Comparison of embryonic nature orifice transumbilical endoscopic surgery with conventional laparoscopic surgery treatmenting Hirschsprung disease / 中华实用儿科临床杂志

Objective To compare the therapeutic effects of embryonic nature orifice transumbilical endoscopic surgery(ENOTES) with conventional laparoscopic(CL) surgery in Hirschsprung disease(HD).Methods A total of 111 children from Sep.2009 to Dec.2010 were included in the retrospective study.The patients were divided into 2groups:ENOTES group (66 cases) and CL group (45 cases).The general conditions of children were reviewed operative situation,postoperative complications and defecation 1 year after operation.Results In the left colectomy,there was no difference between 2 groups in age,weight,operative blood loss and postoperative stay (all P ＞ 0.05),but ENOTES took up less time than CL(P ＜ 0.05) ;in the subtotal colectomy,no significant difference existed in all series.All children underwent primary radical surgery,neither transfer to open surgery nor dead case.In ENOTES group,there were 9 cases suffering from enterocolitis postoperatively (13.6％),while 7 cases (15.6％) in CL group.Twenty-eight patients in ENOTES group and 12 in CL group were followed up for 1 year.Less abdominal distension postoperatively was noted in ENTOES group than CL group(P ＜ 0.05),but no other difference in other available data.In addition,no obvious operative scar was noted on the abdomen in ENOTES group,what meant better cosmetic benefit than CL.Conclusion HD treated with ENOTES can gain the same outcomes with CL with better cosmetic effect.

Transumbilical laparoscopic pull-through for children with hypoganglionosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical outcomes after on transumbilical laparoscopic pull-through procedure for pediatric hypoganglionosis(HYP).</p><p><b>METHODS</b>Twelve children with HYP had received transumbilical laparoscopic pull-through procedure from June 2009 to June 2010. Specially designed curved and elongated laparoscopic instruments were used during the procedures. All the patients were followed up over 10 months. Data were collected and analyzed. The diagnosis of hypoganglionsis was pathologically confirmed.</p><p><b>RESULTS</b>No conversions to laparotomy or traditional laparoscopic surgery were required and there were no damages to the abdominal blood vessels, intestine, ductus deferens, or ureters. The average duration of operation was 140 min. The mean intraoperative blood loss was 45 ml. The mean length of specimen was 40 cm. Postoperatively there were no complications such as anastomotic leak, anastomotic stricture, constipation, seepage, or fecal in continence. The average hospital stay after surgery was 9 days. During 10 to 22 months of follow-up(median 16 months), no postoperative recurrence was noticed. No obvious scar was seen 1 months after surgery.</p><p><b>CONCLUSION</b>It is safe and effective for children with hypoganglionosis to undergo transumbilical laparoscopic pull-through procedure.</p>

Distribution of mast cells and its role in the pathogenesis of Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the distribution of mast cells (MC) in colon tissue of Hirschsprung disease (HD) and explore the role of mast cells in the pathogenesis of HD.</p><p><b>METHODS</b>Forty-one cases of HD (male 23, female 18), age from 2 months to 15 years, and eight age-matched normal cases were enrolled in this study. The distribution of MC in all layers of colon was examined by immunohistochemistry with mouse antihuman mast cell tryptase monoclonal antibody.</p><p><b>RESULTS</b>The count of MC in all layers of colon aganglionic segments of HD was significantly higher as compared with colon ganglionic segments of HD and normal controls (21.47+/-3.59 vs 3.18+/-0.87, 2.75+/-0.51). The average optical density values(A) of MC in aganglionic and ganglionic segments significantly decreased as compared to normal control (0.38+/-0.10,0.31+/-0.11 vs 0.51+/-0.08).</p><p><b>CONCLUSION</b>Mast cells may play an important role in the pathogenesis of HD.</p>

Diagnosis and Treatment of Congenital Mesenteric Hiatual Hernia / 实用儿科临床杂志

Objective To explore the early diagnosis and treatment of congenital mesenteric hiatual hernia.Methods A retrospective study was carried out in 4 patients with congenital mesenteric hiatual hernia in Tongji hospital from Nov.2005 to Mar.2007,and combining lite-rature,the diagnosis and treatment of mesenteric hiatal hernia was summed up.Results Four patients were diagnosed in operation.One case was thought as adhesive intestinal obstruction before operation;two patients were on emergency operation and 2 patients were on time-elective operation;one patient preoperative CT scan may suggest mesenteric hiatal hernia;one case had partial resection of small intestinal,the others were replaced the intestine and fixed the defect.One patient occurred early septic shock;all of them had get well.Conclusions It′s hard to diagnose the congenital mesenteric hiatual hernia before operation.Abdomen CT examination and multislice spiral CT angiography (MSCTA) help to diagnose.Early diagnosis and timely operation are the therapeutic key of congenital mesenteric hiatual heria.For the patients with recurrent abdominal pain,who was not confirmed with a variety of inspection,laparoscopic exploration can provide diagnosis,and can take the initiative to control the development of disease.

Reoperation for postoperative constipation recurrences of Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the causes and treatment experiences of postoperative constipation recurrences of Hirschsprung disease.</p><p><b>METHODS</b>Clinical data of 37 cases receiving operation again for postoperative constipation recurrences of Hirschsprung disease were collected. The recurrent causes, reoperation procedures and therapeutic efficacy were analyzed.</p><p><b>RESULTS</b>Among 37 cases, the recurrent causes included insufficient resection of the intestine in 14 cases, co-existent intestinal neural hypogenesis in 6, gate syndrome in 5, and others in 12 cases. There was no postoperative death. Thirty-one cases (83.8%) were followed-up from 6 months to 11 years. The defecation frequency was 1-2 times per day in 15 cases, one times per two days in 7, one times per three days in 6 cases. Two cases could defecate with the help of laxative purgatives. Nobody had incontinence.</p><p><b>CONCLUSION</b>The main cause of postoperative constipation recurrences of Hirschsprung disease is insufficient resection of the intestine,and reoperation can get better results.</p>

Expressions and Significance of p21 Protein and K-ras Protein in Congenital Biliary Dilatation / 实用儿科临床杂志

Objective To investigate the expressions and significance of p21 protein and K-ras protein in congenital biliary dilatation(CBD),and their relationship.Methods Surgical specimens of CBD were obtained during operation on 36 children from Jan.2000 to Sep.2007.Nine normal bile ducts specimens from miscarried fetus and children's corpse.The specimens were fixed in 40 g?L-1 formalin and embeded by paraffin,slice-fixed.SP immunohistochemical method was used to detect the expressions of p21 protein and K-ras protein.Results The positive rate of K-ras protein was 13.8% in CBD,which was significantly higher than that in normal bile duct tissues.The positive rate of p21 protein was 55.6% in CBD,and 100% in normal bile duct tissues.p21 protein positive expression rate in CBD was significantly lower than that in normal bile duct tissues(P

Clinical Analysis of 20 Children with Ganglioneuroma / 实用儿科临床杂志

Objective To increase the preoperative diagnosis rate,reform the operation and improve the prognosis in children with ganglio -nauroma.Methods Clinical data of 20 children with ganglioneuroma hospitalized in Tongji hospital of Huazhong university of science and technology from Nov.1986 to May.2006 were reviewed(male 9,female 11).The biological,clinical and pathological characteristics of patients were analyzed.Results Among these 20 patients,15 cases were discovered to have no clinical symtom.The B ultrasound showed low-echo in all 16 cases.Under CT scan,20 cases showed low to moderate density shadows,and the distinct enhancement in these tumors was noted with enhanced CT scan.Fourteen cases undergoing MRI all showed low signals in T1W1 and inhomogeneous high signals in T2W1.All patients underwent surgical operations,completely removed in 14 cases,partly in 4 cases, and biopsy was performed only in 2 cases.Fifteen cases were followed up from 7 months to 6 years,tumor recurrence happened only in 1 case.Conclusions Ganglioneuroma is mostly found in chest-abdominal sympathetic chain,it grows up slowly and seems to be innocent.The imaging data of B ultrasound,CT and MRI can give helpful information in the diagnosis of ganglioneuroma.We shall pay attention to the choice of incision and avoidance of injuring the important blood vessels during the operation.Children who have neuroblastoma cells should receive prophylactic chemoprophylaxis treatment and the result of long-time follow up is satisfactory.