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Objective To investigate therapeutic effect of endoscope?guided bougie dilatation on children with benign esophageal stricture. Methods Data of 71 patients with benign esophageal stricture were retrospective analyzed.Patients were divided into group A (reflux stricture),B (congenital esophageal atresia stricture) and C ( caustic injuries stricture) ,based on different causes. The expansion effectiveness and factors of the three groups were analyzed. Results A total of 885 expansions were performed on 71 patients with the total efficacy rate 94?37%( 67/71) . No statistic differences were shown in expansion effectiveness among the 3 groups; group C ( 14?9 times/case, P < 0?05 ) showed more expansion frequencies than group A (9?1 times/case,P<0?05)and group B(10?7 times/case, P<0?05),more complications than group A(1?22%VS 0,P<0?05) and group B(1?22% VS 0?31%,P<0?05). Conclusion Endoscope?guided bougie dilatation is safe and effective for childrens′ benign esophageal stricture. Caustic injuries, refractory benign esophageal stricture,need more expansions and may be accompanied with more complications.
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Objective To discuss the surgical treatment for huge hepatoblastoma in children,and the technique of hepatectomy without blockade of the blood supply to the remained liver lobes.Methods We reviewed 12 cases of huge hepatoblastorna who had been operated from July 2001 to January 2009 in our hospital.The mean age of the children was 3.2 years(range,11 months to 12 years).The diameter of the tumor was from 10 to 23 cm.3～7 cycles of chemotherapy was routinely administrated before operation.When the tumor reduced to a certain size that radical resection could be performed safely,regular hepatectomy was conducted.Hepatoblastoma resection without blocking the blood supply to the remained liver lobes was performed in every patient.Results The operations were successfully accomplished in all the 12 children.5 cases received right trihepatectomy (segment Ⅳ,Ⅴ～Ⅷ),4 cases received right hemihepatectomy(segment Ⅴ～Ⅷ),and the other 3 cases received Ⅳ,Ⅶ,Ⅷ segmentectomy,right Ⅴ,Ⅵ segmentectomy,and left hemihepatectomy respectively.The intraoperative hemodynamic parameters were stable,and there was no perioperative mortality.Postoperative chemotherapy wag routinely administrated.The follow-up period varied from 2 to 92 months.11 children survived and were disease free,among those 6 children have survived for more than 5 years.One child had brain and lung metastasis 5 months post operation,and died 7 months post operation. Conclusion Preoperative chemotherapy administrated to children with huge hepatoblastoma can reduce the tumor size and render tumor reseetable.Hepatoblastoma resection without blocking the blood supply to the remained liver lobes is a safe and feasible surgical technique.
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Objective To explore the safety and feasibility of laparoscopy in diagnosis and treatment of neonates and infants diseases.Methods Laparoscopic operations were performed in 297 neonates and infants aging from 2 hours to 6 months,from January 2001 to May 2007.The diseases of 297 cases included 80 cases of congenital hypertrophic pyloric stenosis,67 cases of obstructive jaundice,35 cases of indirect inguinal hernia,31 cases of biliary atresia,21 cases of middle or high anal atresia,21 cases of biliary hyperviscosity,7 cases of congenital diaphragmatic hernia,7 cases of jejunal atresia,6 cases of choledochal cyst,5 cases of Hirschsprung's disease,5 cases of duodenal web,3 cases of uronephrosis,2 cases of esophageal hernia,2 cases of esophageal atresia,2 cases of intestinal malrotation,1 case of intestinal obstruction,1 case of intussuception,,and 1 case of congenital muscular troticollis.Results The laparoscopic operations were completed in 294 cases,of which 67 received diagnostic cholangiography,80 received pyloromyctomy,35 received hernia sac high ligation,21 received biliary irrigation,5 received operations for membranous stenosis of duodenum,2 received Ladd operations for malrotation of intestine,1 received reduction of intussusception,1 received enterolysis,and 1 received incision of lower end of sternocleidomastoid muscle;and some complicated procedures including 31 cases of hepatic portal duct-jejunostomy,21 anoplasty,7 repair of diaphragmatic hernia,7 enterectomy and entero-anastomosis of intestinal atresia,6 hepatic duct-jejunostomy,5 radical surgery for Hirschsprung's disease(megadolicho-colon),3 pyeloplasty,2 operations for esophageal atresia,and 2 fundoplication for hiatus hernia.No massive hemorrhage,intra-or post-operative blood infusion,accidental damage or peri-operative death was reported.Three cases of biliary atresia were converted to open surgery due to oozing of blood in hepatic portal.All case were followed for 2 months-6 years,and no long-term or short-term complication was found.Conclusions Laparoscopic technique is safe and reliable in the diagnosis and treatment of diseases in neonates and infants,which is characterized by minimal invasion,quick recovery and satisfactory cosmetic effects.
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1 week,7 cases of pneumothorax,11 cases of subcutaneous emphysema,3 cases of bar rotation,and 4 cases of unilateral stabilizing bar displacement.Incisional infection was found in 3 cases,2 of which received a removal of the bar and 1 of which was cured with debridement and dressing changes.During a follow-up evaluation for 3~28 months,the outcomes were calssified as excellent in 42 cases,good in 4 cases,fair in 3 cases,and poor in 4 cases. Conclusions The Nuss procedure is safe and effective for the correction of pecrus excavatum in children.
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Objective To investigate the feasibility of laparoscopically assisted anorectal pull-through in the repair of high imperforate anus. Methods Four infants (3 boys and 1 girl, age range, 1 d～90 d) with high imperforate anus entered this study. During operations, the rectum was exposed via laparoscope down to the rectourethral fistula, which was ligated and dissected out laparoscopically; and then, by way of a passage through the center of pelvic floor musculature, the rectum was exteriorized to the perineum to perform anorectal anastomosis. Results Laparoscopically assisted anorectal pull-through was successfully performed in all the 4 cases as a primary procedure. The mean duration of the laparoscopy was 71 8 min (range, 45 min～90 min) and the mean blood loss 8 3 ml (range, 5 ml～20 ml), no blood transfusion required and no intraoperative complications occurred. All patients recovered uneventfully. In 3～12 months of follow-up, 1 patient was found anal stenosis at 1 month after the operation and was cured with secondary anorectoplasty. No postoperative complications were seen in the other 3 cases. By now, all the 4 patients have normal fecal continence. Conclusions Laparoscopically assisted anorectal pull-through is an effective technique in the repair of high imperforate anus. Experience has shown that this approach offers minimally invasive wounds, excellent visualization of the rectal fistula and accurate identification of the center of pelvic floor musculature.
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Objective To explore the feasibility of simple transanal colon pull-through operation in the management of Hirschsprung's disease(HD) in children. Methods 57 case of HD were performed by transanal macrocolon pull-through operation from July 2001 to May 2002. Results 53 cases underwent simple transanal colon pull-through operation successfully. The mean operative time was 1.5h (1h～2h) and blood loss was 5ml～10ml. Dejection and food taking recovered at the first day after operation in 51 patients; dejection recovered at the third day after operation in 2 patients. 4 patients with long segmental macrocolon, implicated in transverse colon, were operated on by laparoscope-assited surgery, and they began to defecate and take food in 2d～3d postoperatively. The mean operative time was 3h(2h～3.5h). 57 cases had been followed up for (2～9)months, and their dejection function recovered well. Conclusions It is feasible to treat HD in children through simple transanal colon pull-through operation. The method has the advantages of minimal invasion, less bleeding, quicker recovery, shorter hospital stay and good recovery of dejection function.
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Objective To explore the diagnosis and treatment of intestinal duplication by means of laparoscope. Methods 9 cases suspected intestinal duplication before operation underwent intraperitoneal exploration through two-trocar laparoscope. Patients diagnosed as intestinal duplication were performed by enterectomy and end-to-end intestinal anastomosis outside abdominal cavity through a 10mm trocar. Results All cases were operated on under lapascope with a mean operative time of 80min(30min～110min).The postoperative hospital stay was 4d～5d . No complications occurred. Conclusions Two-trocar laparoscope is an effective method to diagnose and treat intestinal duplication.
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Objective To evaluate the value of laparoscope in the diagnosis and treatment of obstructive jaundice in infants. Methods 52 cases of obstructive jaundice were diagnosed and treated under laparoscope. Results 2 cases were converted to open operation because of a lot of ascitic fluid. The diagnosis of other 50 cases was confirmed under laparoscopic cholangiography, including biliary atresia in 33 cases, bile duct hypoplasia in 10 ones and cholestasis in 7 ones. Hepatic portal-intestinal anastomosis was operated on 43 patients. Liver biopsy was done in 38 cases. Biliary duct cannula and irrigation were performed in 9 cases. Conclusions Laparoscope is an accurate and reliable technique in the diagnosis and treatment of obstructive jaundice in infants and it can avoid open surgery for infants with cholestasis.
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Objective To study the value of laparoscope in the diagnosis and treatment of high cryptorchidism. Methods 21 testes in 19 patients were performed by intraperitoneal exploration and cryptorchidopexy. Results The testes of 11 cases were located in inferior extremity of kidneys and the ones of 8 cases in superior part of internal rings.15 testes were fixed in the bottom of scrotums and 4 ones in abdominal cavity for secondary operation; absent testis was found in 1 case; 1 testis was removed due to testis dysplasia. Scrotum emphysema and hematoma occurred in 3 and 1 patients respectively. Wounds of 19 cases healed well postoperatively. 15 patients had been followed up for (3～10) months with an average of 6 months and they recovered well. Conclusions The diagnosis and treatment of high cryptorchidism by means of laparoscope has the advantages of minimal invasion, less bleeding, quicker recovery and no serious complications.
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Objective To explore the method and superiority of laparoscopic management of children's varicocele. Methods High position ligation of varicocele under laparoscope was performed and internal spermatic arteries were reserved intraoperatively. Results 32 cases had smooth recovery after operation, and no complication occurred. The hospital stay was (1～3)days postoperatively. 29 cases had been followed up for 6 months～1 year and no relapse and testis atrophy occurred. Conclusions The method has the advantages of simpleness, minimal invasion and quicker recovery. Reservation of internal spermatic artery can prevent testis atrophy.
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Objective To study the characteristic s of laparoscopic operations in infants younger than 6 months. MethodsWe retrospectively analyzed the perio perative course of laparoscopic operations in 98 infants. Results All the 46 cases got definite diagnosis by explorative laparoscopic operations except 1 case shifted to open laparotomy. Two cases were shifted to open laparotomy in 51 therapeutic laparoscopic proced ures. Post-operative complications such as respiratory tract infection, hyperca pnia and elevation of myocardial enzyme were found in 11, 14 and 1 cases respect ively. There was no postoperative mortality, no infection nor hernia of incision s in the peri-operative period. Conclusion Appropriate application of laparoscopy in infantile surgery i s of optimistic future for less trauma and complications.
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Objective To evaluate the clinical features of and appropriate surgical modality for congenital choledochal cyst(CCC). Methods Retrospective study on the clinical data of 85 surgically treated CCC cases was made. Results Among the 85 cases 12 were found malignant in character(14%). Out of the 29 cases in which the junction of pancreaticobiliary ductal system was showed by image, junction anomaly was identified in 26 cases. Surgical correction was applied to 83 cases with cyst excision and Roux-en-Y hepaticojejunostomy as the main procedure. External drainage of the CCC was adopted first in 4 cases to tide the patients over serious infection, before second stage definite radical resection was carried out. Excellent and good result were achieved on follow-up in 47 out of 60 CCC cases undergoing CCC resection and Roux-en-Y reconstruction, while only one out of 6 undergoing CCC internal drainage enjoyed fair result. Conclusions External drainage is mandatory for CCC patients with severe infection. The total choledochal cyst excision, with Roux-en-Y hepaticojejunstomy is effective in the treatment of CCC.
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Objective To evaluate the diagnostic value of 2D-FIESTA sequence of MRI in the detection of the biliary tract lesions in infant and young children patients(less than 3 years).Methods 8 infant and young children patients were examined by MRI to evaluatetheir biliary tract.Images were obtained with a 1.5T whole body MRI system(GE Medical System,Milwakee,Wis,USA),using theCARDIAC coil.The patients were sedated by chloral hydrate orally or by pentobarbital sodium intravenously.No contrast agents wererequired.All of the axial,coronal and sagittal images were reviewed on an independent workstation and maximum intensity projection(MIP) and multiplanar reformations(MPR) techniques were applied.Results The 2D-FIESTA pulse sequence results in images in which the hepatic vascular structures and the biliary tract were highlighted.In this way,a clear visualization of the hepatic vessels and biliarytract could be obtained in all 8 cases.MRI could demonstrate the anatomy and pathology of post-transplantation changes in 3 patients,choledochal cysts in 2 patients,anomalous connection between the bile and pancreatic ducts in 1 patient.All the abnormalities were proved by operation.2 examinees were diagnosed normal by MRI and were confirmed by follow-up.Conclusion 2D-FIESTA is a fast sequence that allows the high quality images to be generated without breath-hold and without administration of contrast material.It has a potential wide application in the evaluation of biliary tract in the infant patients.
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Objective To study the diagnosis and treatment of Currarino triad Methods A retrospective study was made on clinical features, diagnosis; treatment and prognosis of 7 cases with Currarino triad Results In 6 patients definite diagnosis was made only intraoperatively including reoperation in 3 cases All the 7 cases were cured Postoperative urinary retention and infection developed in one each Conclusion Correct preoperative diagnosis of Currarino triad has great influence on the treatment Total excision of presacral mass should be emphasized
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Objective To explore a new therapy for Hirschsprung's disease ( HD). Methods From Jul 2001 to Aug 2003,72 cases underwent transanal pull-through plus partial myoctomy of internal sphincter. Rectoanal manometry was done for 27 patients perioperatively. Forty-eight patients were followed-up and evaluated according Reding standard. Results Pre-and post-operative rest pressure was (38 ?8) mm Hg and (22?6 ) mm Hg respectively (P
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Objective To investigate the diagnosis and treatment of liver tumor in children. Methods Among 23 cases,21 cases underwent resection. Results Benign tumors were in 10 cases and malignant tumors in 11 cases. AH patients were followed up for 0. 5 - 3 years. Two cases died during the follow-up. Three year survival rate in benign tumor was 100% ( 10/10) and 82% (9/11 ) in malignant tumor. Conclusions Most malignant liver tumors were embryonal in children. Combination therapy of surgery and chemotherapy improves the prognosis. Prognosis of benign tumors after total resection is satisfactory.
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Objective To study the feasibility of laparoscopic repair of congenital diaphragmatic hernia (CDH) in children. Methods Two neonates (age 2 and 7 day) and 4 infants (age 7, 10, 21 and 24 months, averaged 15.5 month), one of them was male, underwent laparoscopic repair of diaphragmatic hernia under general endotracheal anesthesia. Two of them were on the left side, and 4 on the right. 3 or 4 trocars were used. The hernia contents were reduced and the hernia defect was repaired using interrupted sutures. Results The laparoscopic procedures were completed without intra-operative complication in 4 infants. The operating time ranged from 55 to 180 minutes (averaged 121 minutes). Amount of bleeding was less than 5ml. In them full activity and feeding were normal within 1-2 days. 1-2 years follow-up showed no complication or recurrence. In one newborn open abdominal operation was required, and recurrence occurred in the other necessitating re-operation by laparotomy in the other newborn. Conclusions Laparoscopic repair of congenital diaphragmatic hernia in infants is feasible, and its result was satisfactory. The role of laparoscopic correction of diaphragnatic hernia in the newborn period, however, remains to be determined.