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Objective To explore the feasibility and efficacy of endoscopic balloon dilation in treatment of esophageal stenosis caused by operation of congenital esophageal atresia. Methods A retrospective analysis was performed on data of 218 children with type Ⅲ esophageal atresia, who underwent surgery in Zhengzhou Children' s Hospital from January 2009 to December 2017. The occurrence of postoperative complications and efficacy of endoscopic balloon dilation in treatment of esophageal stenosis was analyzed. Results Among the 218 patients with congenital esophageal atresia, 92 were type Ⅲa and 126 were type Ⅲb. Postoperative anastomotic leakage occurred in 46 cases (21. 1％), including 29 (31. 5％) of type Ⅲa and 17 (13. 5％) of type Ⅲb. Postoperative anastomotic stenosis occurred in 53 cases (24. 3％), including 29 ( 31. 5％) of type Ⅲa and 24 ( 19. 0％) of typeⅢb. The incidence of anastomotic leakage and anastomotic stenosis in different types was significantly different (χ2=10. 383, P=0. 001; χ2=4. 497, P=0. 034). The 53 cases of anastomotic stenosis underwent 123 times of endoscopic balloon dilation, with mean time of 3. 5±1. 6, and were finally clinically recovery. No esophagus perforation occurred. Among them, 29 cases of type Ⅲa underwent 73 times with mean of 4. 0±1. 8, and 24 cases of type Ⅲb underwent 50 times with mean of 2. 5±0. 7. The difference between the two types was statistically significant (t=-4. 053, P=0. 027). Conclusion Children with type Ⅲa esophageal atresia has a higher incidence of anastomotic stenosis and leakage, and more times of esophageal dilation. Endoscopic balloon dilation is safe and effective in treatment of esophageal stenosis after surgery for patients with congenital esophageal atresia.
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Objective To study the clinical value of enhanced recovery after surgery (ERAS) in the perioperative treatment of type Ⅰ (Todami,1975) biliary dilatation (BD) of children.Methods To retrospectively analyze the data of children with type Ⅰ BD who were treated in the General Surgery Department of Zhengzhou Children's Hospital from June 2014 to May 2018.A total of twenty children with type Ⅰ BD treated with ERAS and 20 children treated with the traditional method in our department were selected in this study using the random number table method.Postoperative indicators (including operation time,first defecation time,changes in amylase in blood and abdominal cavity exudates,length of hospital stay,and hospitalization fee) and relevant postoperative complications (including sore throat,nausea and vomiting,urethral pain,upper respiratory tract infection,incision wound infection,adhesive intestinal obstruction,anastomotic leakage and pancreatic fistula) of the ERAS group and the control group were compared.Results The first defecation time,length of hospital stay and hospitalization fee were significantly lower in the ERAS group than the control group (all P ＜ 0.05) [first defecation time (1.98 ± 0.25) d vs.(2.25 ± 0.31) d;length of hospital stay (6.91 ± 1.25) d vs.(9.95 ± 1.53) d;hospitalization fee (23.32 ± 2.25)thousand yuan vs.(25.99 ±3.10) thousand yuan].Moreover,the incidences of sore throat,nausea and vomiting,urethral pain and upper respiratory tract infection were significantly lower in the ERAS group than the control group (all P ＜ 0.05) [the incidences of sore throat (5.0％ vs.45.0％);the incidences of sickness and vomiting (5.0％ vs.30.0％);the incidences of urethral pain (5.0％ vs.45.0％);the incidences of upper respiratory tract infection (5.0％ vs.40.0％)].On the other hand,there were no significant differences in the mean operation times,changes in amylase levels in the blood or abdominal cavity exudates,incision wound infection,and incidences of adhesive intestinal obstruction,anastomotic leakage and pancreatic fistula (all P ＞ 0.05).Conclusions ERAS for type Ⅰ BD surgery was safe and reliable in children.It effectively promoted recovery of postoperative gastrointestinal function and reduced the incidence of complications.
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Objective To investigate value of peripheral NLR and PLR for the survival of patients with neuroblastoma.Methods The clinical data of 41 neuroblastoma patients were analyzed by the Kaplan-Meier,Log-rank test,and multivariate COX regression.Results NLR,PLR levels of neuroblastoma patients were significantly higher than that in the healthy control group (1.81 ±0.29 vs.1.07 ±0.29,P ＜ 0.01) (169 ± 23 vs.76 ± 3,P ＜ 0.01);The elder the age,the higher the clinical stages,the higher the serum levels of NSE,and urine VMA were,the higher was the NLR (x2 =3.93,6.286,7.676,6.689,all P＜0.05) and PLR (x2 =4.111,5.707,8.019,8.922,all P ＜0.05).The higher the serum level of LDH,the higher was the NLR (x2 =7.769,P =0.02).3-year overall survival in low NLR group was 84％ and that in high NLR group was 73％ (x2 =4.002,P =0.045);3-year progression-free survival in low NLR group was 74％ and that in high NLR group was 50％ (x2 =4.082,P =0.043);3-year progression-free survival of low PLR group was 85％ and high PLR group was 38％ (x2 =9.388,P =0.002).The clinical stages,MYCN genetic expression,NLR levels were independent factors for the overall survial in patients with neuroblastoma (P ＜ 0.05).Conclusion Pretreatment NLR level can effectively predict the prognosis of neuroblastoma.
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Objective:To evaluate the efficacy of allicin combined with cyclophosphamide on neuroblastoma (NB)-bearing mice and explore the immunological mechanism in it.Methods:A total of30 NB-bearing mice were equally randomized into model group, cyclophosphamide group and combined therapy group,10 nudemice were set as normal saline(NS) group.Cyclophosphamide group and combined therapy group were weekly injected with60 mg/kg cyclophosphamide for four weeks; besides, combined therapy group was given with allicin(10 mg/kg/d) by gastric perfusion for4 weeks; model group and NS group were given with the same volume of NS.Serum VEGF content was detected byELISA pre-treating(0 d) and on the3rd d,14th d and28th d; on 29th d, all mice were sacrificed and the tumor, liver, spleen and thymic tissues were weighted. Tumors were made into paraffin section for detecting tumor cell apoptosis and proliferation by TUNEL and BrdU method, respectively.Survival curves were drawn byKaplan-Meier method. Results:After treatment, both treatment groups relieved on viscera indexes,VEGF level,T cell subsets distribution and tumor growth and each index of combined therapy group was better than cyclophosphamide group(P<0.05 or0.01); only combined therapy group could significantly increase the lifetime of NB-bearing mice(χ2=5.667,P=0.017).Conclusions:Allicin can improve T cell subsets distribution and inhibitVEGF expression through its immunomodulatory activity, thereby improve the efficiency onNB in coordination with cyclophosphamide.
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Objective To review the treatment of repair gastroschisis with autogenous umbilical cord and evaluate its effect. Methods Thirty newborns who underwent the repair gastroschisis with autogenous umbilical cord between August 1992 to October 2007, 26 cases survived under observed and followed-up, observing physical growth, intelligence measuring and whether the area of operated in abdomen need staged repair or not. Compared with 15 cases who underwent traditional operation method at the same time. Results Two cases died, 2 cases abandoned, and 26 ease received survive (survive rate 86.7%)and their growth was well in 26 cases. But in those 15 cases who underwent traditional operation method, 5 cases survived (survive rate 33.3%). There were significant difference in the survive rate, the mean operative time and postoperative hospital stay time between the two operation methods (P <0.05).Conclusion The material is adopted easily in the operation, autogenous umbilical cord is elastic tissue and no toxicity, it can relax the abdominal press effectively after the operation, the survive rate is high.
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Objective To investigate the clinical diagnosis and treatment of children's relapsesable intussusception by Peutz-Jeghers syndrome.Methods 5 cases of relapsesable intussusception result from Peutz-Jeghers syndrome which confirmed by operation and pathological diagnosis in children were analyzed retrospectively.Results All patients were diagnosed definitely by operation and pathological diagnosis and recovered well postoperatively.Conclusions Treated with the intussusception and resected polypus is effect to Peutz-Jeghers syndrome because it caused intussusception recurred easily,and patients should be followed up and examined regularly.
