hip from July 2013 to February 2017. According to the Bowen's radiographic standards, they were divided into 3 groups of closed reduction (A, n=26), failure of closed reduction (B, n=24) and impossibility of reduction (C, n=7). On standard MRI, the preoperative measurement of MRI in joint sacs were anterior access angle, inferior access angle, maximal coronal entrance diameter, maximal axial entrance diameter, axial diameter of femoral head, coronal diameter of femoral head, coronal diameter ratio (CMAD/AFHD) and axial diameter ratio (AMAD/CFHD). And the significant differences of data were compared among three groups. Logistic regression analysis was performed for the correlations of gender, age, degree of dislocation, weight bearing time and final treatment. And receiver operating characteristic (ROC) curve was used for assessing the sensitivity and specificity of closed reduction group and determine the cutoff point. \u0000 \u0000 \u0000Results \u0000No significant difference existed in AAA/CFHD/AFHD among 3 groups (P>0.05). IAA angle (108.2±9.8)° was significantly higher in group A than that in group B (98.8±11.2)° and group C (91.7±6.9)°(P 0.05). Logistic regression analysis revealed that, except for age, no correlation existed in gender, measurement, degree of dislocation, weight bearing time or final treatment (P>0.05). The maximal area of ROC curve was 0.515 (AMAD/CFHD), its specificity (92.3%) and inflection point (0.515). \u0000 \u0000 \u0000Conclusions \u0000Preoperative measurements of MRI of IAA, CMAD, AMAD, CMAD/AFHD, AMAD/CFHD offer certain guiding values for treatment. When AMAD/CFHD ratio is >0.515, closed reduction is recommended. \u0000 \u0000 \u0000Key words: \u0000Magnetic resonance imaging; Developmental dislocation of the hip; Closed reduction; Articular sacs","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"1 1","pages":"83-87"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83244452","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 : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.003
Weihua Pan, Weipeng Wang, Jun Wang, Wei Xie, Yi Wang, Yinchao Jiang
Objective To summarize our experiences of multidisciplinary treatment (MDT) for infants with congenital diaphragmatic hernia (CDH) and explore its effect on outcomes. Methods The medical records were retrospectively reviewed for 152 CDH infants from January 2001 to December 2018. The relevant clinical data included gestational age at diagnosis and delivery, Apgar score, types of hernia, birth weight, site of liver, admission arterial blood gas analysis, types of surgery, duration of mechanical ventilation and length of hospital stay. They were divided into two groups of non-MDT from January 2001 to February 2008 (n=8) and MDT from March 2008 to December 2018 (n=144). Their clinical parameters were compared and analyzed. Results There were 80 boys and 72 girls. And the involved side was left (n=120) and right (n=32). A total of 135 children were operated. In non-MDT group, all patients underwent open surgery. In MDT group, 17 patients died of cardiorespiratory failure without surgery. Among 127 surgical infants, open (n=66) and mini-invasive (n=78) operations were performed. Compared with counterparts in non-MDT group, those infants in MDT group were more likely to delay in surgical timing [(4.8±2.3) vs. (1.1±0.4) days], higher utilization of thoracoscopy (0 vs. 48.0%) and a higher survival rate (75.0% vs. 37.5%)(all P<0.05). However, no inter-group differences existed in gender, birth weight, site/size of defect, types of surgery or prenatal diagnosis. Conclusions MDT provides an feasible and effective model for diagnosing and treating CDH with better outcomes. Key words: Hernia, diaphragmatic; Multidisciplinary treatment; Treatment model; Prognosis
{"title":"Effect of multidisciplinary treatment on outcomes in infants with congenital diaphragmatic hernia: 10-year experience","authors":"Weihua Pan, Weipeng Wang, Jun Wang, Wei Xie, Yi Wang, Yinchao Jiang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.003","url":null,"abstract":"Objective \u0000To summarize our experiences of multidisciplinary treatment (MDT) for infants with congenital diaphragmatic hernia (CDH) and explore its effect on outcomes. \u0000 \u0000 \u0000Methods \u0000The medical records were retrospectively reviewed for 152 CDH infants from January 2001 to December 2018. The relevant clinical data included gestational age at diagnosis and delivery, Apgar score, types of hernia, birth weight, site of liver, admission arterial blood gas analysis, types of surgery, duration of mechanical ventilation and length of hospital stay. They were divided into two groups of non-MDT from January 2001 to February 2008 (n=8) and MDT from March 2008 to December 2018 (n=144). Their clinical parameters were compared and analyzed. \u0000 \u0000 \u0000Results \u0000There were 80 boys and 72 girls. And the involved side was left (n=120) and right (n=32). A total of 135 children were operated. In non-MDT group, all patients underwent open surgery. In MDT group, 17 patients died of cardiorespiratory failure without surgery. Among 127 surgical infants, open (n=66) and mini-invasive (n=78) operations were performed. Compared with counterparts in non-MDT group, those infants in MDT group were more likely to delay in surgical timing [(4.8±2.3) vs. (1.1±0.4) days], higher utilization of thoracoscopy (0 vs. 48.0%) and a higher survival rate (75.0% vs. 37.5%)(all P<0.05). However, no inter-group differences existed in gender, birth weight, site/size of defect, types of surgery or prenatal diagnosis. \u0000 \u0000 \u0000Conclusions \u0000MDT provides an feasible and effective model for diagnosing and treating CDH with better outcomes. \u0000 \u0000 \u0000Key words: \u0000Hernia, diaphragmatic; Multidisciplinary treatment; Treatment model; Prognosis","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":" 2","pages":"13-17"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72380304","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 : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.013
Fulin Li, Yang Lin, Yongbo Zhang, Jinfeng Li
Objective To explore the safety and efficacy of abdominal sequential suspension in laparoscopic Lich-Gregoir procedure in children with primary vesicoureteral reflux (VUR). Methods From April 2017 to April 2018, clinical data were retrospectively analyzed for 14 children with primary VUR undergoing laparoscopic extravesical reimplantation (Lich-Gregoir technique). Results All children were hospitalized for recurrent urinary tract infection. There were 5 boys and 11 girls with a mean age of 36(9-72) months. The involved side was left (n=6) and right (n=8). Grades Ⅲ (n=3) and Ⅳ/Ⅴ (n=11) of VUR were confirmed by voiding cystourethrography (VCUG). Renal scars were assessed by dimercaptosuccinic acid (DMSA) scan. All laparoscopic Lich-Gregoir operations were successful. The average operative duration was 45(40-62) min and the mean intraoperative blood loss 3.5(2-8) ml. The disappearance of VUR was confirmed by VCUG in all children at 3 months postoperatively, except one with grade I. No reflux occurred on contrast-enhanced ultrasonography at 6 months postoperatively and VCUG at 9 months postoperatively. There was no recent renal scarring or urinary tract infections since then. Conclusions During laparoscopic Lich-Gregoir operation, abdominal sequential suspension can effectively expose surgical field and shorten the operative duration of cutting bladder muscle layer and embedding ureter. Key words: Laparoscopes; Vesicoureteral reflux; Lich-Gergoir; Sequential suspension
{"title":"Application of abdominal sequential suspension in Laparoscopic Lich-Gregoir procedure for primary vesicoureteral reflux in children","authors":"Fulin Li, Yang Lin, Yongbo Zhang, Jinfeng Li","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.013","url":null,"abstract":"Objective \u0000To explore the safety and efficacy of abdominal sequential suspension in laparoscopic Lich-Gregoir procedure in children with primary vesicoureteral reflux (VUR). \u0000 \u0000 \u0000Methods \u0000From April 2017 to April 2018, clinical data were retrospectively analyzed for 14 children with primary VUR undergoing laparoscopic extravesical reimplantation (Lich-Gregoir technique). \u0000 \u0000 \u0000Results \u0000All children were hospitalized for recurrent urinary tract infection. There were 5 boys and 11 girls with a mean age of 36(9-72) months. The involved side was left (n=6) and right (n=8). Grades Ⅲ (n=3) and Ⅳ/Ⅴ (n=11) of VUR were confirmed by voiding cystourethrography (VCUG). Renal scars were assessed by dimercaptosuccinic acid (DMSA) scan. All laparoscopic Lich-Gregoir operations were successful. The average operative duration was 45(40-62) min and the mean intraoperative blood loss 3.5(2-8) ml. The disappearance of VUR was confirmed by VCUG in all children at 3 months postoperatively, except one with grade I. No reflux occurred on contrast-enhanced ultrasonography at 6 months postoperatively and VCUG at 9 months postoperatively. There was no recent renal scarring or urinary tract infections since then. \u0000 \u0000 \u0000Conclusions \u0000During laparoscopic Lich-Gregoir operation, abdominal sequential suspension can effectively expose surgical field and shorten the operative duration of cutting bladder muscle layer and embedding ureter. \u0000 \u0000 \u0000Key words: \u0000Laparoscopes; Vesicoureteral reflux; Lich-Gergoir; Sequential suspension","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"72 1","pages":"61-65"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82713435","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 : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.019
Lu Zhao
As a rare portal vein vascular malformation, congenital portosystemic shunt leads to severe complications, including infantile cholestasis, hepatic tumor, portosystemic encephalopathy, hepatopulmonary syndrome and portopulmonary hypertension. Early recognition and prompt therapy prevent and reverse clinically significant complications and improve the long-term outcomes in children. Key words: Child; Congenital portosystemic shunts; Portal vein
{"title":"Diagnosis and management of congenital portosystemic shunts in children","authors":"Lu Zhao","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.019","url":null,"abstract":"As a rare portal vein vascular malformation, congenital portosystemic shunt leads to severe complications, including infantile cholestasis, hepatic tumor, portosystemic encephalopathy, hepatopulmonary syndrome and portopulmonary hypertension. Early recognition and prompt therapy prevent and reverse clinically significant complications and improve the long-term outcomes in children. \u0000 \u0000 \u0000Key words: \u0000Child; Congenital portosystemic shunts; Portal vein","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"26 1","pages":"93-96"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87937723","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 : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.011
Xinke Qin, X. Duan, Zhen Qin, H. Bian, Chong Liang
Objective To evaluate the efficacy of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome (SMAS) in children. Methods Between 2015 to 2018, 4 SMAS children underwent laparoscopic duodenojejunostomy after a failure of conservative measures. For evaluating surgical efficacies, their clinical data and postoperative complications were recorded and analyzed. Results There were 1 boy and 3 girls. All of them were emaciated and slender. There was a sudden postprandial onset of bilious vomiting and abdominal pain. The average duration of illness was 1 month. Disturbances of water and electrolyte and malnutrition were quite common. However, symptomatic relief in knee-chest posture and wave of reverse peristalsis were not obvious. Their average weight at admission was 22.5 kg and body mass index (BMI) 14.2 kg/m2. Upper gastrointestinal radiography revealed obstruction of the third part of duodenum. And abdominal CT indicated an aortomesenteric angle of 13° and an aortomensenteric distance of 7 mm with gastric and proximal duodenal dilatation. If conservative measures failed, laparoscopic duodenojejunostomy was performed. The average operation time was 150 min. There were no postoperative complications such as obstruction, anastomotic leakage or anastomotic stenosis. Vomiting and abdominal pain were relieved. A month later, there was an average weight gain of 5.25 kg and BMI increased to 17.6 kg/m2. Conclusions Laparoscopic duodenojejunostomy is both simple and efficacious for SMAS with fewer postoperative complications and a lower recurrence rate in children. During operation, anastomosis should be large enough to avoid stenosis and anastomotic site should be close to obstruction site for reducing the length of non-functional bowel and lowering the incidence of blind loop syndrome. Key words: Child; Superior mesenteric artery syndrome; Laparoscopic duodenojejunostomy
{"title":"Application of laparoscopic duodenojejunostomy for children with superior mesenteric artery syndrome","authors":"Xinke Qin, X. Duan, Zhen Qin, H. Bian, Chong Liang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.011","url":null,"abstract":"Objective \u0000To evaluate the efficacy of laparoscopic duodenojejunostomy for superior mesenteric artery syndrome (SMAS) in children. \u0000 \u0000 \u0000Methods \u0000Between 2015 to 2018, 4 SMAS children underwent laparoscopic duodenojejunostomy after a failure of conservative measures. For evaluating surgical efficacies, their clinical data and postoperative complications were recorded and analyzed. \u0000 \u0000 \u0000Results \u0000There were 1 boy and 3 girls. All of them were emaciated and slender. There was a sudden postprandial onset of bilious vomiting and abdominal pain. The average duration of illness was 1 month. Disturbances of water and electrolyte and malnutrition were quite common. However, symptomatic relief in knee-chest posture and wave of reverse peristalsis were not obvious. Their average weight at admission was 22.5 kg and body mass index (BMI) 14.2 kg/m2. Upper gastrointestinal radiography revealed obstruction of the third part of duodenum. And abdominal CT indicated an aortomesenteric angle of 13° and an aortomensenteric distance of 7 mm with gastric and proximal duodenal dilatation. If conservative measures failed, laparoscopic duodenojejunostomy was performed. The average operation time was 150 min. There were no postoperative complications such as obstruction, anastomotic leakage or anastomotic stenosis. Vomiting and abdominal pain were relieved. A month later, there was an average weight gain of 5.25 kg and BMI increased to 17.6 kg/m2. \u0000 \u0000 \u0000Conclusions \u0000Laparoscopic duodenojejunostomy is both simple and efficacious for SMAS with fewer postoperative complications and a lower recurrence rate in children. During operation, anastomosis should be large enough to avoid stenosis and anastomotic site should be close to obstruction site for reducing the length of non-functional bowel and lowering the incidence of blind loop syndrome. \u0000 \u0000 \u0000Key words: \u0000Child; Superior mesenteric artery syndrome; Laparoscopic duodenojejunostomy","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"41 1","pages":"52-55"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87805212","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 perform a retrospective analysis of neonates with congenital diaphragmatic hernia (CDH) and to summarize the dilemmas of thoracoscopic repairing. Methods From April 2014 to April 2019, a total of 27 CDH neonates underwent thoracoscopy. Due to an excellent visual field of pulmonary dysplasia, hernia viscera was sequentially returned into abdomen. Sharp instruments should not be directly compressed for restoring spleen along with stomach and colon. For severe defect of posterolateral diaphragm, suturing diaphragm margin-intercostal muscle-diaphragm margin and moderately tightening wire knot are employed for repairing diaphragm muscle and preventing recurrence. For severe diaphragmatic defect, continuous suture should be performed for closing defect as much as possible. And the size of weak defect was measured. Customized mesh was placed into chest cavity and fixed mesh tightly attached to weak diaphragm by interrupted suturing with 4-0 proline thread. Results The involved side was left (n=25) and right (n=2). Twenty-three cases were diagnosed prenatally. The average gestational age of prenatal diagnosis was (28.2±5.1) weeks, the average gestational age (37.5±2.7) weeks and the average birth weight (2.90±0.70) kg. Thoracoscopic repairs were successful (n=23) and converting into open operation (n=4). Among 23 survivors, the average operative age was (41±40) hours and the average operative duration (159±14) min. The average durations of ventilator supports and hospitalization were (5.1±1.2) and (18.0±4.0) days respectively. Three cases complicated with chylothorax were cured after conservative measures. There was one case of recurrence. However, based upon illness severity and operative duration, the prognoses of different groups showed no significant statistical differences. Conclusions Thoracoscopic repair is both safe and feasible for severe congenital diaphragmatic hernia in neonates. If a surgeon has extensive experiences, thoracoscopy may be selected as a first choice and completed successfully with patching. When cardiopulmonary functions are unstable and PaCO2 is continuously higher than (65-75) mmHg, thoracoscopy should be converted timely into open surgery. The thoracoscopic tolerance of low-weight premature infants is no less than that of full-term infants. Key words: Hernia, diaphragmatic; Neonate; Thoracoscopy
{"title":"Neonatal thoracoscopic repair of congenital diaphragmatic hernias","authors":"Lishuang Ma, Jingna Li, Simiao Yu, Chao Liu, Ying Wang, Dong-ying Qu, Yan-dong Wei, Yue Zhang, C. Feng, Yanxia Zhang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.005","url":null,"abstract":"Objective \u0000To perform a retrospective analysis of neonates with congenital diaphragmatic hernia (CDH) and to summarize the dilemmas of thoracoscopic repairing. \u0000 \u0000 \u0000Methods \u0000From April 2014 to April 2019, a total of 27 CDH neonates underwent thoracoscopy. Due to an excellent visual field of pulmonary dysplasia, hernia viscera was sequentially returned into abdomen. Sharp instruments should not be directly compressed for restoring spleen along with stomach and colon. For severe defect of posterolateral diaphragm, suturing diaphragm margin-intercostal muscle-diaphragm margin and moderately tightening wire knot are employed for repairing diaphragm muscle and preventing recurrence. For severe diaphragmatic defect, continuous suture should be performed for closing defect as much as possible. And the size of weak defect was measured. Customized mesh was placed into chest cavity and fixed mesh tightly attached to weak diaphragm by interrupted suturing with 4-0 proline thread. \u0000 \u0000 \u0000Results \u0000The involved side was left (n=25) and right (n=2). Twenty-three cases were diagnosed prenatally. The average gestational age of prenatal diagnosis was (28.2±5.1) weeks, the average gestational age (37.5±2.7) weeks and the average birth weight (2.90±0.70) kg. Thoracoscopic repairs were successful (n=23) and converting into open operation (n=4). Among 23 survivors, the average operative age was (41±40) hours and the average operative duration (159±14) min. The average durations of ventilator supports and hospitalization were (5.1±1.2) and (18.0±4.0) days respectively. Three cases complicated with chylothorax were cured after conservative measures. There was one case of recurrence. However, based upon illness severity and operative duration, the prognoses of different groups showed no significant statistical differences. \u0000 \u0000 \u0000Conclusions \u0000Thoracoscopic repair is both safe and feasible for severe congenital diaphragmatic hernia in neonates. If a surgeon has extensive experiences, thoracoscopy may be selected as a first choice and completed successfully with patching. When cardiopulmonary functions are unstable and PaCO2 is continuously higher than (65-75) mmHg, thoracoscopy should be converted timely into open surgery. The thoracoscopic tolerance of low-weight premature infants is no less than that of full-term infants. \u0000 \u0000 \u0000Key words: \u0000Hernia, diaphragmatic; Neonate; Thoracoscopy","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"1 1","pages":"23-28"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79609266","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 explore the efficacy and application of five predictive outcome scores for neonatal congenital diaphragmatic hernia (CDH). Methods Clinical data were reviewed for 65 CDH neonates from September 1992 to February 2018. They were divided into survival and death groups based upon the prognosis. Postpartum variables were collected and compared by five scores. The overall scores, degree of illness and combination models were statistically analyzed for selecting the optimal evaluation model. Results Overall scores: SNAP-Ⅱyielded the best performance (AUC=0.813). Degree of illness: SNAP-Ⅱand Brindle obtained decent outcomes (AUC=0.803 & 0.725). However, SNAP-Ⅱfared better. Combination models: SNAP-Ⅱ+ Brindle proved to be the best one (AUC=0.841). Conclusions SNAP-Ⅱachieves the best performance among five predictive outcome scores. And the second one is Brindle. Both may be used for guiding clinical practice for CDH neonates nowadays. Key words: Infant, newborn; Congenital diaphragmatic hernia; Scoring model; Prognosis
{"title":"Primary study of five predictive outcome scores for neonatal congenital diaphragmatic hernia","authors":"Jingna Li, Lishuang Ma, Ying Wang, Chao Liu, Simiao Yu, Yan-dong Wei, Yanxia Zhang, Yue Zhang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.007","url":null,"abstract":"Objective \u0000To explore the efficacy and application of five predictive outcome scores for neonatal congenital diaphragmatic hernia (CDH). \u0000 \u0000 \u0000Methods \u0000Clinical data were reviewed for 65 CDH neonates from September 1992 to February 2018. They were divided into survival and death groups based upon the prognosis. Postpartum variables were collected and compared by five scores. The overall scores, degree of illness and combination models were statistically analyzed for selecting the optimal evaluation model. \u0000 \u0000 \u0000Results \u0000Overall scores: SNAP-Ⅱyielded the best performance (AUC=0.813). Degree of illness: SNAP-Ⅱand Brindle obtained decent outcomes (AUC=0.803 & 0.725). However, SNAP-Ⅱfared better. Combination models: SNAP-Ⅱ+ Brindle proved to be the best one (AUC=0.841). \u0000 \u0000 \u0000Conclusions \u0000SNAP-Ⅱachieves the best performance among five predictive outcome scores. And the second one is Brindle. Both may be used for guiding clinical practice for CDH neonates nowadays. \u0000 \u0000 \u0000Key words: \u0000Infant, newborn; Congenital diaphragmatic hernia; Scoring model; Prognosis","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"47 1","pages":"34-38"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75744736","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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