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Objective To compare the surgical and functional outcomes of single-site (transumbilical two-port) intracorporeal purse-suturing (IP) and single-port extracorporeal knotting (EK) for laparoscopic pediatric inguinal hernia (PIH) repair.Methods Between June 2008 and December 2014,358 PIH children underwent lapamscopic inguinal herniorrhaphy,including 126 treated by single-site intracorporeal purse string stitching using a needle-holder (IP group),and 232 by single-port extracorporeal knotting using an inner two-hook needle with preperitoneal hydrodissection (EK group).Results In all patients laparoscopic procedures were completed successfully without conversion.The operating time in IP group was significantly longer than that in EK group [unilateral:(20.4 ± 2.1) min vs.(9.4 ± 1.3) min,t=-5.23,P＜0.01;bilateral:(31.3 ±2.9) min vs.(15.2±1.7) min,t=-4.22,P＜0.01)].The hospital stay were similar between the two groups [(2.35 ±0.25) d vs.(2.38 ±0.18) d,t =-0.062,P ＞ 0.05].Five cases had intraoperative hematoma in the IP group while none in the EK group.One each suffered from recurrence in IP group and EK group.Three postoperative hydroceles were seen in IP group and one in EK group.Subcutaneous knot granulomas were seen in two in EK group.Conclusions Both IP and EK laparoscopic procedures are safe and feasible.With the assistance of preperitoneal hydrodissection technique,single-port laparoscopic EK herniorraphy is superior to single-site IP repair in easy performance and shorter operation time.
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OBJECTIVE To investigate the safety, efficacy, specific injection mode and injection dose of Lauromacrogol for treating laryngopharyngeal hemangioma. METHODS a total of 18 patients with hemangioma of pharynx and larynx from Oct 2015 to Dec 2016 in were collected in our hospital. Among them, there were 18 cases of solitary hemangioma and 2 cases sporadic hemangioma. According to the location and depth of the lesions, different routes were used. Observe the therapeutic effect of local injection. RESULTS All the 18 patients were followed up for 3 months to 1 years. Among them, 1 case of multiple hemangioma patients were significantly affected by the local inflammatory swelling after the injection. 3 patients complained of mild dyspnea after operation, and 10 patients complained of postoperative pain. None of the patients had cough, chest tightness, embolism, adverse ischemic shock and severe amaurosis. CONCLUSION Lauromacrogol injection is safe, reliable and effective to treat hemangioma of pharynx and larynx. Different injection methods should be based on the size of hemangioma, depth and other factors.
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Induced pluripotent stem cell (iPSC) is a type of pluripotent stem cell that can be generated directly from adult cells through gene reprogramme and cell dedifferentiations.The researching history and advantages of iPSC were reviewed in this paper.In addition,the application of iPSC on diabetis mellitus was also summarized and prospected.
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The epidermal stem cell was introduced briefly in this review.And then the spacial characteristics of diabetic wound healing were summarized.In this regards,we focus on the important role of epidermal stem cell in diabetic wound healing.At last,we outlook the research direction and clinical application of epidermal stem cell in diabetic wound.
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[Summary] Between February 2010 and November 2014, a retractor fabricated by stainless steel tongue depressor was used in 30 cases of small incision appendectomy in our department .All the operations were performed via an incision 1.5-3 cm in length.No complications were found .Such self designed retractor can be clinically utilized with characteristics of cheapness , safety, and good exposure of operative field .
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Objective To investigate whether the laparoscopic portoenterostomy is superior to open surgery in the treatment of biliary atresia.Methods A total of 26 children with type Ⅲ biliary atresia underwent laparoscopic portoenterostomy from August 2003 to September 2005(Laparoscopic Group).The operation was performed under 4-port laparoscopy.The hepatic portal was fully exposed and mobilized and the gallbladder was removed.The cut end of the duct was widened by incising along the anterior wall of the hepatic duct following the excision of the narrow segment.By using intraoperative bile duct endoscopy,the optimal level of resection of the common hepatic duct was determined without endangering the orifices of the hepatic ducts or leaving any redundant duct.The Roux-en-Y jejunal loop was fashioned extracorporeally by exteriorizing the jejunum for 40 cm in length distally through the umbilical incision and passed up retrocolically followed by an end-to-side hepaticojejunostomy.They were compared with other group of 34 children,with the same age range and diagnosis,who underwent open portoenterostomy(Open Group) in the same period,in respect of the operative time,the blood loss,the liver functions,complications,the length of hospital stay,the hospitalization expenditure,and the short-term outcomes. Results As compared with the Open Group,the Laparoscopic Group presented a less blood loss(15.4?5.0 ml vs 33.8?19.4 ml;t=-4.709,P=0.000) and a higher hospitalization expenditure(19 153.9?619.5 yuan vs 15 116.7?898.4 yuan;(t=19.607),P=0.000).There were no significant differences between the two groups in the operative time and the length of hospital stay.The serum levels of total bilirubin,direct bilirubin,ALT,and AST were deceased more significantly in the Laparoscopic Group than in the Open Group.Complications happened in 1 case in the Laparoscopic Group(incisional hernia) and in 4 cases in the Open Group(1 case of acute hepatic failure,1 case of incision rupture,and 2 cases of wound infection),the incidence of complications being not significant(?~2=0.395,P=0.530).Follow-up observations at 4 postoperative month found the jaundice had subsided in 13 cases in the Laparoscopic Group(50%) and in 18 cases in the Open Group(53%). Conclusions Laparoscopic portoenterostomy is a minimally invasive,safe,and effective procedure for the treatment of pediatric biliary atresia.
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Objective To investigate curative effects of endoscopic sternocleidomastoid muscle amputation for the treatment of congenital muscular torticollis.Methods A total of 23 children with congenital muscular torticollis were treated in this department.Their age was 1 month ~ 12 years old(median,30 months).A 5 mm trocar was inserted through the right axilla along the cleavage lines.Under the endoscopic visualization,the sarcolemma on the inferior portion of the muscle was bluntly dissected and a subcutaneous space was established by CO_2 inflation at the pressure of 6 mm Hg.Another two 3 mm incisions were made along the cleavage lines at lower lateral part of the neck and the anterior chest wall for the introduction of curved forceps and electric knife,respectively.The sternocleidomastoid muscle was transected with electrocautery and the external fascia within which the sternocleidomastoid muscle resides was also adequately divided. Results The operation was successfully completed under endoscope in all the 23 children.The mean operation time was 51.2 min(range,(35~)135 min) and the intraoperative blood loss was
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Objective To explore the categories and precautions of complications after laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for congenital choledochal cyst in children. Methods Laparoscopic cyst excision with Roux-en-Y hepatoenterostomy was performed in 66 cases of congenital choledochal cyst from July 2001 to June 2006. Their median age was 3.8 years (range, 2 months ~ 28 years). The choledochal cyst was classified as cystic type in 61 cases, with a diameter ranged 2.5~18 cm, and fusiform type in 5 cases, with a diameter ranged 1.2~2.2 cm. Nine cases were associated with hepatic ductal stenosis; they underwent a laparoscopic excision of the cyst with a ductoplasty. Results The laparoscopic operation was successfully completed in all the 66 patients, with a mean operation time of 3.8 h (2.6~9.5 h) and a mean hospital stay of 4.5 d (3~8 d). Early complications included 2 cases of bile leakage (spontaneous recovery in 1 case, and an open surgery required in 1 case because of obstructed drainage, with anastomotic leakage identified and re-anastomosis performed during the operation), 1 case of hyperkalemia (10.8 mmol/L at 7 h after operation, resulting in heart failure and cardiopulmonary resuscitation, and died of renal failure on the 3rd postoperative day), and 2 cases of stress ulcer (spontaneously relieved). There were no infections of the abdominal cavity or the wound. Long-term complications included 1 case of intestinal obstruction (open exploration showed intestinal adhesion and necrosis, and an enterectomy with enteroanastomosis was given). No anastomotic stenosis and postoperative cholangitis were encountered.Follow-up observations for 6~56 months (median, 21 months) were conducted in 65 survived cases, B-ultrasonography found no bilestone, and liver functions were in normal limits. Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy is a complicated operation with high risks. Some complications are similar to those after conventional operations, such as bile leakage, stress ulcer, and intestinal obstruction. Hyperkalemia is perhaps the most serious one, which maybe related to carbon dioxide pneumoperitoneum. It is essential to monitoring hyperkalemia in postoperative period.