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Lymphatic Malformations in Parkes Weber's Syndrome: Retrospective Review of 16 Cases in a Vascular Anomalies Center. Parkes-Weber综合征的淋巴畸形:血管异常中心16例病例的回顾性分析。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-02-01 Epub Date: 2023-08-18 DOI: 10.1055/a-2156-5000
Julio César Moreno Alfonso, Irune Méndez-Maestro, Aniol Coll I Prat, Lara Rodríguez-Laguna, Victor Martínez-Glez, Paloma Triana, Juan Carlos López-Gutiérrez

Introduction:  Parkes Weber's syndrome (PWS) is a rare genetic disorder characterized by overgrowth and vascular malformations, primarily affecting the extremities. While PWS is known to be associated with arteriovenous and capillary malformations, the potential involvement of lymphatic malformations (LMs) has not been previously reported. The objective of this study is to investigate the presence of lymphatic anomalies in PWS patients and their role in the development of limb asymmetry.

Materials and methods:  This is a retrospective study of patients diagnosed with PWS in a Vascular Anomalies Center from 1994 to 2020. Clinical data were obtained from medical records including diagnostic imaging, lymphoscintigraphy, and genetic testing. The Institutional Review Board and Ethics Committee have approved this study.

Results:  A total of 16 patients aged 18 interquartile range 14.7 years diagnosed with PWS were included (50% female). Six of the 16 patients with PWS had clinical and imaging data suggestive of LM (37.5%) and 3 of them had genetic variants in RASA1 (2/3) or KRAS (1/3). Limb asymmetry was greater in patients with isolated PWS (2.6 ± 0.8 cm) than in the PWS-lymphatic anomalies population (2 ± 0.7 cm), although not significant (p = 0.247). One in 6 patients with PWS-LM required amputation (16.6%) versus 1 in 10 in isolated PWS (10%).

Conclusion:  Lymphatic anomalies may be present in a significant number of patients with PWS and could have a role in limb asymmetry and outcomes. It is paramount to investigate their existence and distinguish them from true overgrowth.

简介: 帕克斯-韦伯综合征(PWS)是一种罕见的遗传性疾病,其特征是过度生长和血管畸形,主要影响四肢。虽然PWS已知与动静脉和毛细血管畸形有关,但淋巴管畸形(LMs)的潜在参与此前尚未报道。本研究的目的是研究PWS患者淋巴异常的存在及其在肢体不对称发展中的作用。材料和方法: 这是对1994年至2020年在血管异常中心诊断为PWS的患者的回顾性研究。临床数据来自医疗记录,包括诊断成像、淋巴闪烁扫描和基因检测。机构审查委员会和道德委员会已经批准了这项研究。结果: 共有16名患者被纳入研究,年龄为18岁,四分位间距14.7岁,诊断为PWS(50%为女性)。16名PWS患者中有6名患者的临床和影像学数据提示LM(37.5%),其中3名患者的RASA1(2/3)或KRAS(1/3)存在遗传变异。孤立性PWS患者的肢体不对称性更大(2.6 ± 0.8 cm)比PWS淋巴异常人群(2 ± 0.7 cm),尽管不显著(p = 0.247)。每6例PWS-LM患者中就有1例需要截肢(16.6%),而孤立性PWS患者中每10例中就有一例需要截肢。结论: 淋巴异常可能存在于大量PWS患者中,并可能在肢体不对称和预后中发挥作用。调查它们的存在并将其与真正的过度生长区分开来是至关重要的。
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引用次数: 0
Vocal Cord Paralysis after Repair of Esophageal Atresia. 食道闭锁修复术后的声带麻痹。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-02-01 Epub Date: 2023-09-05 DOI: 10.1055/s-0043-1774370
A I Koivusalo, J S Suominen, J Nokso-Koivisto, M P Pakarinen

Objective:  Etiology of vocal cord paralysis (VCP) and laryngeal dysfunction may be congenital or surgical trauma of recurrent and superior laryngeal nerves. We assessed the incidence, risk factors, and morbidity of VCP after repair of esophageal atresia (EA).

Methods:  Medical records of 201 EA patients from 2000 to 2022 were reviewed for this retrospective study. Postrepair vocal cord examination (VCE) included awake nasolaryngeal fiberoscopy by otolaryngologist or laryngoscopy under spontaneous breathing anesthesia. Before 2017, postoperative VCE was performed in symptomatic patients only and routinely after 2017.

Main results:  Overall, VCE was performed on 79 (38%) patients (52 asymptomatic), whereas 122 asymptomatic patients underwent no VCE. VCP was diagnosed in 32 of 79 patients (right 12, left 10, and bilateral 10; symptomatic 25 and asymptomatic unilateral 7) corresponding with extrapolated overall VCP incidence of 16 to 24% among 201 patients including asymptomatic ones. Ten patients (bilateral VCP 8 and left VCP 2) required tracheostomy. Of 10 patients with bilateral VCP, three underwent laryngotracheal expansion surgery (left VC lateralization in one and laryngoplasty in two with acquired subglottic stenosis), three remained tracheostomy dependent, three were off tracheostomy, and one died of complications after redo esophageal reconstruction. All patients with unilateral VCP managed without tracheostomy. Cervical dissection or ostomy formation was a major risk factor of VCP.

Conclusion:  Repair of EA is associated with a considerable risk of VCP and associated morbidity. Cervical EA surgery significantly increased the risk of VCP. Bilateral VCP may eventually require laryngotracheal expansion surgery.

目的:声带麻痹(VCP)和喉功能障碍的病因可能是先天性的,也可能是喉返神经和喉上神经的手术创伤。我们评估了食道闭锁(EA)修复术后声带麻痹的发生率、风险因素和发病率:这项回顾性研究回顾了 2000 年至 2022 年期间 201 名食道闭锁患者的病历。修复后声带检查(VCE)包括由耳鼻喉科医生进行的清醒鼻咽纤维镜检查或在自主呼吸麻醉下进行的喉镜检查。2017 年之前,术后 VCE 仅在有症状的患者中进行,2017 年之后则常规进行:总体而言,79 名(38%)患者(52 名无症状)进行了 VCE,而 122 名无症状患者未进行 VCE。79 名患者中有 32 人(右侧 12 人、左侧 10 人、双侧 10 人;有症状 25 人、无症状单侧 7 人)确诊为 VCP,推断 201 名患者(包括无症状患者)中 VCP 的总发病率为 16% 至 24%。10 名患者(双侧 VCP 8 例,左侧 VCP 2 例)需要进行气管造口术。在 10 名双侧 VCP 患者中,3 人接受了喉气管扩张手术(1 人接受了左侧 VC 侧切术,2 人接受了喉成形术,并伴有后天性声门下狭窄),3 人仍然依赖气管造口术,3 人脱离了气管造口术,1 人在重新进行食管重建后死于并发症。所有单侧 VCP 患者均无需气管造口术。颈椎解剖或造口形成是 VCP 的主要风险因素:结论:EA修复术与VCP的高风险和相关发病率有关。宫颈 EA 手术大大增加了 VCP 的风险。双侧 VCP 最终可能需要进行喉气管扩张手术。
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引用次数: 0
Age as an Exclusion Criterion for Nonoperative Management in Simple Acute Appendicitis in Children. 年龄作为儿童单纯性急性阑尾炎非手术治疗的排除标准。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-02-01 Epub Date: 2023-08-17 DOI: 10.1055/a-2155-7642
Gal Becker, Audelia Eshel Fuhrer, Keren Kremer, Annabella Hochschild, Haguy Kammar, Igor Sukhotnik

Objective:  Nonoperative management (NOM) for simple acute appendicitis (SAA) is an acceptable mode of treatment in healthy children. Previous studies of NOM routinely excluded young children (< 5 years); however, the effect of age on NOM failure has not been directly assessed. Efficiency of NOM in young adults is questionable. Therefore, adolescents may also be at greater risk of NOM failure. Our aim was to investigate the effect of age on NOM failure.

Methods:  This is a retrospective analysis of children with SAA who received NOM between January 1, 2019, and June 30, 2021, at our institution. NOM failure was defined by subsequent appendectomy. Age was assessed as a continuous variable, and we also compared different age subgroups.

Results:  In this study, 151 children were included (60% male), mean age 11.2 ± 3.2 years (range: 5-17). Overall, 66 children (44%) failed NOM, 90% of them within the first year (median 7 weeks). Ten percent of the cohort were younger than 6 years of age and 33% of them failed NOM (p = 0.39). Per 1 year increase in age, the odds of NOM failure increased by 12% (p = 0.027). Children over 14 years of age had 2.46 times higher odds to fail NOM (p = 0.03). These higher odds remained after adjusting for appendiceal diameter and appendicolith. Linear regression showed a decrease by a factor of 12 at the time of NOM failure with every 1-year increase in age (β = -12, p = 0.09).

Conclusion:  The risk of NOM failure in children increases with age; therefore, age should be considered when deciding on the optimal management of SAA, especially in adolescents. Effectiveness of NOM in children younger than 6 years is noninferior to older children and therefore should not be excluded.

目标: 单纯性急性阑尾炎(SAA)的非手术治疗(NOM)是健康儿童可接受的治疗模式。先前的NOM研究通常排除幼儿(<5岁);然而,年龄对NOM失败的影响尚未得到直接评估。NOM在年轻人中的有效性值得怀疑。因此,青少年也可能面临更大的NOM失败风险。我们的目的是研究年龄对NOM失败的影响。方法: 这是对2019年1月1日至2021年6月30日在我们机构接受NOM治疗的SAA儿童的回顾性分析。NOM失败是由随后的阑尾切除术确定的。年龄被评估为一个连续变量,我们还比较了不同的年龄亚组。结果: 在这项研究中,包括151名儿童(60%为男性),平均年龄11.2岁 ± 3.2年(范围:5-17年)。总体而言,66名儿童(44%)未通过NOM,其中90%在第一年内(中位数为7周)。10%的研究对象年龄小于6岁,33%的研究对象未通过NOM(p = 年龄每增加1年,NOM失败的几率增加12%(p = 0.027)。14岁以上儿童NOM失败的几率高出2.46倍(p = 0.03)。在调整阑尾直径和阑尾厚度后,这些较高的几率仍然存在。线性回归显示,在NOM失败时,随着年龄的每增加1年,NOM下降了12倍(β = -12,p = 0.09)。结论: 儿童NOM失败的风险随着年龄的增长而增加;因此,在决定SAA的最佳管理时,应考虑年龄,尤其是在青少年中。NOM在6岁以下儿童中的有效性不劣于年龄较大的儿童,因此不应被排除在外。
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引用次数: 0
Editorial. 社论
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-02-01 Epub Date: 2024-02-22 DOI: 10.1055/s-0044-1779024
Annika Mutanen, Benno Ure
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引用次数: 0
Selection of Quality Indicators to Evaluate Quality of Care for Patients with Esophageal Atresia Using a Delphi Method 用德尔菲法选择评价食道闭锁患者护理质量的质量指标
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2023-12-12 DOI: 10.1055/s-0043-1777100
Nadine M. Teunissen, Julia Brendel, L.W Ernest van Heurn, Benno Ure, Rene Wijnen, Simon Eaton, on behalf of the EPSA|ERNICA Registry Group, the EA Quality of Care Initiative

Objective Survival of neonates with esophageal atresia (EA) is relatively high and stable, resulting in increased attention to optimizing care and longer-term morbidity. This study aimed to reach consensus on a quality indicator set for benchmarking EA care between hospitals, regions, or countries in a European clinical audit.

Methods Using an online Delphi method, a panel of EA health care professionals and patient representatives rated potential outcome, structure, and process indicators for EA care identified through systematic literature and guideline review on a nine-point Likert scale in three questionnaires. Items were included based on predefined criteria. In rounds 2 and 3, participants were asked to select the five to ten most essential of the included indicators.

Results An international panel of 14 patient representatives and 71 multidisciplinary health care professionals representing 41 European hospitals completed all questionnaires (response rate: 81%), eventually including 22 baseline characteristics and 32 indicators. After ranking, 10 indicators were prioritized by both stakeholder groups. In addition, each stakeholder group highly prioritized one additional indicator. Following an additional online vote by the other group, these were both added to the final set.

Conclusion This study established a core indicator set of twenty-two baseline characteristics, eight outcome indicators, one structure indicator, and three process indicators for evaluating (quality of) EA care in Europe. These indicators, covering various aspects of EA care, will be implemented in the European Pediatric Surgical Audit to enable recognition of practice variation and focus EA care improvement initiatives.

目标 食管闭锁(EA)新生儿的存活率相对较高且稳定,因此人们越来越关注优化护理和长期发病率。本研究旨在就一套质量指标达成共识,以便在欧洲临床审核中为不同医院、地区或国家之间的食管闭锁护理设定基准。方法 由EA医护人员和患者代表组成的小组采用在线德尔菲法,在三份问卷中以九分李克特量表对通过系统文献和指南审查确定的EA护理潜在结果、结构和流程指标进行评分。项目根据预定义标准纳入。在第二轮和第三轮中,要求参与者从所包含的指标中选出五到十个最重要的指标。结果 由代表欧洲 41 家医院的 14 名患者代表和 71 名多学科医护人员组成的国际小组完成了所有问卷(回复率:81%),最终包括 22 项基线特征和 32 项指标。经过排序,10 项指标被两个利益相关群体列为优先指标。此外,每个利益相关者小组还高度优先考虑了另外一项指标。在另一组进行了额外的在线投票后,这两个指标都被添加到了最终的指标集中。结论 本研究确立了一套核心指标,包括 22 个基线特征、8 个结果指标、1 个结构指标和 3 个过程指标,用于评估欧洲的紧急护理(质量)。这些指标涵盖了 EA 护理的各个方面,将在欧洲小儿外科审计中实施,以便识别实践中的差异,并关注 EA 护理改进措施。
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引用次数: 0
The Role of Postoperative Dressing in Hypospadias Surgery: A Systematic Review and Meta-analysis of the Pediatric Literature. 尿道下裂手术中术后敷料的作用:儿科文献的系统回顾与元分析》。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-03-07 DOI: 10.1055/a-2048-7486
Maria Escolino, Luisa Florio, Giovanni Esposito, Ciro Esposito

This study aimed to describe the available dressings and their management in patients undergoing hypospadias repair and compare postoperative outcomes with and without dressing and between the different dressing types. A comprehensive electronic literature search of PubMed, Embase, and Cochrane Library was conducted to obtain studies, published in the period 1990 to 2021, reporting on the dressing used following hypospadias surgery. All information regarding the dressing was considered as primary endpoints, whereas surgical outcomes were assessed as secondary outcomes. Thirty-one studies containing 1,790 subjects undergoing hypospadias repair were included. Dressings were divided into three categories: nonadherent to the wound, adherent to the wound, and glue-based dressings. Most authors preferred to remove/change the dressing in the ward and the median time of removal/change was 6.56 postoperative days. The dressing removal appeared as the most frequent factor generating parental anxiety. The median rate of wound-related complications was 8.18%, of urethroplasty complications 9.08% and of reoperations 8.18%. Meta-analysis of outcomes showed higher risk of reoperations using conventional dressing, with no differences in urethroplasty and wound-related complications rates between conventional and glue-based dressings. Furthermore, the use of dressing reported increased risk of wound-related complications compared with no dressing, without significant differences regarding occurrence of urethroplasty complications and reoperations. The current evidence confirmed that there is no difference in outcomes of hypospadias repair depending on a certain dressing type. To date, surgeon's preference remains the main factor determining the choice for a specific dressing or for no dressing at all.

本研究旨在描述尿道下裂修补术患者可用的敷料及其处理方法,并比较使用和不使用敷料以及不同类型敷料的术后效果。研究人员对PubMed、Embase和Cochrane图书馆进行了全面的电子文献检索,以获取1990年至2021年期间发表的有关尿道下裂手术后使用敷料的研究报告。有关敷料的所有信息均被视为主要终点,而手术结果则被评估为次要终点。31项研究共纳入了1790名接受尿道下裂修补术的受试者。敷料分为三类:与伤口不粘连的敷料、与伤口粘连的敷料和基于胶水的敷料。大多数作者倾向于在病房内去除/更换敷料,术后去除/更换敷料的中位时间为 6.56 天。移除敷料似乎是引起家长焦虑的最常见因素。伤口相关并发症的中位发生率为 8.18%,尿道成形术并发症的中位发生率为 9.08%,再次手术的中位发生率为 8.18%。对结果的 Meta 分析表明,使用传统敷料的再手术风险更高,而传统敷料和胶水敷料在尿道成形术和伤口相关并发症的发生率上没有差异。此外,与不使用敷料相比,使用敷料会增加伤口相关并发症的风险,但尿道成形术并发症和再次手术的发生率无明显差异。目前的证据证实,尿道下裂修补术的结果并不因敷料类型的不同而有所差异。迄今为止,外科医生的偏好仍是决定选择特定敷料还是不使用敷料的主要因素。
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引用次数: 0
Preoperative Bladder Capacity Predicts Social Continence following Bladder Neck Reconstruction in Children Born with Exstrophy-Epispadias Complex. 术前膀胱容量可预测先天性尿失禁儿童膀胱颈重建术后的社会连续性。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2022-12-22 DOI: 10.1055/a-2003-1823
Yuval Bar-Yosef, Ziv Savin, Margaret Ekstein, Reuben Ben-David, Snir Dekalo, Noam Bar-Yaakov, Mario Sofer, Jacob Ben-Chaim

Introduction:  The aim of the study is to review the continence and volitional voiding rate in a single center cohort of exstrophy-epispadias patients following Young-Dees-Leadbetter bladder neck reconstruction and to explore factors which predict continence.

Materials and methods:  Children who underwent Young-Dees-Leadbetter bladder neck reconstruction as a final stage of repair in a large single low-volume center in a small-population country between 1997 and 2019 were included. Demographic and clinical details were extracted from the patients' charts. The primary end point was continence and volitional voiding. Patients were categorized as incontinent, socially continent (daytime dry intervals > 3 hours, wet nights) and fully continent (daytime dry intervals > 3 hours, dry nights).

Results:  The study cohort included 27 patients whose median age at reconstruction was 5 years, and median follow-up was 7.8 years (interquartile range [IQR] 6-11.2). The cohort included 24 classic exstrophy patients (89%, 17 males and 7 females) and 3 isolated complete epispadias patients (11%, 1 male and 2 females). Nine (33%) patients achieved full continence and social continence was achieved by nine (33%) patients, for an overall social continence rate of 67%. Preoperative bladder capacity of 110 mL or more was associated with achieving social continence (odds ratio = 6.4, p = 0.047). The overall volitional voiding rate was 67%.

Conclusion:  Young-Dees-Leadbetter bladder neck reconstruction yielded rates of 33% for full continence and 67% for social continence and volitional voiding. These rates are comparable to those of large high-volume centers. A preoperative capacity of 110 mL or more was the sole predictor of social continence.

简介该研究的目的是回顾Young-Dees-Leadbetter膀胱颈重建术后,单个中心队列的外萎缩-外尿道患者的尿失禁和自主排尿率,并探索预测尿失禁的因素:纳入1997年至2019年期间在一个人口较少国家的大型单一低容量中心接受Young-Dees-Leadbetter膀胱颈重建术作为最后阶段修复的儿童。从患者病历中提取了人口统计学和临床细节。主要终点是尿失禁和自主排尿。患者被分为尿失禁、社交性尿失禁(白天干燥间隔时间大于 3 小时,夜间潮湿)和完全性尿失禁(白天干燥间隔时间大于 3 小时,夜间干燥):研究队列包括 27 名患者,重建时的中位年龄为 5 岁,中位随访时间为 7.8 年(四分位数间距 [IQR] 6-11.2 年)。队列中包括24名典型外翻患者(89%,17名男性和7名女性)和3名孤立性完全外翻患者(11%,1名男性和2名女性)。9名患者(33%)实现了完全尿失禁,9名患者(33%)实现了社交尿失禁,总体社交尿失禁率为67%。术前膀胱容量达到或超过 110 毫升与实现社交尿失禁有关(几率比 = 6.4,P = 0.047)。总体自主排尿率为 67%:结论:Young-Dees-Leadbetter膀胱颈重建术的完全排尿率为33%,社交排尿率和自主排尿率为67%。这些比率与大容量中心的比率相当。术前排尿量达到或超过 110 毫升是预测社会排尿连续性的唯一指标。
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引用次数: 0
Perioperative Hypoxemia and Postoperative Respiratory Events in Infants with Hypertrophic Pyloric Stenosis. 肥厚性幽门狭窄婴儿围手术期的低氧血症和术后呼吸事件。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2022-11-23 DOI: 10.1055/a-1984-9803
Fenne A I M van den Bunder, Markus F Stevens, Job B M van Woensel, Tim van de Brug, L W Ernest van Heurn, Joep P M Derikx

Background:  Normalization of metabolic alkalosis is an important pillar in the treatment of infantile hypertrophic pyloric stenosis (IHPS) because uncorrected metabolic alkalosis may lead to perioperative respiratory events. However, the evidence on the incidence of respiratory events is limited. We aimed to study the incidence of peroperative hypoxemia and postoperative respiratory events in infants undergoing pyloromyotomy and the potential role of metabolic alkalosis.

Materials and methods:  We retrospectively reviewed all patients undergoing pyloromyotomy between 2007 and 2017. All infants received intravenous fluids preoperatively to correct metabolic abnormalities close to normal. We assessed the incidence of perioperative hypoxemia (defined as oxygen saturation [SpO2] < 90% for > 1min) and postoperative respiratory events. Additionally, the incidence of difficult intubations was evaluated. We performed a multivariate logistic regression analysis to evaluate the association between admission or preoperative serum pH values, bicarbonate or chloride, and peri- and postoperative hypoxemia or respiratory events.

Results:  Of 406 included infants, 208 (51%) developed 1 or more episodes of hypoxemia during the perioperative period, of whom 130 (32%) experienced it during induction, 43 (11%) intraoperatively, and 112 (28%) during emergence. About 7.5% of the infants had a difficult intubation and 17 required more than 3 attempts by a pediatric anesthesiologist. Three patients developed respiratory insufficiency and 95 postoperative respiratory events were noticed. We did not find a clinically meaningful association between laboratory values reflecting metabolic alkalosis and respiratory events.

Conclusions:  IHPS frequently leads to peri- and postoperative hypoxemia or respiratory events and high incidence of difficult tracheal intubations. Preoperative pH, bicarbonate, and chloride were bad predictors of respiratory events.

背景:使代谢性碱中毒恢复正常是治疗婴儿肥厚性幽门狭窄(IHPS)的重要支柱,因为未纠正的代谢性碱中毒可能导致围手术期呼吸系统事件。然而,有关呼吸系统事件发生率的证据却很有限。我们旨在研究接受幽门切开术的婴儿围术期低氧血症和术后呼吸事件的发生率以及代谢性碱中毒的潜在作用:我们回顾性研究了2007年至2017年间接受幽门切除术的所有患者。所有婴儿术前都接受了静脉输液,以纠正接近正常的代谢异常。我们评估了围手术期低氧血症(定义为血氧饱和度 [SpO2] 1 分钟)和术后呼吸事件的发生率。此外,我们还评估了困难插管的发生率。我们进行了多变量逻辑回归分析,以评估入院或术前血清pH值、碳酸氢盐或氯化物与围手术期和术后低氧血症或呼吸事件之间的关联:在纳入的 406 例婴儿中,有 208 例(51%)在围手术期出现过 1 次或 1 次以上的低氧血症,其中 130 例(32%)在诱导过程中出现低氧血症,43 例(11%)在术中出现低氧血症,112 例(28%)在苏醒过程中出现低氧血症。约 7.5%的婴儿插管困难,17 名婴儿需要儿科麻醉师进行 3 次以上的插管尝试。有 3 名患者出现呼吸功能不全,95 例术后呼吸事件。我们没有发现反映代谢性碱中毒的实验室值与呼吸事件之间存在有临床意义的关联:结论:IHPS 经常导致围手术期和术后低氧血症或呼吸事件,气管插管困难的发生率也很高。术前pH值、碳酸氢盐和氯化物是预测呼吸事件的不良指标。
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引用次数: 0
Reconstructive Strategies in Pediatric Patients after Oncological Chest Wall Resection: A Systematic Review. 肿瘤性胸壁切除术后小儿患者的重建策略:系统回顾
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-01-14 DOI: 10.1055/a-2013-3074
Pieter W Lonnee, Zachri N Ovadja, Caroline C C Hulsker, Michiel A J van de Sande, Cornelis P van de Ven, Emma C Paes

An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. The aim of this study was to provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients less than 18 years old. A systematic literature search of the complete available literature was performed and results were analyzed. A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of nonautologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]), or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.

儿童胸壁肿瘤手术切除后,适当的重建策略对于优化治疗效果非常重要,但对于理想的方法还没有达成共识。本研究的目的是对有关 18 岁以下患者胸壁缺损的不同重建策略的文献进行最新的系统性回顾。我们对现有的全部文献进行了系统性检索,并对检索结果进行了分析。共有 22 篇文章被纳入分析,其中描述了 130 例胸壁重建。所有文章均为回顾性分析,其中包括 8 篇病例报告。重建方案分为初次闭合(21 例 [16.2%])、使用非自体材料(83 例 [63.8%])、自体组织修复(2 例 [1.5%])或后两者的组合(24 例 [18.5%])。证据质量较差,结果大多不尽相同。胸壁缺损的重建可分为四大类,每一类都有自己的优缺点。需要更高质量的证据和指南,以便统一报告治疗结果和评估适当的重建策略。
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引用次数: 0
Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia. 有症状的先天性膈疝婴儿术前和术后早期肠内营养与生长。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2023-12-01 Epub Date: 2023-03-16 DOI: 10.1055/s-0043-1767829
Ulla Lei Larsen, Gitte Zachariassen, Sören Möller, Wilhelmine Ursin Førre, Ingvild Grøsle, Susanne Halken, Anne Maria Herskind, Thomas Strøm, Palle Toft, Mark Ellebæk, Niels Qvist

Objectives:  Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months.

Methods:  We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database.

Results:  From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0-26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6-12.6) and 10.6 (7.6-21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5-18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported.

Conclusion:  Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.

目的:先天性膈疝(CDH)新生儿期和术后的营养支持具有挑战性和争议性。我们旨在报告无症状 CDH 患者术前和术后早期肠内营养支持的情况,包括可行性、建立全肠内营养的相关因素以及出生、出院和 18 个月时的体重:我们回顾性地收集了有关营养的数据:肠内营养的类型和量以及父母的支持。术前从婴儿出生后第 1 天开始进行肠内喂养,然后逐步增加(首选母乳),并在 CDH 修复术后第 1 天恢复肠内喂养。基线数据可从我们的 CDH 数据库中获得:从 2011 年到 2020 年,我们共发现了 45 名 CDH 婴儿。其中22例为女婴(51.1%),35例为左侧肢体(77.8%),40例接受了CDH修复术(88.9%)。术后,分别在中位数6.5天(3.6-12.6)和10.6天(7.6-21.7)后实现了120毫升/千克/天和160毫升/千克/天的肠内营养。共有 31 例(68.9%)患者需要在中位 8 天(5-18 天)内补充肠外营养,其中 11 例患者在 CDH 修复前就开始接受肠外营养。没有关于肠内喂养并发症的报道:结论:对 CDH 婴儿进行早期肠内营养是可行的,并有可能减少对父母营养的需求,缩短术后完全肠内营养的时间。
{"title":"Early Pre- and Postoperative Enteral Nutrition and Growth in Infants with Symptomatic Congenital Diaphragmatic Hernia.","authors":"Ulla Lei Larsen, Gitte Zachariassen, Sören Möller, Wilhelmine Ursin Førre, Ingvild Grøsle, Susanne Halken, Anne Maria Herskind, Thomas Strøm, Palle Toft, Mark Ellebæk, Niels Qvist","doi":"10.1055/s-0043-1767829","DOIUrl":"10.1055/s-0043-1767829","url":null,"abstract":"<p><strong>Objectives: </strong> Nutritional support during the neonatal and postoperative period in congenital diaphragmatic hernia (CDH) is challenging and controversial. We aimed to report on early enteral nutritional support in symptomatic CDH patients during the pre- and postoperative period, including feasibility, associated factors with established full enteral nutrition, and weight at birth, discharge, and 18 months.</p><p><strong>Methods: </strong> We retrospectively collected data on nutrition: type and volume of enteral nutrition and parental support. Enteral feeding was introduced preoperatively from day 1 after birth, increased step-wised (breastmilk preferred), and resumed after CDH repair on the first postoperative day. Baseline data were available from our CDH database.</p><p><strong>Results: </strong> From 2011 to 2020, we identified 45 CDH infants. Twenty-two were girls (51.1%), 35 left sided (77.8%), and 40 underwent CDH repair (88.9%). Median (interquartile range) length of stay in the pediatric intensive care unit was 14.6 days (6.0-26.5), and 1-year mortality was 17.8%.Postoperatively, 120 and 160 mL/kg/d of enteral nutrition was achieved after a median of 6.5 (3.6-12.6) and 10.6 (7.6-21.7) days, respectively. In total, 31 (68.9%) needed supplemental parenteral nutrition in a median period of 8 days (5-18), and of those 11 had parenteral nutrition initiated before CDH repair. No complications to enteral feeding were reported.</p><p><strong>Conclusion: </strong> Early enteral nutrition in CDH infants is feasible and may have the potential to reduce the need for parental nutrition and reduce time to full enteral nutrition in the postoperative period.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9180533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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European Journal of Pediatric Surgery
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