Seminars in Pediatric Surgery最新文献

英文中文

Differences in sex development: Taking inventory of function and anatomy to empower self care 性别发展的差异：盘点功能和解剖以增强自我照顾能力。

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-10-01 DOI: 10.1016/j.sempedsurg.2025.151537

Kathleen Heller , Stephanie Brierley , Natalya Foreman , Erica M Weidler , Kathleen van Leeuwen

The umbrella term disorders of sexual development (DSD) encompasses a broad spectrum of congenital conditions with atypical chromosomal, gonadal or anatomic sex development¹^, ². These conditions include mosaic chromosomal disorders, gonadal disorders of development, disorders of androgen synthesis, action or excess, and anatomical disorders, such as cloacal anomalies or mullerian structural errors¹. The incidence of DSD is estimated to be around 1% of all live births².

DSD patients can also be considered to have congenital conditions affecting reproductive development (CCARD) and an important element of their care as the age is taking regular inventory of their anatomy so decisions regarding medical, surgical and psychological options can be made. There are many specialties that are asked to help these families, including pediatricians, endocrinologists, urologists, pediatrics surgeons and, as they age, pediatric/adolescent gynecologists and adult gynecologists. Keeping the message consistent is difficult across such a wide spectrum of specialists. Tools that can offer a review of the function of the body and, in particular, the specific anatomy unique to these diagnoses, is essential. We present a review of common DSD or CCARD conditions and propose education delivered at typical milestones to help empower decision making.

性发育障碍（DSD）的总称涵盖了广泛的先天性疾病与非典型染色体，性腺或解剖性发育1,2。这些疾病包括镶嵌染色体疾病、性腺发育障碍、雄激素合成、作用或过量障碍，以及解剖学上的疾病，如阴囊异常或苗勒管结构错误1。据估计，DSD的发生率约占所有活产婴儿的1%。DSD患者也可被视为患有影响生殖发育的先天性疾病（CCARD），这是他们护理的一个重要因素，因为年龄正在定期清点他们的解剖结构，以便就医疗、手术和心理选择作出决定。有许多专家被要求帮助这些家庭，包括儿科医生、内分泌学家、泌尿科医生、儿科外科医生，随着他们年龄的增长，还有儿科/青少年妇科医生和成人妇科医生。在如此广泛的专家中保持信息的一致性是很困难的。工具，可以提供一个检讨的身体功能，特别是具体的解剖独特的这些诊断，是必不可少的。我们对常见的DSD或CCARD条件进行了回顾，并建议在典型的里程碑上提供教育，以帮助制定决策。

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Tubo-ovarian abscess etiology, presentation, and management in youth and adolescents 青少年输卵管卵巢脓肿的病因、表现和处理。

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-10-01 DOI: 10.1016/j.sempedsurg.2025.151563

Garrett Garbo , Stephanie Cizek

Tubo-ovarian abscesses (TOA) in children and adolescents may be missed or delayed in diagnosis due to differences in the etiologies, presentation, and clinical evaluation compared to adult patients. Management of TOA should include intravenous (IV) broad-spectrum antibiotics for all patients; additional abscess drainage through image-guided techniques may be co-initiated with antibiotics as first line treatment for those with risk factors for treatment failure, or reserved as second-line treatment for those who do not improve with IV antibiotics. Surgical interventions impose a higher risk of complications and are generally reserved for clinically unstable patients or for those who fail both IV antibiotics and image-guided abscess drainage. Selection of management must balance complication risk of the TOA itself with iatrogenic complication risks. This article reviews TOA in the pediatric and adolescent population, highlighting the different etiologies in younger patients compared to adults, and reviewing current recommendations for evaluation and management.

与成人患者相比，由于病因、表现和临床评估的差异，儿童和青少年的输卵管卵巢脓肿（TOA）可能会错过或延迟诊断。TOA的管理应包括所有患者静脉注射广谱抗生素；对于那些有治疗失败危险因素的患者，通过图像引导技术进行脓肿引流可以与抗生素共同作为一线治疗，或者保留作为静脉注射抗生素没有改善的二线治疗。手术干预有较高的并发症风险，通常用于临床不稳定的患者或静脉注射抗生素和图像引导下脓肿引流失败的患者。治疗方案的选择必须平衡TOA本身的并发症风险和医源性并发症风险。本文回顾了儿科和青少年人群的TOA，强调了与成人相比，年轻患者的不同病因，并回顾了目前评估和管理的建议。

引用次数: 0

fm i -- Contents fm i -目录

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-10-01 DOI: 10.1053/S1055-8586(25)00089-7

引用次数: 0

Developments and prospects of robotic-assisted surgery in the treatment of pediatric Hirschsprung’s disease: a comprehensive review 机器人辅助手术治疗儿童先天性巨结肠病的进展与前景：综述

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-09-01 DOI: 10.1016/j.sempedsurg.2025.151527

Ken Chen , Shuhao Zhang , Zhigang Gao, Qingjiang Chen

With the continuous advancement of surgical instruments and techniques, laparoscopic minimally invasive surgery (LMIS) has become a standard practice in many pediatric medical centers. LMIS offers significant benefits over traditional open surgery, including reduced perioperative complications and enhanced postoperative recovery. In comparison to laparoscopic surgery, the robotic system is equipped with magnified 3D image, superior visualization, dexterity and tremor filter, enabling more precise operative actions, stable control, and clearer exposure of surgical field, facilitating the handling of deep anatomical structures and protecting critical blood vessels and nerves. Robotic surgery represents the pinnacle of precision in minimally invasive techniques and is gaining popularity among surgeons for complex reconstructive procedures.

随着手术器械和技术的不断进步，腹腔镜微创手术（LMIS）已成为许多儿科医疗中心的标准做法。与传统的开放手术相比，LMIS具有显著的优势，包括减少围手术期并发症和增强术后恢复。与腹腔镜手术相比，机器人系统具有放大的3D图像、优越的可视化、灵巧性和震颤滤光功能，可实现更精确的手术动作、稳定的控制和更清晰的手术视野，便于处理深层解剖结构，保护关键血管和神经。机器人手术代表了微创技术精度的顶峰，在复杂的重建手术中越来越受外科医生的欢迎。

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Vascularization patterns of the upper lobes in the fetal population 胎儿上叶的血管形成模式。

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-09-01 DOI: 10.1016/j.sempedsurg.2025.151491

Gorodner Arturo, Zarate Lautaro, Baez Raul, Estenaga Julian, Sandoval Obregon, Rodas Mauricio

The vascularization of the lung is predominantly provided by the pulmonary artery, which transports blood from the right ventricle to the pulmonary parenchyma. During fetal life pulmonary vascularization is more intense than in adults due to the phases of development: embryonic, pseudo glandular, canalicular, saccular, and alveolar. In the adult lung upper lobes, the main arteries are the apicoposterior branch and the anterior branch for the right upper lobe, and three branches (anterior, apicoposterior, and lingual) for the left upper lobe. This study focused on identifying the patterns of arterial branching in the upper lobes of fetal lungs. Seven fetal specimens were dissected, injected with latex, and fixed in formaldehyde. A predominance of vascularization was found in the upper lobes, with patterns identified as anterior, superior, posterior, and mixed. In the right upper lobes, the anterior pattern predominated in most cases, while greater diversity was observed in the left upper lobes, including anterior, posterior, superior, and mixed patterns. This study highlights the importance of understanding vascularization patterns in fetuses to improve surgical planning in neonates and infants, considering the high vascularization during pulmonary development. Despite the heterogeneity of the sample, which limits statistical precision, the findings provide valuable information to reduce complications in neonatal and pulmonary surgery. This study proposes a clear nomenclature that adheres to international standards to facilitate interpretation.

肺的血管化主要由肺动脉提供，它将血液从右心室输送到肺实质。在胎儿时期，由于发育阶段：胚胎期、假腺期、小管期、囊状期和肺泡期，肺血管形成比成人更强烈。成人肺上叶主要动脉为右肺上叶的顶后支和前支，左肺上叶的三个分支（前支、顶后支和舌支）。本研究的重点是确定胎儿肺上叶动脉分支的模式。解剖7个胎儿标本，注射乳胶，用甲醛固定。血管形成的优势是发现在上叶，其模式确定为前，上，后，和混合。在右上叶中，大多数病例以前型为主，而在左上叶中观察到更大的多样性，包括前型、后型、上型和混合型。本研究强调了了解胎儿血管形成模式对改善新生儿和婴儿手术计划的重要性，考虑到肺部发育期间的高血管形成。尽管样本的异质性限制了统计精度，但研究结果为减少新生儿和肺部手术的并发症提供了有价值的信息。这项研究提出了一个明确的术语，坚持国际标准，以方便解释。

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引用次数: 0

fm i -- Contents fm i -目录

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-09-01 DOI: 10.1053/S1055-8586(25)00081-2

引用次数: 0

The efficacy and safety of single-port versus multi-port laparoscopic surgery for pediatric inguinal hernia: a systematic review and meta-analysis 单孔与多孔腹腔镜手术治疗小儿腹股沟疝的疗效和安全性：一项系统综述和荟萃分析。

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-09-01 DOI: 10.1016/j.sempedsurg.2025.151526

Guiquan Fan , Xindan Zhang , Yongke He, Xiaogang Lu, Zongyang Pang, Xiyang Gan

Objective

This study evaluates the safety and efficacy of single-port versus multi-port laparoscopic surgery in pediatric inguinal hernia repair through a systematic review and meta-analysis.

Methods

Following PRISMA guidelines, a comprehensive literature search was conducted up to December 2024. Studies comparing single-port and multi-port laparoscopic surgery in pediatric inguinal hernia patients were included. Two researchers independently assessed study quality and extracted data. Primary outcomes were surgical duration, intraoperative blood loss, and postoperative complications. Stata 15.1 was used for analysis.

Results

Eleven studies with 3,494 pediatric patients were included. No significant differences were found in postoperative recurrence (RR = 0.53, 95%CI: 0.22 to 1.26), complications (RR = 0.60, 95%CI: 0.30 to 1.19), or hospital stay (SMD = -0.34, 95%CI: -0.88 to 0.21). However, single-port surgery resulted in significantly less intraoperative blood loss (SMD = -2.87, 95% CI: -4.43 to -1.31) and shorter bilateral hernia repair time (SMD = -0.93, 95% CI: -1.71 to -0.16), with better cosmetic outcomes.

Conclusions

Both approaches are safe and effective. Single-port surgery offers advantages in minimizing scarring, reducing blood loss, and shortening surgery time for bilateral cases but requires advanced skills and is unsuitable for larger or complex hernias. Multi-port surgery provides more flexibility for complex cases.

目的：本研究通过系统回顾和荟萃分析，评价单孔与多孔腹腔镜手术在小儿腹股沟疝修补中的安全性和有效性。方法：根据PRISMA指南，检索截至2024年12月的综合文献。比较单孔和多孔腹腔镜手术在小儿腹股沟疝患者中的应用。两名研究人员独立评估研究质量并提取数据。主要结局是手术时间、术中出血量和术后并发症。采用Stata 15.1进行分析。结果：纳入11项研究，3,494名儿科患者。术后复发率（RR = 0.53, 95%CI: 0.22 ~ 1.26）、并发症（RR = 0.60, 95%CI: 0.30 ~ 1.19）、住院时间（SMD = -0.34, 95%CI: -0.88 ~ 0.21）均无显著差异。然而，单孔手术可显著减少术中出血量（SMD = -2.87, 95% CI: -4.43至-1.31），缩短双侧疝修复时间（SMD = -0.93, 95% CI: -1.71至-0.16），并具有更好的美容效果。结论：两种方法均安全有效。单孔手术在减少疤痕、减少失血和缩短双侧病例手术时间方面具有优势，但需要先进的技术，不适合较大或复杂的疝。多端口手术为复杂病例提供了更大的灵活性。

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引用次数: 0

ERCP first vs. Surgery first: A comparative perspective in pediatric choledocholithiasis ERCP优先与手术优先：儿童胆总管结石的比较研究

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-09-01 DOI: 10.1016/j.sempedsurg.2025.151529

Wesley Judy , Micaela K Gomez , Quin Liu , Lucas Neff

Pediatric choledocholithiasis is a rare but increasingly recognized disease process that is predominantly managed with either an “endoscopy-first” or “surgery-first” approach. In the endoscopy-first approach, a preoperative endoscopic retrograde cholangiopancreatography is performed with subsequent cholecystectomy. In contrast, the surgery-first approach is a single-stage procedure that includes a laparoscopic cholecystectomy and intraoperative cholangiogram, followed by a laparoscopic common bile duct exploration when indicated. Recent studies have highlighted the potential advantages of the SF approach. However, no standardized treatment algorithm exists, and institutional capabilities and practicing patterns heavily influence management decisions. This point-counterpoint review explores both approaches, analyzing their effects on clinical outcomes and healthcare resources. Continued research and a multidisciplinary approach are needed to develop consensus-driven treatment algorithms.

小儿胆总管结石是一种罕见但越来越被认可的疾病过程，主要是通过“内窥镜优先”或“手术优先”的方法进行治疗。在内镜先入路中，术前行内镜逆行胆管造影，随后行胆囊切除术。相比之下，手术先入路是一种单阶段手术，包括腹腔镜胆囊切除术和术中胆管造影，然后在需要时进行腹腔镜胆总管探查。最近的研究强调了SF方法的潜在优势。然而，没有标准化的治疗算法存在，机构能力和实践模式严重影响管理决策。这篇点对点综述探讨了这两种方法，分析了它们对临床结果和医疗资源的影响。需要持续的研究和多学科方法来制定共识驱动的治疗算法。

引用次数: 0

Advancing advocacy for evidence-based opioid stewardship 推进倡导以证据为基础的阿片类药物管理

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-08-01 DOI: 10.1016/j.sempedsurg.2025.151524

Jenna S. Lee , Emma Kirkpatrick , Lorraine I. Kelley-Quon

Opioids are frequently prescribed for postsurgical and acute pain management for both adults and children. However, research has shown that overprescription and improper handling of these medications contribute to problematic substance use, dependency, and overdose among the pediatric population. Despite increased awareness and efforts to mitigate the opioid epidemic, challenges persist, including inconsistent prescribing practices, inadequate education on safe disposal practices, gaps in prescription monitoring systems, and barriers to naloxone availability. In this review, we will highlight actionable steps and strategies for advocacy and intervention to reduce the burden of the opioid crisis in children and adolescents. Key topics include the critical role of opioid stewardship when managing postoperative pain, the importance of family engagement and education on safe disposal methods, the ongoing challenges of safe prescribing and monitoring, and opportunities to extend substance use screening and treatment referral for injured adolescents. Additionally, we will highlight policy recommendations to promote equitable access and availability of harm reduction tools such as naloxone. These strategies, if implemented together, can significantly reduce the risks associated with pediatric opioid use and mitigate the impact of the opioid epidemic on children and adolescents.

阿片类药物经常用于成人和儿童的术后和急性疼痛管理。然而，研究表明，这些药物的过度处方和不当处理导致了儿科人群中有问题的物质使用、依赖和过量使用。尽管在减轻阿片类药物流行方面的认识和努力有所提高，但挑战依然存在，包括处方做法不一致、安全处置做法教育不足、处方监测系统存在差距以及纳洛酮供应方面存在障碍。在本次审查中，我们将重点介绍宣传和干预的可行步骤和战略，以减轻儿童和青少年阿片类药物危机的负担。主要议题包括阿片类药物管理在处理术后疼痛时的关键作用，家庭参与和安全处置方法教育的重要性，安全处方和监测的持续挑战，以及扩大对受伤青少年的物质使用筛查和治疗转诊的机会。此外，我们将强调政策建议，以促进纳洛酮等减少危害工具的公平获取和可得性。这些战略如果一起实施，可以大大减少与儿科类阿片使用有关的风险，并减轻类阿片流行病对儿童和青少年的影响。

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引用次数: 0

Protecting our patients’ future through perioperative sustainability: Action and advocacy for the pediatric surgeon 通过围手术期可持续性保护患者的未来：儿科外科医生的行动和倡导

IF 2.5 3区医学 Q3 PEDIATRICS

Seminars in Pediatric Surgery

Pub Date : 2025-08-01 DOI: 10.1016/j.sempedsurg.2025.151518

Grace A. Nicksa , Nicole Chicoine , Linda T. Li , Ramin Jamshidi , Alison J. Lehane , Mehul V. Raval , Sarah D. King , Sarah Greenberg

Climate change is a significant threat to human health and health equity. Marginalized populations, including children, are most impacted by our rapidly changing environment. Both the prevalence of pediatric surgical disease, as well as the ability to deliver surgical care, are affected by climate change. Ironically, healthcare systems have a significant, deleterious effect on the planet. However, there are many proven mitigation strategies to reduce the injurious climate impact of the delivery of surgical services, augment equity, and improve health. We describe five domains through which pediatric surgical care providers can act to generate more sustainable healthcare systems: reduce, repurpose, reuse, refuse, and recycle. We highlight successful examples instituted through various healthcare organizations and provide recommendations that pediatric surgical care providers can use to support the health of our planet through their daily work. These actions can increase sustainability, reduce cost, and promote equity for our patients and future generations.

气候变化是对人类健康和卫生公平的重大威胁。包括儿童在内的边缘人口受我们迅速变化的环境影响最大。儿童外科疾病的患病率以及提供外科护理的能力都受到气候变化的影响。具有讽刺意味的是，医疗保健系统对地球有着重大的有害影响。然而，有许多经过验证的缓解战略可以减少外科手术服务提供对气候的有害影响，增加公平性，并改善健康。我们描述了五个领域，通过这些领域，儿科外科护理提供者可以采取行动，以产生更可持续的医疗保健系统：减少，重新利用，再利用，拒绝和回收。我们强调通过各种医疗保健组织建立的成功案例，并提供建议，儿科外科护理提供者可以通过他们的日常工作来支持我们地球的健康。这些行动可以提高可持续性，降低成本，促进患者和子孙后代的公平。

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