Pub Date : 2020-01-15DOI: 10.3760/CMA.J.ISSN.0253-3006.2020.01.018
Feng Chen, Hongmei Li
With constant refining of surgical methods for tetralogy of Fallot (TOF), the survival rate of TOF children has greatly improved. However, the long-term postoperative complications of TOF have become important prognostic factors. The most common complication of pulmonary regurgitation (PR) may lead to right ventricular dysfunction, exercise intolerance, arrhythmia and even sudden death. As an effective treatment for PR, pulmonary valve replacement (PVR) includes surgical pulmonary valve replacement (SPVR), percutaneous pulmonary valve replacement (PPVR) and hybrid therapy. Bioprosthetic valve has remained a primary choice of substituting pulmonary valve. With the improvements of anticoagulation regimens, mechanical valve has its own applicable population and anticoagulation regimens after PVR are also inconsistent. This article reviews the indications of pulmonary valve replacement after radical TOF operations, selecting pulmonary valve replacements, anticoagulant regimens after radical TOF operations and clinical therapeutic advances. Key words: Pulmonary Valve Insufficiency; Tetralogy of Fallot; Pulmonary valve replacement; Research progress
{"title":"Recent advances of pulmonary valve replacement after repairing tetralogy of Fallot","authors":"Feng Chen, Hongmei Li","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.018","url":null,"abstract":"With constant refining of surgical methods for tetralogy of Fallot (TOF), the survival rate of TOF children has greatly improved. However, the long-term postoperative complications of TOF have become important prognostic factors. The most common complication of pulmonary regurgitation (PR) may lead to right ventricular dysfunction, exercise intolerance, arrhythmia and even sudden death. As an effective treatment for PR, pulmonary valve replacement (PVR) includes surgical pulmonary valve replacement (SPVR), percutaneous pulmonary valve replacement (PPVR) and hybrid therapy. Bioprosthetic valve has remained a primary choice of substituting pulmonary valve. With the improvements of anticoagulation regimens, mechanical valve has its own applicable population and anticoagulation regimens after PVR are also inconsistent. This article reviews the indications of pulmonary valve replacement after radical TOF operations, selecting pulmonary valve replacements, anticoagulant regimens after radical TOF operations and clinical therapeutic advances. \u0000 \u0000 \u0000Key words: \u0000Pulmonary Valve Insufficiency; Tetralogy of Fallot; Pulmonary valve replacement; Research progress","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"28 1","pages":"88-92"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72692740","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.0253-3006.2020.01.014
Jun Zhang, Zhen Chen, Yan-dong Wei
Objective To explore the safety, feasibility and superiority of laparoscopy for lumbar hernia in children. Methods There were 4 boys and 5 girls with an average age of 4(1.5-10) years. The location of lumbar hernia was in lower lumbar triangle (n=7) and upper lumbar triangle (n=2). And the involved waist was left (n=6) and right (n=3). Laparoscopic mini-invasive herniorrhaphy was performed. Results All laparoscopic procedures were successful and curative. There was no onset of intraoperative massive hemorrhage, intraoperative or postoperative blood transfusion, unintentional injury or perioperative death. The average hospitalization stay was 5 days. During a follow-up period of 1-8 years, there was no onset of short/long-term complications. Conclusions Laparoscopy is both safe and reliable for treating lumbar hernia in children. With the advantages of minimal trauma, rapid recovery and satisfactory cosmetics, it is worthy of wider clinical promotions. Key words: Laparoscopys; Operation; Lumbar hernia in children
{"title":"Laparoscopy for lumbar hernia in children","authors":"Jun Zhang, Zhen Chen, Yan-dong Wei","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.014","url":null,"abstract":"Objective \u0000To explore the safety, feasibility and superiority of laparoscopy for lumbar hernia in children. \u0000 \u0000 \u0000Methods \u0000There were 4 boys and 5 girls with an average age of 4(1.5-10) years. The location of lumbar hernia was in lower lumbar triangle (n=7) and upper lumbar triangle (n=2). And the involved waist was left (n=6) and right (n=3). Laparoscopic mini-invasive herniorrhaphy was performed. \u0000 \u0000 \u0000Results \u0000All laparoscopic procedures were successful and curative. There was no onset of intraoperative massive hemorrhage, intraoperative or postoperative blood transfusion, unintentional injury or perioperative death. The average hospitalization stay was 5 days. During a follow-up period of 1-8 years, there was no onset of short/long-term complications. \u0000 \u0000 \u0000Conclusions \u0000Laparoscopy is both safe and reliable for treating lumbar hernia in children. With the advantages of minimal trauma, rapid recovery and satisfactory cosmetics, it is worthy of wider clinical promotions. \u0000 \u0000 \u0000Key words: \u0000Laparoscopys; Operation; Lumbar hernia in children","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"64 1","pages":"66-68"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80876283","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.0253-3006.2020.01.001
Jun Wang
{"title":"Diagnosis and treatment of congenital diaphragmatic hernia under a multidisciplinary treatment model","authors":"Jun Wang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.001","url":null,"abstract":"","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"26 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76033824","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.0253-3006.2020.01.006
Weipeng Wang, Wei Xie, Quanhua Liu, Weihua Pan, J. Yi, Wang Yi, Jianhua Zhang, Jun Wang
Objective To assess the pulmonary function recovery of infants with congenital diaphragmatic hernia (CDH). Methods The medical records were retrospectively reviewed for CDH infants receiving pulmonary function test (PFT) from November 2016 to March 2019. The relevant data included lung function, follow-up time, gender, sideness of hernia, Apgar score, birth weight, location of liver, admission arterial blood gas analysis, duration of mechanical ventilation and length of hospital stay. Results Forty-five infants were included for analysis. There were 19 boys and 26 girls. And the involved side was left (n=39) and right (n=6). PFT was performed for a total of 89 cases. The mean age at PFT was (9.3±7.3) months. And the frequency of PFT was once (n=20) and twice and more (n=25). Pulmonary function was normal (n=7, 15.6%) and abnormal (n=38, 84.4%). The results were normal pulmonary function (n=10), airflow obstruction (n=62), mixed ventilatory dysfunction (n=11) and airflow restriction (n=6). Significant correlation existed between lung function and age at PFT, sideness of hernia and liver herniation (all P<0.05). Compared with counterparts with airflow restriction, those with airflow obstruction had a later age of PFT [(8.9±6.9) vs.(1.3±05) months, P=0.001]. As compared with previous indices, percent of expiratory time to peak tidal time and percent of tidal volume to peak tidal expiratory flow increased subsequently. Conclusions Pulmonary function abnormality is present in some CDH survivors after repairing. Lung function may be correlated with age at PFT, sideness of hernia and liver herniation. Key words: Hernia, diaphragmatic; Pulmonary function; Follow-up
{"title":"Pulmonary function in infants with congenital diaphragmatic hernia","authors":"Weipeng Wang, Wei Xie, Quanhua Liu, Weihua Pan, J. Yi, Wang Yi, Jianhua Zhang, Jun Wang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.006","url":null,"abstract":"Objective \u0000To assess the pulmonary function recovery of infants with congenital diaphragmatic hernia (CDH). \u0000 \u0000 \u0000Methods \u0000The medical records were retrospectively reviewed for CDH infants receiving pulmonary function test (PFT) from November 2016 to March 2019. The relevant data included lung function, follow-up time, gender, sideness of hernia, Apgar score, birth weight, location of liver, admission arterial blood gas analysis, duration of mechanical ventilation and length of hospital stay. \u0000 \u0000 \u0000Results \u0000Forty-five infants were included for analysis. There were 19 boys and 26 girls. And the involved side was left (n=39) and right (n=6). PFT was performed for a total of 89 cases. The mean age at PFT was (9.3±7.3) months. And the frequency of PFT was once (n=20) and twice and more (n=25). Pulmonary function was normal (n=7, 15.6%) and abnormal (n=38, 84.4%). The results were normal pulmonary function (n=10), airflow obstruction (n=62), mixed ventilatory dysfunction (n=11) and airflow restriction (n=6). Significant correlation existed between lung function and age at PFT, sideness of hernia and liver herniation (all P<0.05). Compared with counterparts with airflow restriction, those with airflow obstruction had a later age of PFT [(8.9±6.9) vs.(1.3±05) months, P=0.001]. As compared with previous indices, percent of expiratory time to peak tidal time and percent of tidal volume to peak tidal expiratory flow increased subsequently. \u0000 \u0000 \u0000Conclusions \u0000Pulmonary function abnormality is present in some CDH survivors after repairing. Lung function may be correlated with age at PFT, sideness of hernia and liver herniation. \u0000 \u0000 \u0000Key words: \u0000Hernia, diaphragmatic; Pulmonary function; Follow-up","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"1 1","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86585261","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.0253-3006.2020.01.016
Xiangshui Sun, Xiongdong Wang
Objective To explore the distribution and imaging manifestations of pelvic bone destruction to improve the diagnostic level of pelvic bone destruction in children. Methods Retrospective analysis was performed for the clinical data of 41 children with pelvic bone destruction confirmed by surgically and pathological at two children's hospitals from August 2008 to September 2018. In conjunctions with postoperative pathological diagnosis, the distribution and imaging findings were analyzed. Results There were 29 boys and 12 girls with an average age of treatment (6.2±2.2)(11 moths to 13 years). The initial symptoms included hip pain (n=16), limping (n=11), hip pain with low fever (n=9) and unintentional radiographic findings (n=4). The locations of lesion were iliac bone (n=33), ischium (n=4), pubis (n=2), sacrum (n=1) and iliac & sacrum (n=1). The average duration of disease was (12.6±4.3)(2-30) days. Routine DR films of anterior/posterior pelvis (n=41), spiral CT scan with three-dimensional reconstruction (n=36) and sagittal, axial and coronal MRI scans (n=26) were performed. The major imaging findings were osteolytic bone destruction (n=27), mixed bone destruction (n=10), inflated bone destruction (n=4), distinct lesion boundary (n=21) and blurred boundary (n=20). There were associated soft tissue mass or swelling of different sizes (n=12) and periosteal reaction (n=7). Histopathological diagnoses included Langerhans cell histiocytosis (n=16), iliac metastasis of neuroblastoma (n=9), osteomyelitis (n=5), Ewing's sarcoma (n=3), tuberculosis (n=2), giant cell tumor of bone (n=1), chondroma (n=1), bone cyst (n=1), peripheral primitive neuroectodermal tumor (n=1), fibrous dysplasia of bone (n=1) and non-Hawking's lymphoma (n=1). Conclusions For various types of pelvic bone destruction in children, bony destruction is located predominantly in iliac wing. Langerhans cell histiocytosis and neuroblastoma are the most common iliac tumors in childhood. Imaging manifestations have certain characteristics of iliac osteolytic destruction. However, the specificity of imaging manifestations is not high so that histopathology is required for making a definite diagnosis. Key words: Ilium; Destruction of bone; Imaging diagnosis; Child
{"title":"Distribution and imaging features of pelvic bone destruction in children","authors":"Xiangshui Sun, Xiongdong Wang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.016","url":null,"abstract":"Objective \u0000To explore the distribution and imaging manifestations of pelvic bone destruction to improve the diagnostic level of pelvic bone destruction in children. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for the clinical data of 41 children with pelvic bone destruction confirmed by surgically and pathological at two children's hospitals from August 2008 to September 2018. In conjunctions with postoperative pathological diagnosis, the distribution and imaging findings were analyzed. \u0000 \u0000 \u0000Results \u0000There were 29 boys and 12 girls with an average age of treatment (6.2±2.2)(11 moths to 13 years). The initial symptoms included hip pain (n=16), limping (n=11), hip pain with low fever (n=9) and unintentional radiographic findings (n=4). The locations of lesion were iliac bone (n=33), ischium (n=4), pubis (n=2), sacrum (n=1) and iliac & sacrum (n=1). The average duration of disease was (12.6±4.3)(2-30) days. Routine DR films of anterior/posterior pelvis (n=41), spiral CT scan with three-dimensional reconstruction (n=36) and sagittal, axial and coronal MRI scans (n=26) were performed. The major imaging findings were osteolytic bone destruction (n=27), mixed bone destruction (n=10), inflated bone destruction (n=4), distinct lesion boundary (n=21) and blurred boundary (n=20). There were associated soft tissue mass or swelling of different sizes (n=12) and periosteal reaction (n=7). Histopathological diagnoses included Langerhans cell histiocytosis (n=16), iliac metastasis of neuroblastoma (n=9), osteomyelitis (n=5), Ewing's sarcoma (n=3), tuberculosis (n=2), giant cell tumor of bone (n=1), chondroma (n=1), bone cyst (n=1), peripheral primitive neuroectodermal tumor (n=1), fibrous dysplasia of bone (n=1) and non-Hawking's lymphoma (n=1). \u0000 \u0000 \u0000Conclusions \u0000For various types of pelvic bone destruction in children, bony destruction is located predominantly in iliac wing. Langerhans cell histiocytosis and neuroblastoma are the most common iliac tumors in childhood. Imaging manifestations have certain characteristics of iliac osteolytic destruction. However, the specificity of imaging manifestations is not high so that histopathology is required for making a definite diagnosis. \u0000 \u0000 \u0000Key words: \u0000Ilium; Destruction of bone; Imaging diagnosis; Child","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"1 1","pages":"75-82"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84845318","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.0253-3006.2020.01.012
Mengjiao Li, Da Zhang
Objective To summarize and analyze the curative effect that modified Soave procedure treats congenital anorectal stenosis, and to discuss the accuracy of diagnosis and the surgical treatment of primary cure. Methods Retrospective analysis was performed for clinical data of 5 cases who were operated by modified Soave procedure from 2015 to 2018 and to observe the curative effect in short and long term by clinical follow-up. Results Five children of congenital anorectal stenosis achieved primary postoperative healing. Defecation was satisfactory. At 1 month postoperatively, there was no onset of enterocolitis, bleeding/leakage of anastomotic stoma, infection of muscular sleeves, urinary system infection or peritonitis. During a follow-up period of 12-37 months, there was no occurrence of constipation, obstruction syndrome, anastomotic stricture or re-hospitalization. One case developed Ⅰ° proctoptoma. At Month 3 after stopping anal expansion, the frequency of Ⅰ° proctoptoma recovered gradually. At Month 15, proctoptosia disappeared and daily defecation was normalized. One case had occasional nocturnal soiling and normal daytime defecation. Conclusions As an rare type of anorectal malformations without standardized treatments, congenital anorectal stenosis is frequently complicated with megacolon. Modified Soave procedure offers a possible primary cure by one-stage operation. A definite diagnosis is made by large intestine gas-barium sulphate double contrast radiograph. And stenotic segment is located predominantly between pubic coccyx (PC) and I lines. Key words: Anal canal; Megacolon; Modified Soave procedure; Congenital anorectal stenosis
{"title":"Modified Soave procedure for congenital anorectal stenosis","authors":"Mengjiao Li, Da Zhang","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.012","url":null,"abstract":"Objective \u0000To summarize and analyze the curative effect that modified Soave procedure treats congenital anorectal stenosis, and to discuss the accuracy of diagnosis and the surgical treatment of primary cure. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for clinical data of 5 cases who were operated by modified Soave procedure from 2015 to 2018 and to observe the curative effect in short and long term by clinical follow-up. \u0000 \u0000 \u0000Results \u0000Five children of congenital anorectal stenosis achieved primary postoperative healing. Defecation was satisfactory. At 1 month postoperatively, there was no onset of enterocolitis, bleeding/leakage of anastomotic stoma, infection of muscular sleeves, urinary system infection or peritonitis. During a follow-up period of 12-37 months, there was no occurrence of constipation, obstruction syndrome, anastomotic stricture or re-hospitalization. One case developed Ⅰ° proctoptoma. At Month 3 after stopping anal expansion, the frequency of Ⅰ° proctoptoma recovered gradually. At Month 15, proctoptosia disappeared and daily defecation was normalized. One case had occasional nocturnal soiling and normal daytime defecation. \u0000 \u0000 \u0000Conclusions \u0000As an rare type of anorectal malformations without standardized treatments, congenital anorectal stenosis is frequently complicated with megacolon. Modified Soave procedure offers a possible primary cure by one-stage operation. A definite diagnosis is made by large intestine gas-barium sulphate double contrast radiograph. And stenotic segment is located predominantly between pubic coccyx (PC) and I lines. \u0000 \u0000 \u0000Key words: \u0000Anal canal; Megacolon; Modified Soave procedure; Congenital anorectal stenosis","PeriodicalId":10157,"journal":{"name":"Chinese Journal of Pediatric Surgery","volume":"39 1","pages":"56-60"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81865232","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.0253-3006.2020.01.015
Xin Jin, Yi Wang, Junhong Liu, Yifan Sun, Yu Wang, Ziyang Hang, Qiang Yu, Yi Wei
Objective To evaluate the day surgery mode of children and inpatient hospitalization surgery mode by using health economical methods and provide reference for optimization and decision of children indirect inguinal hernia operated. Methods Clinical data were collected from 389 children of uninterrupted unilateral indirect inguinal hernia from June 2016 to July 2017. Two modes were day surgery (day group, n=324) and inpatient hospitalization surgery (special group, n=65). The inter-group differences in general patient data, treatment index, fault tolerance, incidence of postoperative complications, recurrence rate and hospital infection were compared. And the inter-group differences in Hospital Consumer Assessment of Healthcare Providers and Systems Survey satisfaction, hospitalization stay, hospitalization cost and other health economic indicators were compared. The cost-effect of two modes was analyzed statistically, including weight of therapeutic effect W, treatment effect index of EI and cost-effect ratio CER. Results No inter-group statistical difference existed in gender or region. However, age distribution was wider in special group. The average bed occupancy time in day and inpatient groups was (23.17±0.49) and (112.06±19.75) hours respectively and the differences was statistically significant (P<0.01). And the hospitalization expenditure was (3372±430) and (6063±2104) yuan in day and special groups and the differences was statistically significant (P<0.01). The inter-group differences were statistically significant in the proportion of anesthetic grade ASA . And the incidence of complications showed no significant inter-group differences. In day and inpatient groups, the treatment effect index was 0.98 and 1.02 and the cost-effect ratio 3305 and 6184 respectively. Thus the economic benefits were greater in day group. Conclusions The cost-effect ratio of day surgery mode is superior to that of inpatient hospitalization surgery mode. No obvious differences exist in patient satisfaction or postoperative recurrence rate. Day surgery mode may be recommended for children with the indications of day surgery. Key words: Child; Day surgery; Inguinal hernia; Indirect hernia; Health economics evaluation
{"title":"Comparison of health economical evaluation between day surgery and inpatient hospitalization surgery mode for inguinal hernia","authors":"Xin Jin, Yi Wang, Junhong Liu, Yifan Sun, Yu Wang, Ziyang Hang, Qiang Yu, Yi Wei","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.015","url":null,"abstract":"Objective \u0000To evaluate the day surgery mode of children and inpatient hospitalization surgery mode by using health economical methods and provide reference for optimization and decision of children indirect inguinal hernia operated. \u0000 \u0000 \u0000Methods \u0000Clinical data were collected from 389 children of uninterrupted unilateral indirect inguinal hernia from June 2016 to July 2017. Two modes were day surgery (day group, n=324) and inpatient hospitalization surgery (special group, n=65). The inter-group differences in general patient data, treatment index, fault tolerance, incidence of postoperative complications, recurrence rate and hospital infection were compared. And the inter-group differences in Hospital Consumer Assessment of Healthcare Providers and Systems Survey satisfaction, hospitalization stay, hospitalization cost and other health economic indicators were compared. The cost-effect of two modes was analyzed statistically, including weight of therapeutic effect W, treatment effect index of EI and cost-effect ratio CER. \u0000 \u0000 \u0000Results \u0000No inter-group statistical difference existed in gender or region. However, age distribution was wider in special group. The average bed occupancy time in day and inpatient groups was (23.17±0.49) and (112.06±19.75) hours respectively and the differences was statistically significant (P<0.01). And the hospitalization expenditure was (3372±430) and (6063±2104) yuan in day and special groups and the differences was statistically significant (P<0.01). The inter-group differences were statistically significant in the proportion of anesthetic grade ASA . And the incidence of complications showed no significant inter-group differences. In day and inpatient groups, the treatment effect index was 0.98 and 1.02 and the cost-effect ratio 3305 and 6184 respectively. Thus the economic benefits were greater in day group. \u0000 \u0000 \u0000Conclusions \u0000The cost-effect ratio of day surgery mode is superior to that of inpatient hospitalization surgery mode. No obvious differences exist in patient satisfaction or postoperative recurrence rate. Day surgery mode may be recommended for children with the indications of day surgery. \u0000 \u0000 \u0000Key words: \u0000Child; Day surgery; Inguinal hernia; Indirect hernia; Health economics evaluation","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"1 1","pages":"69-74"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86977461","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.0253-3006.2020.01.009
H. Shang, Da Zhang, Lin Yang, Ge Zhao
Objective To evaluate the impact of Nuss procedure by comparing the dimensional changes of thoracic cavity of pectus excavatum (PE) patients on computed tomography (CT) images. Methods A total of 50 PE cases undergoing Nuss procedure from January 2014 to December 2018 were selected. Retrospective reviews were performed for clinical data and CT examinations of chest. The anteroposterior and transverse diameters were measured at multiple thoracic vertebral levels. Paired-sample t-test was employed for comparing the differences between preoperative and postoperative parameters. And independent sample t-test was performed for comparing the inter-group differences in patient age, gender, insertion time of bar and type of PE. Results The postoperative anteroposterior diameters from T8 to T12 were significantly higher than their preoperative values while T3 to T5 anteroposterior diameters and T8 to T10 transverse diameters were lower than their preoperative values. In children aged under 10 years, the duration of bar placement time ≥2 years and girl gender, the anteroposterior diameter changes were larger than the other groups at multiple vertebral levels (P<0.05) and the differences were statistically significant. Conclusions Anterior chest wall depression significantly improves after Nuss procedure. Early correction and longer correction time offer better corrective outcomes. The transverse diameter of thoracic cavity is somewhat limited in growth. Key words: Thoracic vertebrae; Nuss procedure; Thoracic change; CT measurement; Pectus excavatum
{"title":"Impact of Nuss procedure on thoracic cavity and analysis of related factors","authors":"H. Shang, Da Zhang, Lin Yang, Ge Zhao","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.009","url":null,"abstract":"Objective \u0000To evaluate the impact of Nuss procedure by comparing the dimensional changes of thoracic cavity of pectus excavatum (PE) patients on computed tomography (CT) images. \u0000 \u0000 \u0000Methods \u0000A total of 50 PE cases undergoing Nuss procedure from January 2014 to December 2018 were selected. Retrospective reviews were performed for clinical data and CT examinations of chest. The anteroposterior and transverse diameters were measured at multiple thoracic vertebral levels. Paired-sample t-test was employed for comparing the differences between preoperative and postoperative parameters. And independent sample t-test was performed for comparing the inter-group differences in patient age, gender, insertion time of bar and type of PE. \u0000 \u0000 \u0000Results \u0000The postoperative anteroposterior diameters from T8 to T12 were significantly higher than their preoperative values while T3 to T5 anteroposterior diameters and T8 to T10 transverse diameters were lower than their preoperative values. In children aged under 10 years, the duration of bar placement time ≥2 years and girl gender, the anteroposterior diameter changes were larger than the other groups at multiple vertebral levels (P<0.05) and the differences were statistically significant. \u0000 \u0000 \u0000Conclusions \u0000Anterior chest wall depression significantly improves after Nuss procedure. Early correction and longer correction time offer better corrective outcomes. The transverse diameter of thoracic cavity is somewhat limited in growth. \u0000 \u0000 \u0000Key words: \u0000Thoracic vertebrae; Nuss procedure; Thoracic change; CT measurement; Pectus excavatum","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"38 1","pages":"42-46"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73210052","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.0253-3006.2020.01.010
Baihui Liu, Jiwei Li, Xian-min Xiao, Kai Li, Lian Chen, K. Dong
Objective To explore the pathological types and clinical values of intraoperative frozen pathology for surgical children with persistent hyperinsulinemic hypoglycemia of infancy (PHHI). Methods A total of 25 PHHI infants were operated from April 2011 to October 2016. And retrospective analyses were performed for clinical data, surgical approaches and pathological characteristics. Results There were 17 boys and 8 girls with an age range from 16 days to 12 months. The fasting levels of blood glucose and insulin were (0.6-5.5) mmol/L and (3.1-50.1) mU/L respectively. Based upon the preoperative examinations and intraoperative frozen pathology, they underwent focal type and subtotal pancreatectomy respectively. During a postoperative follow-up period of (2-38) months, fasting blood glucose had a range of (3.0-12.6) mmol/L. Fifteen children recovered well without any complication. One case of hypoglycemia required glucagon. And a low fasting level of glucose normalized after ingesting (n=3) and postoperative hyperglycemia required medications for controlling blood glucose (n=6). One case with suspected focal pancreatic lesion underwent a focal resection of 50% and relapsed after 2 weeks. According to the pathological classification criteria, their clinical types were focal (n=6), diffuse (n=18) and atypical (n=1). Conclusions Clinically it is important to confirm the classification of pathological types. Preoperative examinations and intraoperative frozen pathology may help to find effective treatments and improve the outcomes. The most common pathological type is diffuse. Further studies are required for atypical type. Key words: Pathology; Persistent hyperinsulinemic hypoglycemia in infancy; Intraoperative frozen
{"title":"Values of intraoperative frozen pathology and pathological analysis for persistent hyperinsulinemic hypoglycemia in infants","authors":"Baihui Liu, Jiwei Li, Xian-min Xiao, Kai Li, Lian Chen, K. Dong","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.010","url":null,"abstract":"Objective \u0000To explore the pathological types and clinical values of intraoperative frozen pathology for surgical children with persistent hyperinsulinemic hypoglycemia of infancy (PHHI). \u0000 \u0000 \u0000Methods \u0000A total of 25 PHHI infants were operated from April 2011 to October 2016. And retrospective analyses were performed for clinical data, surgical approaches and pathological characteristics. \u0000 \u0000 \u0000Results \u0000There were 17 boys and 8 girls with an age range from 16 days to 12 months. The fasting levels of blood glucose and insulin were (0.6-5.5) mmol/L and (3.1-50.1) mU/L respectively. Based upon the preoperative examinations and intraoperative frozen pathology, they underwent focal type and subtotal pancreatectomy respectively. During a postoperative follow-up period of (2-38) months, fasting blood glucose had a range of (3.0-12.6) mmol/L. Fifteen children recovered well without any complication. One case of hypoglycemia required glucagon. And a low fasting level of glucose normalized after ingesting (n=3) and postoperative hyperglycemia required medications for controlling blood glucose (n=6). One case with suspected focal pancreatic lesion underwent a focal resection of 50% and relapsed after 2 weeks. According to the pathological classification criteria, their clinical types were focal (n=6), diffuse (n=18) and atypical (n=1). \u0000 \u0000 \u0000Conclusions \u0000Clinically it is important to confirm the classification of pathological types. Preoperative examinations and intraoperative frozen pathology may help to find effective treatments and improve the outcomes. The most common pathological type is diffuse. Further studies are required for atypical type. \u0000 \u0000 \u0000Key words: \u0000Pathology; Persistent hyperinsulinemic hypoglycemia in infancy; Intraoperative frozen","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"1 1","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89752799","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.0253-3006.2020.01.008
Yi Zhang, Ji-cui Zheng, R. Zhao, W. Shi, Weiming Chen, G. Lu, Hao Li
Objective To explore the diagnosis, treatment and prognosis of intracranial hemorrhage after extracorporeal membrane oxygenation (ECMO) in children. Methods Retrospective analysis was performed for 89 ECMO cases with intracranial hemorrhage from 2011 to 2018. Their clinical data were collected and analyzed.Six children (6.7%) had intracranial hemorrhage during ECMO treatment. Among 6 cases of intracranial hemorrhage, there were 4 boys and 2 girls with an age range from 1 day to 11 years. The causes were myocarditis (n=1) and severe pneumonia (n=5). Two cases required ECMO out-hospital catheterization. The average ECMO duration was 126.8(28.0-229.5) hours. Results Computed tomography was examined for unequal pupils (n=2), magnetic resonance imaging (MRI) for hemiplegia (n=1), B-mode ultrasound for routine uses (n=2) and MRI for intracranial hemorrhage (n=1). The locations of lesion were subdural (n=1), deep brain tissue (n=1) and brain lobe (n=4). The interventions were surgery (n=2), conservative measures (n=2) and death after giving up treatments (n=2). GOS score of surgical children was 5 points (epidural hemorrhage) and 4 points (hemiparesis). Conclusions Intracranial hemorrhage is a severe hemorrhagic complication after ECMO. Early diagnosis and surgical treatment may improve its prognosis. Key words: Intracranial hemorrhages; Extracorporeal membrane oxygenation; Surgical treatment
{"title":"Treatments of intracranial hemorrhage after extracorporeal membrane oxygenation: case report and literature review","authors":"Yi Zhang, Ji-cui Zheng, R. Zhao, W. Shi, Weiming Chen, G. Lu, Hao Li","doi":"10.3760/CMA.J.ISSN.0253-3006.2020.01.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.0253-3006.2020.01.008","url":null,"abstract":"Objective \u0000To explore the diagnosis, treatment and prognosis of intracranial hemorrhage after extracorporeal membrane oxygenation (ECMO) in children. \u0000 \u0000 \u0000Methods \u0000Retrospective analysis was performed for 89 ECMO cases with intracranial hemorrhage from 2011 to 2018. Their clinical data were collected and analyzed.Six children (6.7%) had intracranial hemorrhage during ECMO treatment. Among 6 cases of intracranial hemorrhage, there were 4 boys and 2 girls with an age range from 1 day to 11 years. The causes were myocarditis (n=1) and severe pneumonia (n=5). Two cases required ECMO out-hospital catheterization. The average ECMO duration was 126.8(28.0-229.5) hours. \u0000 \u0000 \u0000Results \u0000Computed tomography was examined for unequal pupils (n=2), magnetic resonance imaging (MRI) for hemiplegia (n=1), B-mode ultrasound for routine uses (n=2) and MRI for intracranial hemorrhage (n=1). The locations of lesion were subdural (n=1), deep brain tissue (n=1) and brain lobe (n=4). The interventions were surgery (n=2), conservative measures (n=2) and death after giving up treatments (n=2). GOS score of surgical children was 5 points (epidural hemorrhage) and 4 points (hemiparesis). \u0000 \u0000 \u0000Conclusions \u0000Intracranial hemorrhage is a severe hemorrhagic complication after ECMO. Early diagnosis and surgical treatment may improve its prognosis. \u0000 \u0000 \u0000Key words: \u0000Intracranial hemorrhages; Extracorporeal membrane oxygenation; Surgical treatment","PeriodicalId":10157,"journal":{"name":"中华小儿外科杂志","volume":"1 1","pages":"39-41"},"PeriodicalIF":0.0,"publicationDate":"2020-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89753651","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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