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Development Methodology, Availability, and Implementation of Core Outcome Sets in Pediatric Surgery. 儿科外科核心结果集的开发方法、可用性和实施。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2023-10-23 DOI: 10.1055/a-2196-1887
Benjamin S R Allin, George S Bethell, Nigel J Hall

Core outcome sets (COSs) provide a mechanism to guide researchers and clinicians when deciding which outcomes to report in research related to a specific clinical condition or intervention. The intention behind creating a COS for a specific condition is to improve the reporting of important and meaningful outcomes, thus enhancing the relevance of research. Additionally, a COS helps facilitate comparison of outcomes between different clinical studies and reduces research waste. In this paper, we discuss the availability of COSs in the field of pediatric general surgery. We provide an overview of the methodologies used to develop a COS, including common pitfalls, and finally, we discuss COS uptake and implementation. An understanding of all these aspects is important for researchers considering developing a new COS and for those reading research where a COS has been developed or used within a study. Failure to adequately appreciate the nuances of COS development, in particular, risks fundamental flaws that may jeopardize COS validity and subsequently hinder COS uptake and implementation.

核心结果集(COS)提供了一种机制,用于指导研究人员和临床医生决定在与特定临床状况或干预相关的研究中报告哪些结果。为特定情况创建COS的目的是改进重要和有意义结果的报告,从而提高研究的相关性。此外,COS有助于促进不同临床研究之间的结果比较,并减少研究浪费。在本文中,我们讨论了COS在儿科普通外科领域的可用性。我们概述了用于开发COS的方法,包括常见的陷阱,最后,我们讨论了COS的吸收和实施。对于考虑开发新COS的研究人员以及在研究中开发或使用COS的阅读研究人员来说,了解所有这些方面都很重要。尤其是,如果不能充分理解COS开发的细微差别,就有可能出现根本性缺陷,从而危及COS的有效性,进而阻碍COS的吸收和实施。
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引用次数: 0
Unlocking the Power of Data: Standardized Data Collection in Pediatric Surgery. 解锁数据的力量:儿科手术中的标准化数据收集。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2023-11-08 DOI: 10.1055/a-2206-6790
Nadine M Teunissen, Rene M H Wijnen
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引用次数: 0
The Development of the International Intestinal Failure Registry and an Overview of its Results. 国际肠衰竭登记处的发展及其结果概述。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2023-11-16 DOI: 10.1055/a-2212-6874
Yaron Avitzur, Eric Pahl, Robert Venick

Pediatric intestinal failure (IF) is a rare disease that represents an evolving field in pediatric gastroenterology and surgery. With only a limited number of multicenter collaborations, much of the research in pediatric IF is often confined to single-center reports with small sample sizes. This has resulted in challenges in data interpretation and left many knowledge gaps unanswered. Over the past two decades, five large multicenter collaborations, primarily from North America and Europe, have published their findings. Apart from one ongoing European adult and pediatric registry, these relatively large-scale efforts have been concluded.In 2018, the International Intestinal Failure Registry (IIFR) was initiated by the International Intestinal Rehabilitation and Transplant Association to continue these efforts and answer some of the knowledge gaps in pediatric IF. The IIFR goals are to prospectively assess the natural history of children diagnosed with IF and creating a worldwide platform to facilitate benchmarking and evidence-based interventions in pediatric IF. A pilot phase involving 204 enrolled patients was initiated in 2018 to assess the feasibility of an international IF registry and refine the study protocol and data collection forms. Following the successful completion of this phase, the current phase of the IIFR was launched in 2021. As of May 2023, the registry includes 362 prospectively followed children from 26 centers worldwide. This review provides an overview of the development, structure, and challenges of the IIFR, as well as the main findings from both the pilot and current phase.

小儿肠衰竭(IF)是一种罕见的疾病,代表了儿科胃肠病学和外科的一个不断发展的领域。由于多中心合作的数量有限,儿童IF的大部分研究往往局限于小样本量的单中心报告。这导致了数据解释方面的挑战,并留下了许多知识空白。在过去的二十年里,主要来自北美和欧洲的五个大型多中心合作组织发表了他们的发现。除了一个正在进行的欧洲成人和儿科登记外,这些相对大规模的努力已经结束。2018年,国际肠康复和移植协会(IIRTA)发起了国际肠衰竭登记处(IIFR),以继续这些努力并回答儿科肠衰竭方面的一些知识空白。IIFR的目标是对诊断为IF的儿童的自然病史进行前瞻性评估,并创建一个全球平台,以促进儿童IF的基准制定和循证干预。2018年启动了涉及204名入组患者的试点阶段,以评估国际IF注册的可行性,并完善研究方案和数据收集表格。在这一阶段成功完成后,IIFR的当前阶段于2021年启动。截至2023年5月,该登记处包括来自全球26个中心的362名儿童。本综述概述了IIFR的发展、结构和挑战,以及试点和当前阶段的主要发现。
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引用次数: 0
The CDH Study Group: Past, Present, and Future. CDH 研究小组:过去、现在和未来
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2024-01-19 DOI: 10.1055/s-0043-1778021
Kylie I Holden, Ashley H Ebanks, Kevin P Lally, Matthew T Harting

The Congenital Diaphragmatic Hernia Study Group (CDHSG) is an international consortium of medical centers actively collecting and voluntarily contributing data pertaining to live born congenital diaphragmatic hernia (CDH) patients born and/or managed at their institutions. These data are aggregated to construct a comprehensive registry that participating centers can access to address specific clinical inquiries and track patient outcomes. Since its establishment in 1995, 147 centers have taken part in this initiative, including 53 centers from 17 countries outside the United States, with 95 current active centers across the globe. The registry has amassed data on over 14,000 children, resulting in the creation of over 75 manuscripts based on registry data to date. International, multicenter consortia enable health care professionals managing uncommon, complex, and diverse diseases to formulate evidence-based hypotheses and draw meaningful and generalizable conclusions for clinical inquiries. This review will explore the formation and structure of the CDHSG and its registry, outlining their functions, center participation, and the evolution of data collection. Additionally, we will provide an overview of the evidence generated by the CDHSG, with a particular emphasis on contributions post-2014, and look ahead to the future directions the study group will take in addressing CDH.

先天性膈疝研究组(CDHSG)是一个由医疗中心组成的国际联盟,该联盟积极收集并自愿提供在其医疗中心出生和/或接受治疗的活产先天性膈疝(CDH)患者的相关数据。这些数据经汇总后建立了一个全面的登记册,参与中心可利用该登记册解决特定的临床问题并跟踪患者的治疗效果。自 1995 年成立以来,已有 147 家中心参与了这项计划,其中包括来自美国以外 17 个国家的 53 家中心,目前全球有 95 家中心在开展活动。注册中心已积累了超过 14,000 名儿童的数据,迄今为止,根据注册中心数据撰写的手稿已超过 75 篇。国际多中心联盟使医护人员在管理不常见、复杂和多样化的疾病时能够提出循证假设,并为临床研究得出有意义和可推广的结论。本综述将探讨 CDHSG 及其注册中心的形成和结构,概述其功能、中心参与情况以及数据收集的演变。此外,我们还将概述 CDHSG 生成的证据,特别强调 2014 年后的贡献,并展望研究小组在应对 CDH 方面的未来方向。
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引用次数: 0
A Narrative Review of Patient-Reported Outcome Measures and Their Application in Recent Pediatric Surgical Research: Advancing Knowledge and Offering New Perspectives to the Field. 患者报告结果衡量标准及其在近期小儿外科研究中应用的叙述性回顾:增进知识,为该领域提供新视角。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2024-01-25 DOI: 10.1055/s-0043-1778108
Olivia K C Spivack, Michaela Dellenmark-Blom, Jens Dingemann, Chantal A Ten Kate, Vuokko Wallace, Wichor M Bramer, Julia H Quitmann, Andre Rietman

Introduction:  Patient-reported outcome measures (PROMs) can be employed in both research and clinical care to enhance our understanding of outcomes that matter to patients. This narrative review aims to describe PROM use in recent pediatric surgical research, identify and describe psychometrically robust PROMs, providing an overview of those derived from pediatric patient input, and make recommendations for future research.

Materials and methods:  A search was conducted to identify articles published from 2021 to August 2023 describing the availability and/or use of at least one valid or reliable PROM in children with conditions including anorectal malformations, biliary atresia, congenital diaphragmatic hernia, duodenal atresia, esophageal atresia, abdominal wall defects, Hirschsprung's disease, sacrococcygeal teratoma, and short bowel syndrome. Articles were categorized based on their objectives in applying PROMs. Psychometrically robust PROMs were identified and described.

Results:  Out of the 345 articles identified, 49 met the inclusion criteria. Seventeen focused on esophageal atresia and 14 on Hirschsprung's disease. Twenty-nine PROMs were identified, with 12 deemed psychometrically robust. Seven psychometrically robust PROMs were developed using patient input in the primary item generation. Most PROMs were applied to advance understanding of conditions and/or treatment and fewer were developed or psychometrically evaluated. No PROMs were assessed for their impact or incorporated into an implementation study.

Conclusions:  This review reveals gaps in the application of PROMs in recent pediatric surgical research. Emphasis should be placed on the development and utilization of psychometrically robust PROMs, broadening the scope of covered diseases, conducting impact assessments, and evaluating implementation strategies.

导言:患者报告的结果测量(PROMs)可用于研究和临床护理,以加深我们对患者重要结果的了解。这篇叙述性综述旨在描述近期儿科手术研究中使用的PROM,识别并描述心理计量学上可靠的PROM,概述从儿科患者意见中得出的PROM,并为未来研究提出建议:通过检索发现了2021年至2023年8月期间发表的文章,这些文章描述了至少一种有效或可靠的PROM在儿童肛门直肠畸形、胆道闭锁、先天性膈疝、十二指肠闭锁、食道闭锁、腹壁缺损、赫氏病、骶尾部畸胎瘤和短肠综合征等疾病中的可用性和/或使用情况。文章根据其应用 PROMs 的目的进行分类。结果:在确定的 345 篇文章中,49 篇符合纳入标准。其中 17 篇侧重于食道闭锁,14 篇侧重于赫氏病。共鉴定出 29 篇 PROMs,其中 12 篇被认为在心理测量学上是可靠的。在主要项目的生成过程中,利用患者的意见开发了 7 个心理测量稳健的 PROM。大多数 PROM 都用于促进对病情和/或治疗的理解,而开发或进行心理测量学评估的 PROM 则较少。没有对 PROM 进行影响评估或将其纳入实施研究:本综述揭示了近期儿科手术研究中 PROMs 应用方面的不足。重点应放在开发和使用心理测量学上可靠的 PROMs、扩大涵盖疾病的范围、进行影响评估以及评估实施策略上。
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引用次数: 0
Moving toward the Development and Effective Implementation of High-Quality Guidelines in Pediatric Surgery: A Review of the Literature. 小儿外科高质量指南的制定与有效实施:文献综述。
IF 1.5 3区 医学 Q2 PEDIATRICS Pub Date : 2024-04-01 Epub Date: 2024-01-19 DOI: 10.1055/s-0043-1778020
Willemijn F E Irvine, Olivia K C Spivack, Erwin Ista

Applying evidence-based guidelines can enhance the quality of patient care. While robust guideline development methodology ensures credibility and validity, methodological variations can impact guideline quality. Besides methodological rigor, effective implementation is crucial for achieving improved health outcomes. This review provides an overview of recent literature pertaining to the development and implementation of guidelines in pediatric surgery. Literature was reviewed to provide an overview of sound guideline development methodologies and approaches to promote effective guideline implementation. Challenges specific to pediatric surgery were highlighted. A search was performed to identify published guidelines relevant to pediatric surgery from 2018 to June 2023, and their quality was collectively appraised using the AGREE II instrument. High-quality guideline development can be promoted by using methodologically sound tools such as the Guidelines 2.0 checklist, the GRADE system, and the AGREE II instrument. While implementation can be promoted during guideline development and post-publication, its effectiveness may be influenced by various factors. Challenges pertinent to pediatric surgery, such as limited evidence and difficulties with outcome selection and heterogeneity, may impact guideline quality and effective implementation. Fifteen guidelines were identified and collectively appraised as suboptimal, with a mean overall AGREE II score of 58%, with applicability being the lowest scoring domain. There are identified challenges and barriers to the development and effective implementation of high-quality guidelines in pediatric surgery. It is valuable to prioritize the identification of adapted, innovative methodological strategies and the use of implementation science to understand and achieve effective guideline implementation.

应用循证指南可以提高患者护理质量。虽然可靠的指南制定方法可确保可信度和有效性,但方法上的差异也会影响指南的质量。除了方法的严谨性外,有效的实施对于取得更好的医疗效果也至关重要。本综述概述了与儿科手术指南的制定和实施相关的最新文献。通过文献综述,我们了解了完善的指南制定方法以及促进指南有效实施的方法。文中强调了小儿外科所面临的特殊挑战。通过检索,确定了2018年至2023年6月期间发表的与小儿外科相关的指南,并使用AGREE II工具对其质量进行了集体评估。通过使用方法合理的工具,如指南 2.0 核对表、GRADE 系统和 AGREE II 工具,可促进高质量指南的制定。虽然在指南制定过程中和发布后可以促进指南的实施,但其有效性可能会受到各种因素的影响。与小儿外科相关的挑战,如证据有限、结果选择困难和异质性,可能会影响指南的质量和有效实施。15份指南被认定为不达标,AGREE II平均总得分为58%,其中适用性是得分最低的领域。在制定和有效实施高质量的儿科手术指南方面存在已确定的挑战和障碍。因此,有必要优先确定适应性强的创新方法策略,并利用实施科学来理解和实现指南的有效实施。
{"title":"Moving toward the Development and Effective Implementation of High-Quality Guidelines in Pediatric Surgery: A Review of the Literature.","authors":"Willemijn F E Irvine, Olivia K C Spivack, Erwin Ista","doi":"10.1055/s-0043-1778020","DOIUrl":"10.1055/s-0043-1778020","url":null,"abstract":"<p><p>Applying evidence-based guidelines can enhance the quality of patient care. While robust guideline development methodology ensures credibility and validity, methodological variations can impact guideline quality. Besides methodological rigor, effective implementation is crucial for achieving improved health outcomes. This review provides an overview of recent literature pertaining to the development and implementation of guidelines in pediatric surgery. Literature was reviewed to provide an overview of sound guideline development methodologies and approaches to promote effective guideline implementation. Challenges specific to pediatric surgery were highlighted. A search was performed to identify published guidelines relevant to pediatric surgery from 2018 to June 2023, and their quality was collectively appraised using the AGREE II instrument. High-quality guideline development can be promoted by using methodologically sound tools such as the Guidelines 2.0 checklist, the GRADE system, and the AGREE II instrument. While implementation can be promoted during guideline development and post-publication, its effectiveness may be influenced by various factors. Challenges pertinent to pediatric surgery, such as limited evidence and difficulties with outcome selection and heterogeneity, may impact guideline quality and effective implementation. Fifteen guidelines were identified and collectively appraised as suboptimal, with a mean overall AGREE II score of 58%, with applicability being the lowest scoring domain. There are identified challenges and barriers to the development and effective implementation of high-quality guidelines in pediatric surgery. It is valuable to prioritize the identification of adapted, innovative methodological strategies and the use of implementation science to understand and achieve effective guideline implementation.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11357791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139503267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The French Experience with a Population-Based Esophageal Atresia Registry (RENATO). 法国基于人群的食管闭锁登记(RENATO)的经验。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-04-01 Epub Date: 2023-11-08 DOI: 10.1055/a-2206-6837
Rony Sfeir, Madeleine Aumar, Dyuti Sharma, Julien Labreuche, Luc Dauchet, Frederic Gottrand

This paper presented a national register for esophageal atresia (EA) started in January 2008. We report our experience about the conception of this database and its coordination. Data management and data quality are also detailed. In 2023, more than 2,500 patients with EA are included. Prevalence of EA in France was calculated at 1.8/10,000 live birth. Main clinical results are listed with scientific publications issued directly from the register.

本文介绍了2008年1月开始的国家食管闭锁登记。我们报告了我们对这个数据库的概念及其合作的经验。还详细介绍了数据管理和数据质量。2023年,超过2500名食道闭锁患者被纳入其中。在法国,EA的患病率计算为1.8/1000活产。主要临床结果与直接从注册处发布的科学出版物一起列出。
{"title":"The French Experience with a Population-Based Esophageal Atresia Registry (RENATO).","authors":"Rony Sfeir, Madeleine Aumar, Dyuti Sharma, Julien Labreuche, Luc Dauchet, Frederic Gottrand","doi":"10.1055/a-2206-6837","DOIUrl":"10.1055/a-2206-6837","url":null,"abstract":"<p><p>This paper presented a national register for esophageal atresia (EA) started in January 2008. We report our experience about the conception of this database and its coordination. Data management and data quality are also detailed. In 2023, more than 2,500 patients with EA are included. Prevalence of EA in France was calculated at 1.8/10,000 live birth. Main clinical results are listed with scientific publications issued directly from the register.</p>","PeriodicalId":56316,"journal":{"name":"European Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523526","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}
引用次数: 0
The Diagnostics and Management of Bronchopulmonary Sequestration: An International Survey among Specialized Caregivers. 支气管肺封闭的诊断和管理:对专业护理人员的国际调查。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-03-06 DOI: 10.1055/s-0044-1782237
C M Kersten, M D G Jansen, M J P Zuidweg, R M W H Wijnen, T B Krasemann, J M Schnater

Background:  Our objective was to explore the treatment preferences for bronchopulmonary sequestration (BPS) among an international group of specialized caregivers.

Methods:  Sixty-three participants from 17 countries completed an online survey concerning the diagnostics, treatment, and follow-up. Recruitment took place among members of the Collaborative Neonatal Network for the first European Congenital Pulmonary Airway Malformation Trial Consortium and through the Association for European Pediatric and Congenital Cardiology working group database.

Results:  Most of the 63 participants were pediatric surgeons (52%), followed by pediatric pulmonologists (22%), and pediatric cardiologists (19%). The majority (65%) treated more than five cases per year and 52% standardly discussed treatment in a multidisciplinary team. Half of the participants (52%) based the management on the presence of symptoms, versus 32% on the intralobar or extralobar lesion localization. Centers with both surgical and interventional cardiac/radiological facilities (85%) preferred resection to embolization in symptomatic cases (62 vs. 15%). In asymptomatic cases too, resection was preferred over embolization (38 vs. 9%); 32% preferred noninterventional treatment, while 11% varied in preference. These treatment preferences were significantly different between surgeons and nonsurgeons (p < 0.05). Little agreement was observed in the preferred timing of intervention as also for the duration of follow-up.

Conclusions:  This survey demonstrates a variation in management strategies of BPS, reflecting different specialist expertise. Most centers treat only a handful of cases per year and follow-up is not standardized. Therefore, management discussion within a multidisciplinary team is recommended. Recording patient data in an international registry for the comparison of management strategies and outcomes could support the development of future guidelines.

Level of evidence: Level IV.

背景:我们的目的是探讨国际专业护理人员对支气管肺动脉栓塞(BPS)治疗的偏好:来自 17 个国家的 63 名参与者完成了一项有关诊断、治疗和随访的在线调查。调查对象是欧洲首个先天性肺气道畸形试验联盟新生儿合作网络的成员,以及欧洲儿科和先天性心脏病学协会工作组数据库的成员:63名参与者中大多数是儿科外科医生(52%),其次是儿科肺病专家(22%)和儿科心脏病专家(19%)。大多数参与者(65%)每年治疗五例以上病例,52%的参与者在多学科团队中对治疗进行标准讨论。半数参与者(52%)根据是否存在症状进行治疗,而 32% 则根据椎管内或椎管外病变定位进行治疗。同时拥有手术和介入心脏/放射设施的中心(85%)更倾向于对有症状的病例进行切除而非栓塞治疗(62% 对 15%)。在无症状病例中,切除术也比栓塞术更受青睐(38% 对 9%);32% 的病例倾向于非介入治疗,而 11% 的病例在选择上各不相同。外科医生和非外科医生对这些治疗方法的偏好存在明显差异(P 结论:外科医生和非外科医生对这些治疗方法的偏好存在明显差异:这项调查表明,BPS 的治疗策略存在差异,反映了不同的专科专业知识。大多数中心每年只治疗少数病例,随访也没有标准化。因此,建议在多学科团队内进行管理讨论。在国际登记册中记录患者数据,以便对管理策略和结果进行比较,这有助于制定未来的指南:证据等级:IV 级。
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引用次数: 0
Peroral Endoscopic Myotomy in Pediatric Patients with Achalasia up to 12 Years of Age: A Pilot Study in a Single-Center Experience in Japan. 12岁以下贲门失弛缓症患儿经口内镜下肌切开术:日本单中心经验的初步研究。
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-02-01 Epub Date: 2023-08-18 DOI: 10.1055/a-2156-5099
Yoshitomo Samejima, Shohei Yoshimura, Yuichi Okata, Hiroya Sakaguchi, Hirofumi Abe, Shinwa Tanaka, Yuzo Kodama, Yuko Bitoh

Introduction:  Peroral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure for achalasia; its indication has expanded from adults to children. We aimed to evaluate the postoperative efficacy and antireflex status of POEM in young children with achalasia aged 12 years or younger.

Patients: AND METHODS:  Pediatric patients with achalasia aged 18 years or younger who underwent POEM in our hospital between 2016 and 2021 were included and divided into two age groups: group A (≤ 12 years) and group B (13-18 years). The success rate (Eckardt score ≤ 3), endoscopic reflux findings, and antiacid use at 1 year postoperatively were compared between the groups.

Results:  Ten patients (four boys and six girls; Chicago classification type I: five, type II: four, and unclassified: one) were included. Mean age and preoperative Eckardt scores in groups A (n = 4) and B (n = 6) were 9.2 ± 3.0 versus 15.6 ± 0.6 years (p = 0.001) and 5.5 ± 3.9 versus 7.2 ± 3.7 (p = 0.509), respectively, and mean operative time and myotomy length were 51.3 ± 16.6 versus 52.5 ± 13.2 minutes (p = 0.898) and 10.8 ± 4.6 versus 9.8 ± 3.2 cm (p = 0.720), respectively. The 1-year success rate was 100% in both groups. Mild esophagitis (Los Angeles classification B) was endoscopically found in one patient in each group (16.7 vs. 25.0%, p = 0.714), and antiacid use was required in three patients (group A, two; group B, one; 50.0 vs. 16.7%, p = 0.500).

Conclusion:  The success rate of POEM within 1 year in young children with achalasia aged 12 years or younger was equal to that in adolescent patients. However, young children tended to require antiacids 1 year postoperatively; therefore, long-term follow-up is necessary.

简介: 经口内镜肌切开术(POEM)是一种微创内镜手术治疗贲门失弛缓症;它的适应症已经从成年人扩展到儿童。我们旨在评估POEM在12岁或以下贲门失弛缓症幼儿中的术后疗效和抗反射状态。患者:和方法: 将2016年至2021年间在我院接受POEM的18岁或以下的贲门失弛缓症儿童患者纳入研究,并将其分为两个年龄组:A组(≤12岁)和B组(13-18岁)。比较两组术后1年的成功率(Eckardt评分≤3)、内镜反流检查结果和抗酸剂使用情况。结果: 包括10名患者(4名男孩和6名女孩;芝加哥分类I型:5名,II型:4名,未分类:1名)。A组(n组)的平均年龄和术前Eckardt评分 = 4) 和B(n = 6) 为9.2 ± 3.0对15.6 ± 0.6年(p = 0.001)和5.5 ± 3.9与7.2 ± 3.7(p = 0.509),平均手术时间和切开肌长度分别为51.3 ± 16.6对52.5 ± 13.2 分钟(p = 0.898)和10.8 ± 4.6对9.8 ± 3.2 厘米(p = 0.720)。两组的1年成功率均为100%。每组有一名患者在内镜下发现轻度食管炎(洛杉矶分类B)(16.7%对25.0%,p = 0.714),三名患者需要使用抗酸剂(A组,两名;B组,一名;50.0%对16.7%,p = 0.500)。结论: 12岁及以下贲门失弛缓症幼儿1年内POEM的成功率与青少年患者相同。然而,年幼的儿童往往需要在术后1年服用抗酸药;因此,长期随访是必要的。
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引用次数: 0
Neonatal Intestinal Segmental Volvulus: What Are the Differences with Midgut Volvulus? 新生儿肠段外翻:与中肠溃疡的区别是什么?
IF 1.8 3区 医学 Q1 Medicine Pub Date : 2024-02-01 Epub Date: 2023-08-11 DOI: 10.1055/s-0043-1772173
Maria Casalino, Maria Enrica Miscia, Giuseppe Lauriti, Estelle Gauda, Augusto Zani, Elke Zani-Ruttenstock

Objective:  Intestinal volvulus in the neonate is a surgical emergency caused by either midgut volvulus (MV) with intestinal malrotation or less commonly, by segmental volvulus (SV) without intestinal malrotation. The aim of our study was to investigate if MV and SV can be differentiated by clinical course, intraoperative findings, and postoperative outcomes.

Methods:  Using a defined search strategy, two investigators independently identified all studies comparing MV and SV in neonates. PRISMA guidelines were followed, and a meta-analysis was performed using RevMan 5.3.

Results:  Of 1,026 abstracts screened, 104 full-text articles were analyzed, and 3 comparative studies were selected (112 patients). There were no differences in gestational age (37 vs. 36 weeks), birth weight (2,989 vs. 2,712 g), and age at presentation (6.9 vs. 3.8 days). SV was more commonly associated with abnormal findings on fetal ultrasound (US; 65 vs. 11.6%; p < 0.00001). Preoperatively, SV was more commonly associated with abdominal distension (32 vs. 77%; p < 0.05), whereas MV with a whirlpool sign on ultrasound (57 vs. 3%; p < 0.01). Bilious vomiting had similar incidence in both (88 ± 4% vs. 50 ± 5%). Intraoperatively, SV had a higher incidence of intestinal atresia (2 vs. 19%; p < 0.05) and need for bowel resection (13 vs. 91%; p < 0.00001). There were no differences in postoperative complications (13% MV vs. 14% SV), short bowel syndrome (15% MV vs. 0% SV; data available only from one study), and mortality (12% MV vs. 2% SV).

Conclusion:  Our study highlights the paucity of studies on SV in neonates. Nonetheless, our meta-analysis clearly indicates that SV is an entity on its own with distinct clinical features and intraoperative findings that are different from MV. SV should be considered as one of the differential diagnoses in all term and preterm babies with bilious vomiting after MV was ruled out-especially if abnormal fetal US and abdominal distension is present.

目的:新生儿肠套叠是一种外科急症,其原因可能是中肠套叠(MV)伴有肠旋转不良,也可能是不伴有肠旋转不良的节段性肠套叠(SV)。我们的研究旨在探讨是否可以通过临床过程、术中发现和术后结果来区分中段肠套叠和节段性肠套叠:方法:两位研究者采用明确的检索策略,独立鉴定了所有比较新生儿 MV 和 SV 的研究。结果:在筛选出的 1,026 篇摘要中,有 1,000 多篇是关于新生儿 MV 和 SV 的:在筛选出的 1026 篇摘要中,对 104 篇全文进行了分析,选出了 3 项对比研究(112 名患者)。胎龄(37 周与 36 周)、出生体重(2989 克与 2712 克)和发病年龄(6.9 天与 3.8 天)均无差异。SV 更常见于胎儿超声检查(US;65% 对 11.6%;P P P P P 结论:我们的研究凸显了有关新生儿 SV 的研究很少。然而,我们的荟萃分析清楚地表明,SV 是一个独立的实体,具有不同于 MV 的临床特征和术中发现。在排除 MV 后,所有出现胆汁性呕吐的足月儿和早产儿都应将 SV 作为鉴别诊断之一,尤其是在胎儿超声检查异常和腹胀的情况下。
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引用次数: 0
期刊
European Journal of Pediatric Surgery
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