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@#Objective To compare and analyze the treatment effect of thoracoscopic surgery and traditional open surgery on infants with congenital diaphragmatic eventration, and summarize the experience of thoracoscopic surgery in infants with congenital diaphragmatic eventration. Methods We retrospectively analyzed the clinical data of 105 children with congenital diaphragmatic eventration who received operation in the Department of Cardiothoracic Surgery of Children’s Hospital of Chongqing Medical University from January 2010 to January 2019. The patients were divided into an open group and a thoracoscopic group according to the operation methods. There were 41 patients in the thoracoscopic group, including 30 males and 11 females, with an average of 13.42±11.08 months (range: 1 d to 3 years). There were 64 patients in the open group, including 44 males and 20 females, with an average age of 8.21±9.33 months (range: 15.0 d to 1.6 years). The operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, hospital stay and other operation indexes as well as the mortality, recurrence rate and complication rate of the two groups were observed. Results The operation indexes such as operation time, intraoperative bleeding volume, postoperative mechanical ventilation time, thoracic drainage time, CCU stay and hospital stay of the thoracoscopic group were better than those in the open group (P<0.05). There was no statistical difference between two groups in postoperative diaphgram muscles descent, postoperative feeding time or patients needing thoracic drainage (P>0.05). The incidence of postoperative complications in the thoracoscopic group (19.51%) was lower than that in the open group (23.44%, P>0.05), and the difference in mortality and recurrence rate between the two groups was not statistically significant (P>0.05). Conclusion Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with traditional open surgery, thoracoscopic diaphragmatic plication has the advantages of shorter operation time, less trauma, more rapid recovery and fewer complications, so it should be the first choice for children with congenital diaphragmatic eventration.
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Pectus excavatum is the most common congenital deformity of the chest wall in children.Currently, surgery remains to be the most effective treatment available for this disease.The Nuss procedure has become the most widely used technique in clinical work since 1998.However, the optimal operation time remains controversial, no consensus exists among surgeons.Mostly, surgeons from western countries believe it′s best to repair the deformity around the time of puberty, while Chinese surgeons prefer to perform the surgery earlier, mainly at three to six years old, or around school age.Hence, this review was carried out to summarize the surgical results and postoperative complications of Nuss procedure among different age groups, purposed to offer a reference for the rational decision of pediatric surgeons.
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Objective To investigate the effect of early involvement in clinical practice in improving comprehensive abilities of medical students and strengthening their occupational cognition. Methods The students in the 5-year class of 2014 of pediatrics in our university were enrolled as subjects, among whom 78 students who received early involvement in clinical practice and teaching were enrolled as experimental group and 81 students who did not receive such teaching were enrolled as control group. A questionnaire survey was performed for the students participating in the teaching, including basic information, pre-training quality evaluation, development of personal knowledge and abilities, and comments or suggestions. The two groups were compared in terms of the score of the theoretical course of pediatric surgery, so as to explore whether"early involvement in clinical practice"could improve the theoretical study of students. Finally, the performance of students in clinical practice was evaluated and compared between the two groups to assess the role of "early involvement in clinical practice" in improving comprehensive abilities and occupational cognition. Results More than 90％of the students were satisfied with early involvement in clinical practice and they thought this activity helped them to improve clinical thinking, strengthen occupational cognition, enhance learning interests, improve communication skills, and promote the combination of basic and clinical knowledge. In addition, the follow-up analysis found that compared with the control group, the experimental group had a significantly higher average score [(74.59 ±0.50) vs. (68.89 ±0.67)] and a significantly higher proportion of students with a score of >70, and no students failed. As for the score of clinical practice, the experimental group had significantly better clinical work proficiency, clinical thinking, operational ability,and doctor-patient communication ability than the control group. Conclusion Early involvement in clinical practice among medical students can improve their comprehensive abilities and help to cultivate clinical thinking and doctor-patient communication skills and strengthen their occupational cognition, which lays a good foundation for cultivating high-quality talents through medical education.
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Objective Analysis the influence risk factors of infants and young children tetralogy of Fallot for radical treatment , and explore the perioperative treatment methods .Methods 195 cases(include death group and survival group)of hospitalized data of TOF resection in this hospital were collected in January 2003 to November 2012 ,then statistical analysis was done .Results Uni-variate analysis of variance showed ,age ,weight ,McGoon ratio ,cardiopulmonary bypass time and aortic clamping time were statisti-cally significant in two groups ,Multivariate Logistic regression analysis showed McGoon ratio 90 min ,aortic clamping time>70 min ,age<3 months were related to the postoperative death of TOF radical operation .Conclu-sion It is safe and reliable of radical surgery in infants and young children ,McGoon ratio ,cardiopulmonary bypass time and aortic clamping time ,age are the risk factors of the postoperative death of TOF radical operation .
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Objective To explore the diagnosis and surgical treatment experience of vascular ring in infants and children.Methods Fourteen cases (9 boys and 5 girls,aged 2 months to 6 years,weighted 4.5 - 15.0 kg) with vascular ring were diagnosed and treated surgically in Children's Hospital of Chongqing Medical University from Sep.2009 to Dec.2010.All children underwent X-ray,echocardiography and spiral computed tomography examination preoperatively.Bronchoscopy and barium swallow was performed in 5 cases respectively.The pathological types of vascular rings included double aortic arch in 1 ( 7.1％ ),pulmonary artery sling in 7 (50.0％),right aortic arch with left patent ductus arteriosus or persistent left ligament in 6 (42.9％).Associated cardiac anomalies were present in 7 (50.0％) patients.Tracheal stenosis of different length ( 12％ -62％ ) and severity (45％ -74％ cross-sectional luminal narrowing) was observed in the group.Barium swallow in 5cases showed localized compression of the esophagus.12 cases underwent repair of vascular ring with cardiopulmonary bypass (CPB),and the associated congenital heart defects were repaired simultaneously.2 cases of right aortic arch with left patent ductus arteriosus or persistent left ligament underwent surgery without CPB.Results The median duration of CPB in 12 cases and aortic cross-clamp time in 7 patients were 77.5 minutes ( range:55 - 186 minutes) and 36 minutes ( range:22 - 110 minutes) respectively.The median duration of postoperative ventilation and ICU stay were 21 hours (range:7 -308 hours) and 79.5 hours (range:16-314 hours) respectively.One baby with pulmonary artery sling died on the postoperative 12th day ( in-hospital mortality 7.1％ ).Of the 13 cases discharged from the hospital,1 case were lost to follow up.In the follow-up ( 1- 15 months) of 12 cases,digestive symptoms were disappeared.Development,exercise tolerance and symptoms showed obvious improvement,although 5 (41.7％) patients had residual respiratory problems.Conclusion Prolonged or recurrent aerodigestive issues in children should alert the pediatrician to the possibility of a vascular ring.Multislice spiral CT scanning is the best imaging modality.All vascular rings should be surgically corrected,and the associated long-segment severe tracheal stenosis needs.The short to midterm outcomes of surgical division are excellent.
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Objective ; To study the pulmonary function changes before and after operation in infants with pectus excavatum( PE). Methods; Thirty - two patients under 3 years were selected as study group and thoracoplasty were performed in all cases. The same number of normal infants with identical basic conditions was chosen as control group. Lung function was measured before, 3 and 12 months after operation respectively in study group and in control group. The effects of thoracoplasty on lung function in infants with PK was analyzed. Meanwhile the clinical results were assessed postoperatively. Results:TE/TI, % V - PK and V25/PK in study group were abnormal before operation and significantly improved 1 year after operation. Except that one had logical notch in thorax, all patients had satisfactory results. Conclusions; The effects of thoracoplasty on infants with PE under 3 years is satisfactory and the lung function could recover to normal about one year after operation.
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0.05). The levels of ET-1 increased significantly in 1 h after CPB (P0.05). Conclusion The priming fluid with dexamethasone and aprotinin could inhibit the CBP-induced IL-6, TNF-?releasing, but have no such effects on ET-1, TXB 2 and 6-Keto-PGF 1? .
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Objective:To review the surgical experience with pectus excavatum deformities in infants.Methods:Retrospective study was carried out on 43 infants with pectus excavatum deformities from January 1994 to October 2001.There were 31 male patients and 12 female patients.40 patients with PE underwent modified sternal elevation and 3 sternal turn-over operation.Results:Except one case of associated pneumonia and another of wound infection,the other cases had normal contours.The follow-up period was 6 months～7 years postoperatively.Except that two had logical notch and one had a flat contour in thorax,all patients had satisfactory results.Conclusion:Pectus excavatum deformities can be early operated.Correction of pectus excavatum by using sternal elevation procedure and fixation with Lucite results in an excellent cosmetic outcome.
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Objective:To review experience of the surgical treatment for large ventricular septal defect(VSD)with pulmonary hypertension(PH)in infants less than 5kg.Methods:From January 2003 to May 2006,45cases of large ventricular septal defects in weighting less than 5kg were operated.Their age ranged from 1month to 11months.Among then,15cases were aged from 1 to 3months,14cases from 3 to 6months and 16cases over 6months,the mean weight was 4.1?0.4(2.5~5.0)kg.All the cases had single incidence of VSD,and among them,the perimembranous type was in 36 patients,the conal septal defect in 9,six patients were associated with atrial septal defect(ASD),three with patent ductus arteriosus(PDA),three with ASD and PDA,and one with PDA and coarctation of the aorta(COA).All were repaired by cardiopulmonary bypass(CPB)under general anesthesia.Results:There was no death after operation.There were 18cases of postoperative complications,with the incidence rate as 40%.And the complications included low cardiac output syndrome(2cases),arrhythmia(3cases),pneumonia(5cases),pleural effusion(1case)and atelectasis(7cases).In the early phase after operation,all cases were checked by color ultrasound and found that heart function and valve closure were all normal except 2cases with slight residue difflunce,All patients were discharged after full recovery.Conclusions:Infants with large VSD,having lower weight and being quite young should be operated on as early as possible.During the operation,extracorporeal circulation lesion should be alleviated,viscera functions protected,and after operation,the control of respiratory duct strengthened,and low cardiac output and high pressure of pulmonary artery prevented,which are the keys to decrease the complications and mortality.