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Objective:To study the strategies in the diagnosis and treatment of pancreatic tumors in children.Methods:The clinical data of 18 children with pancreatic tumor managed at the Children's Hospital Affiliated to Chongqing Medical University from March 2015 to September 2020 were retrospectively studied. There were 8 males and 10 females, age ranged from 3 months to 14 years and 11 months, with a median age of 8 years and 2 months. Clinical data including age, gender, pathological data, surgical methods, chemotherapy, tumor location and treatment outcomes were collected. Follow-up was conducted by outpatient visits and by telephone.Results:Abdominal ultrasound, enhanced CT and/or MRI examinations were performed on all these patients, with findings of either a cystic or solid lesion of pancreas. All patients were treated by laparotomy under endotracheal intubation and general anesthesia. The operations were all completed successfully. Among the 18 patients, there were 11 patients with solid pseudopapillary tumors and 7 patients with pancreatoblastoma (PBL). The tumors were located in the head of the pancreas in 13 patients (including 3 patients who underwent pancreaticoduodenectomy, 1 patient who underwent resection of the head of the pancreas with preservation of the duodenum, and 9 patients who underwent resection of the tumors). The tumors were located in the body and tail of the pancrease in 5 patients (including 3 patients who underwent resection of the body and tail of the pancreas with preservation of spleen, and 2 patients who underwent resection of tumors). Because of huge tumors, 1 patient had bilateral lung, left supraclavicular fossa lymph node and retroperitoneal lymph node metastasis, 3 patients were confirmed to have PBL by biopsy, and these tumors were resected completely after neoadjuvant chemotherapy. Postoperative pathology showed that all the 3 patients had PBL and were given systematic chemotherapy. Postoperative pancreatic fistula occurred in 1 patient and chylous fistula in another patient, both were discharged home successfully after conservative treatments. All patients were followed-up for 2-7 years, and all children were tumor-free.Conclusion:It is not difficult to diagnose pediatric pancreatic tumors by ultrasound, CT and MRI before operation, and postoperative pathology was needed to confirm the diagnosis. Function-preserving surgical resection was the treatment of choice for pancreatic tumors in children.
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Children with biliary atresia generally present nutritional deficiency, and often have growth failure and neurodevelopmental impairments.Increasing evidence shows that malnutrition is not only a risk factor for growth failure and neurodevelopmental impairments in children with biliary atresia, but also a risk factor for morbidity and mortality.Nutritional support is extremely important to improve the prognosis.This article reviews the relationship between malnutrition, growth failure and neurodevelopmental impairments in children with BA, and discusses the timing and methods of nutritional support.
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Objective To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation.Method The data of 22 children who were underwent liver transplantation with preopera-tive splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery,Children's Hospital of Chongqing Medical University from December 2008 to January 2019 were collected.There were 13 male patients and9 female patients with a median age of 6.5 months.The changes of erythrocyte,platelet,white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st,3rd and 6th months after surgery.Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery.Results There were 21 cases of red blood cell decreased before surgery,with a mean value of(3.1±0.5)X 1012/L,and(3.7±0.7)×1012/L,(4.6±0.6)×1012/L and(4.3±0.5)×1012/L at the 1st,3rd and 6th months after operation,respective-ly.The differences between the preoperative and postoperative groups were statistically significant(P＜0.05).There were 7 cases of thrombocytopenia before operation,with an average of(70.0±17.0)×109/L,and(191.0±129.0)×109/L,(156.0±79.0)×109/L and(167.0±63.0)×109/L at the 1st,3rd and 6th months after operation,respectively.The differences between the first,third,and sixth months after sur-gery were significant compared with that before surgery(P＜0.05).Leukocyte count decreased in 5 cases with an average value of(3.30±0.56)×109/L before surgery,(7.5±4.4)×109/L,(7.4±1.4)× 109/L,(5.1±2.5)×109/L at the 1st.3rd and 6th months after operation,respectively.The differences between the two groups were significant(P＜0.05).The average value of preoperative spleen length times thickness was(35.7±12.9)em2 and at the 1st,3rd.6th month after surgery it was(26.2±8.1)cm2,(25.2±13.4)cm2,(27.2±7.4)cm2,respectively.The differences between the first,third months after surgery were significant compared with that before surgery(P＜0.05).The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively(correlation coefficients were-0.902,-0.933,respectively),and the differences were statistically significant(P＜0.05).Conclusions In the early stage of liver transplantation,the size of spleen retracts to varying degrees,and hypersplenism can be alleviated continuously.Therefore,it is unnecessary to treat splenomegaly and hyper-splenism before and during liver transplantation.
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Objective@#To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation.@*Method@#The data of 22 children who were underwent liver transplantation with preoperative splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from December 2008 to January 2019 were collected. There were 13 male patients and 9 female patients with a median age of 6.5 months. The changes of erythrocyte, platelet, white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st, 3rd and 6th months after surgery. Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery.@*Results@#There were 21 cases of red blood cell decreased before surgery, with a mean value of(3.1±0.5)×1012/L, and(3.7±0.7)×1012/L, (4.6±0.6)×1012/L and (4.3±0.5)×1012/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the preoperative and postoperative groups were statistically significant (P<0.05). There were 7 cases of thrombocytopenia before operation, with an average of (70.0±17.0)×109/L, and (191.0±129.0)×109/L, (156.0±79.0)×109/L and (167.0±63.0)×109/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the first, third, and sixth months after surgery were significant compared with that before surgery (P<0.05). Leukocyte count decreased in 5 cases with an average value of (3.30±0.56)×109/L before surgery, (7.5±4.4)×109/L, (7.4±1.4)×109/L, (5.1± 2.5)×109/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the two groups were significant (P<0.05). The average value of preoperative spleen length times thickness was (35.7±12.9) cm2 and at the 1st, 3rd, 6th month after surgery it was (26.2±8.1)cm2, (25.2±13.4)cm2, (27.2±7.4)cm2, respectively. The differences between the first, third months after surgery were significant compared with that before surgery (P<0.05). The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively (correlation coefficients were -0.902, -0.933, respectively), and the differences were statistically significant (P<0.05).@*Conclusions@#In the early stage of liver transplantation, the size of spleen retracts to varying degrees, and hypersplenism can be alleviated continuously. Therefore, it is unnecessary to treat splenomegaly and hypersplenism before and during liver transplantation.
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Objective To study the clinical features,diagnosis and treatment of pancreatic pseudocysts in children.Methods A retrospective study was conducted on 50 children with pancreatic pseudocysts diagnosed and treated in the Children's Hospital of Chongqing Medical University from September 2006 to August 2017.36 of these 50 children were treated with external drainage (including 2 patients after conservative treatment),5 internal drainage (including 2 patients after external drainage),and 13 conservative treatment.Results 47 patients were diagnosed by clinical symptoms,amylase examinations,ultrasound and CT scans;and 3 patients by surgical exploration.Of the 36 patients who were treated with external drainage,29 recovered and 5 improved.Two patients relapsed and underwent internal drainage.Five patients who were treated with internal drainage recovered.Of 13 patients who were treated with conservation treatment,10 were cured,1 recovered well,and the remaining 2 developed relapse and underwent external drainage.Conclusions The incidence of pancreatic pseudocyst in children was low.The diagnosis depended on clinical symptoms,biochemical and radiological examinations.For patients with small cysts,no complications and asymptomatic,conservative treatment is suggested.There were no obvious differences in the treatment results between internal and external drainage,and external drainage is advocated because of its advantages.Differences in the etiology play a vital role in the choice of treatment.In elective surgery for a pancreatic pseudocyst caused by trauma,external drainage is preferred.For those who developed after pancreatitis,internal drainage is advocated.
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Objective To study the clinical characteristics of immune tolerance after liver transplantation in children and to identify possible predictors.Methods The clinical data of 37 pediatric patients who underwent liver transplantation between April 2006 and April 2014 at the Children's Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into the no-drug (n =4),single-drug (n =16) and multi-drug (n =17) groups according to the status of their current immunosuppressant medications.The possible predictive factors were screened based on their clinical data,and statistical analysis was performed.Results The 37 liver transplantation recipients included 16 males (43.2％) and 21 females (56.8％).The factors that differed among the groups included age at transplantation and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the transplant recipients.Age,ALT level,and AST level of the transplant recipients were significantly different between the single-drug group and the multi-drug group (all P ＜ 0.05).However,only the ALT Ievel was significantly different (P ＜ 0.05) between the no-drug group and the multi-drug group.No significant differences were found in the various other factors between the no-drug and single-drug groups.Conclusion The age of the recipient at transplantation was a predictive factor affecting clinical immune tolerance in pediatric liver transplantation,while ALT and AST levels were potential predictors of postoperative immune tolerance.
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Objective serous endotoxin(ET) were measured to determine the relationship between serous endotoxin and differ‐ent type of intestinal obstruction in children .Methods 25 inguinal hernia patients and 43 intestinal obstruction patients were classi‐fied into control group(n=25) ,incomplete intestinal obstruction (n=20) and complete intestinal obstruction group without necrosis of intestine (n=23) according to degree of obstruction .Serous endotoxin were measured in different time (the day of admission ,one day after admission or ,preoperation and one day postoperation ) ,and t test is used to determine the difference between them . Results ET in different group was(6 .53 ± 14 .96) ,(4 .40 ± 1 .15) ,(4 .20 ± 1 .20) ,(4 .09 ± 1 .31) ,(3 .70 ± 1 .46)EU/mL ,respec‐tively .There were no difference between each group .Conclusion ET examination suggests there is no difference between different type of intestinal obstruction in children and endotoxemia is not found in intestinal obstruction according to the results .
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Objective To summarize the clinical experience of successful liver transplantation from infant donation after cardiac death (DCD) for infant with biliary astresia (BA).Methods The donor was a 16-months-old girl with a body weight of 10 kg,who died of irreversible anoxic cerebral damage after sudden asphyxiation.The recipient was a 24-months-old girl with a body weight of 12 kg,who suffered from icteric concurrent late biliary cirrhosis after the Porta-jejunum anastomosis because of congenital BA.The DCD liver was classically orthotopically transplanted into the infants recipient.The warm ischemia time was 7 min,the cold ischemia time was 360 min,and the graft volume to the standard liver volume (GV/SLV) was 1.02.After operation,the vital signs and transplanted liver function of the recipient were monitored,and the recipient was given treatments of anti-infection,anticoagulation,and improving the microcirculation.The recipient was treated with the triple immunosuppression protocol of tacrolimus,mycophenolate and prednisone to prevent rejection.Results The operating time of the recipient was 480 min,the non-liver stage was 65 min,and the blood loss was 230 mL.The endotracheal intubation was removed from the recipient at 12 h,and the recipient started to eat at 48 h aftcr operation.The recipient had a hepatic artery thrombus on the 3rd and 15th day after operation,and the hepatic artery had re-blood-supply after the hepatic artery catheterization and continuous perfusion with urokinase.The recipient was discharged on the 42nd day,and the recipient was in satisfactory condition to present.Conclusion The infant DCD liver is a better graft for infant liver transplantation for BA.The surgical complications can be reduced with matched volume of donor-recipient liver; and it can guarantee a successful operation with perfect operative technique and careful perioperative management.
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This paper discusses the development and utilization of the TCM literature. Ancient records involved the knowlcdgc of Chinese drug efficacy of single herb development, the formula development, the treatment technology and experience for reference, traditional Chinese medicine knowledge of modern literature records screening, famous doctors of traditional Chinese medicine experience finishing, the patent document technology transfers, the implementation of standard literature and the use of medical record data analysis.Suggestions on strengthening bibliography compilation and arranging of TCM literatures were put forward.
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Objective To investigate the cause of jejunum perforation after infantile livingrelated liver transplantation (ILRLT) and summarize the experience of treatment. Methods The clinical data of 28 infants with biliary atresia who underwent ILRLT were analyzed and 4 of 28 infantile recipients (14. 3%) developed jejunum perforation after ILDLT. Results Four patients had 7 episodes of jejunum perforation after transplantation among 28 infantile recipients who underwent ILRLT because of biliary atresia. The median time between transplantation and perforation was 11 days.Perforation occurred at the point of silk in jejunum stoma (n = 3) and the Roux-en-Y limb (n = 1 ).None had a history of prior operation including Kasai in 4 patients. Clinical manifestation included fever, increased heart rate, abdominal distention, leukocytosis, and no free air on abdominal roentgenograrns. A simple repair was performed in three infants with silk: two developed recurrent perforation (67%) and underwent a re-exploration,and another had a third perforation and underwent a third repair because of re-perforation. Another child underwent a simple repair with prolene, and there was no recurrence. None died from the perforation in our study. Conclusion The occurrence and location of jejunum perforation after ILDLT suggests that the cause of the perforation is related to the jejunal anastomosis with silk, and the jejunum perforation may be avoided in the jejunal anastomosis with prolene. Early diagnosis and exploration may ensure better survival.
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Objective To summarize the clinical experience of segmental living related liver transplantation for very small infant with biliary atresia. Methods The recipient was a 145-day-old male with congenital biliary atresia. The infant was 66 cm in height and weighed 3.08 kg. The donor was his 36-year-old mother. Her segment Ⅱ of the liver was excised and orthotopically transplanted into the infant's body as the graft. The portal vein of the graft was end-to-end anastomosed to the portal vein of the recipient, the hepatic artery of the graft was end-to-end anastomosed to the proper hepatic artery of the recipient with lateral superficial vein of left great saphenous vein from donor as a bridge, and the hepatic vein was end-to-end anastomosed to the hepatic vein of the recipient whose hepatic vein was conformed from right, middle and left hepatic vein. Biliary tract was reconstructed via Roux-en-Y operation. Results Segment Ⅱ (160 g) of liver from donor was resected, and there was no blood infusion. The donor retained her liver function within 5 days and was discharged on the eighth day. The operating time of graft implantation was 451 min. The blood loss was 250 ml. Non-liver stage was 71 min. The cold ischemic time was 132 min. Cyclosporine, mycophenolate mofetil (MMF) and prednisone were used for postoperative immunosuppression. The bilirubin level of the infant was decreased to the normal level one week after operation, and the liver function became normal in 9 days. Jejuno-leakage on the 7th day after the transplantation was recovered by mend and drainage and discharged on the 35th day. The donor and recipient were in satisfactory condition to present. Conclusion The segmental living related liver transplantation is advisable for very small infant with biliary atresia. Perfect operative technique and postoperative intensive care are the keys to ensure the success of the procedure.
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<p><b>OBJECTIVE</b>To investigate the expression of mdr1 gene in hematopoietic cells of a murine bone marrow transplantation model and to explore the feasibility of transferring mdr1 gene into hematopoietic cells to pro-vent myelosuppression from chemotherapy.</p><p><b>METHODS</b>mdr1 gene was transferred into hematopoietic cells of murine bone marrow by retrovirus vector. The expression and function of mdr1 gene in vivo was tested in a murine bone marrow transplantation model.</p><p><b>RESULTS</b>(1) mdr1 gene was successfully transferred into murine MNC, the transduction rate was 35%. (2) mdr1 gene transferred murine bone marrow transplantation model was established successfully by scheduled-bone marrow transplantation method. (3) In 1 approximately 5 months period, stable and effective expression of mdr1 gene could be detected in hematopoietic cells of the recipient mouse, the percentage of mdr1 gene expression cells in recipient's hematopoietic cells decreased monthly to 8.0%, 8.0%, 7.5%, 4.0% and 3.0%. (4) mdr1 expression hematopoietic cells had efficient resistance to chemotherapy.</p><p><b>CONCLUSION</b>It is an effective approach to transfer mdr1 gene into hematopoietic cells for preventing myelosuppression in chemotherapy.</p>