Value of staged repair for hypospadias / 中华实用儿科临床杂志

Objective To investigate the value and strategy of staged repair in hypospadias surgery.Methods One hundred and sixty-three cases of severe proximal and complex hypospadias were retrospectively analyzed.According to the operation process,all the cases were divided into 2 groups.Staged repair group:there were 46 cases in all,included 31 cases of severe proximal hypospadias and 15 cases cases of complex hypospadias,the diorthosis for penis curvature and urethral reconstruction were completed by staged.One-stage repair group:there were 117 cases as control group,included 108 cases of severe proximal hypospadias and 9 cases of complex hypospadias,their diorthosis for penis curvature and urethral reconstruction were completed in single stage.Results The adverse factors such as a serious deformity in penis or limited local tissue were more common in staged repair group,and the conditions of repair were worse than one-stage repair group.In severe proximal hypospadias,the incidence of penis curvature in staged repair group was obvious lower than one-stage repair group (P ＜ 0.05),within the period of follow up,which only 1 case (3.2％) showed a slight penis curvature.However,there were 23 cases (21.3％) with penis curvature in one-stage repair group,in which 7 cases showed up penis torsion,20 cases with a bowstring shape of breviate urethra in penile ventral,and 19 cases(17.6％) needed reoperation.Compared of 2 groups,the incidences of urinary fistula,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).In complex hypospadias,the incidence of urinary fistula in staged repair group was significantly lower than one-stage repair group,and then the rate of urinary fistula was 20.0％ vs 66.7％ (P ＜ 0.05).The incidence of penis curvature,urethral stricture and urethral diverticulum showed no difference in statistics (all P ＞ 0.05).Conclusions Staged repair is relatively simple and effective,can be used in the treatment of severe proximal or complex hypospadias,especially in the cases with a worse condition.The mode of operation should be chosen not only according to the penial state and tissue conditions,but also combined with the technology and experience of the surgeon,and avoid the forced of one-staged repair for hypospadias.

Application of santulli procedure enterostomy in treatment of high unformed small bowel fistula in children / 中华实用儿科临床杂志

Objective To explore the role of Santulli procedure enterostomy in treatment of high unformed small bowel fistula in children.Methods From May 2007 to Oct.2011,6 cases suffered with high unformed small bowel fistula were treated with Santulli procedure enterostomy.Five male and 1 female were involved and their ages were ranged from 15 days to 5 years.Results The mean time from final diagnosis of intestinal fistula to the definite operation was (52.33 ± 19.03) h,the distance between fistula to the ligament of Treize was (17.33 ± 4.68)cm,the output of enterostomy was (760.00 ± 107.56) mL/d.In the surgical explore,6 cases suffered intestinal adhesions but none of the cases could be separated,5 cases suffered severe and 1 case with moderate intra-abdominal pollution.The preoperative complications included 6 cases with incision infection,1 case with a fully dehiscence of incision,6 cases with generalized peritonitis,2 cases with impaired renal function,1 case with liver dysfunction,3 cases with systemic inflammatory reaction syndrome and sepsis respectively,1 case of incision infection appeared in post-operation.The pediatric critical illness scores and serum albumin of postoperative 3 days and 7 days were higher than those of preoperative (all P ＜0.05).None of the cases suffered the anastomotic leak.The nutrition and growth were normal during the follow-up period of 8 months to 2 years.Conclusions Santulli procedure enterostomy is suitable in treatment of high unformed small bowel fistula in children,and the early performance will improve prognosis.

Expressions of hypoxia inducible factor-1α and angiopoietin-2 in pediatric nephroblastoma / 中华实用儿科临床杂志

Objective To explore the expressions ofhypoxia-inducible factor-1α(HIF-1α) and angiopoietin-2 (Ang-2) in children with nephroblastoma (NB) and its correlation with clinicopathology,prognosis and microvessel density(MVD).Methods Forty-five cases of NB treated by Pediatric Surgery Department of the First Affiliated Hospital of Guangxi Medical University,with NB resected from Jan.2008 to Jan.2012,were divided into groups according to histopathological type,clinical stage and National Wilm's Tumor Study-5 risk factors.The expressions of HIF-1α,Ang-2 and CD34/MVD in NB tissues and adjacent tissues were tested by immunohistochemical method,and the findings were analyzed with the combination of the clinical data and results of the follow-up.Results The ratio of HIF-1α and Ang-2 expressions in NB group was higher than that in the normal adjacent tissues(95.6％ vs 40％ and 86％ vs31.0％,respectively,P ＜ 0.05).HIF-1α and Ang-2 expressions were positively correlated with clinic stage and risk factors,and the postoperative cumulated survival rate was higher in low expression group of HIF-1α,Ang-2 compared with the higher expression group of HIF-1α,Ang-2 (P ＜ 0.05).MVD was higher in NB group than in normal adjacent tissue groups (58.22 ± 10.009 vs 49.43 ±-8.114,P＜0.05) and had a positive correlation with HIF-1α(r =0.442,P＜0.05) and Ang-2 (r =0.590,P ＜ 0.05).HIF-1α had a positive correlation with Ang-2 (r =0.442,P ＜ 0.05).Conclusion HIF-1α and Ang-2 could promote angiogenesis and proliferation in NB,which affects the prognosis.

Expression of matrix metalloproteinase-2 in liver tissues of children with biliary atresia / 中华实用儿科临床杂志

Objective To explore the relation of matrix metalloproteinase-2(MMP-2) expressed in liver tissue of biliary atresia(BA) and liver fibrosis,jaundice free,cholangitis onset and survival time with native liver after Kasai hepatoenterostomy (KH).Methods Clinical and pathological data were collected in 65 cases of BA,with a completely 2 years' follow-up after KH(BA group) from Jan.2009 to Dec.2010 and 15 cases of children without hepatobiliary disease (control group) were compared at the same time,while expression of MMP-2 in liver tissue was measured by adopting immunohistochemistry.Results Ohkuma's score of liver fibrosis was higher in BA group than that in control group(Z =-4.02,P ＜ 0.001).The staining positive rate and the expression of MMP-2 were higher in BA group than those in control group(x2 =33.88,P ＜ 0.001 ;Z =-5.14,P ＜ 0.001,respectively).With the increase of Ohkuma's score and the age at KH,the expression of MMP-2 was higher(r =0.686,0.465,P ＜ 0.001,respectively).With the higher expression of MMP-2,the rate of jaundice free was lower(r =-0.687,P ＜ 0.001) and the incidence of cholangitis was increased (r =0.361,P =0.003).Those with lower expression of MMP-2 increased 2 year's survival time of native liver 2 years after operation (x2 =64.000,P ＜ 0.001).Conclusions In BA,the expression of M MP-2 in liver is related to the development of liver fibrosis,jaundice clearawe,cholangitis occurrence and survival time of native liver and it can be used as an index to evaluate therapeutic effect and prognosis after KH.

Characteristics and treatment of pediatric malignant solid tumor in Guangxi / 中华实用儿科临床杂志

Objective To explore the clinical data of the pediatric malignant solid tumor and to summarize the experiences of the pediatric malignant solid tumor treatment in Guangxi.Methods The clinical data of 323 cases of pediatric malinant solid tumor,treated surgically in the First Affiliated Hospital of Guangxi Medical University from Dec.1988 to Dec.2008.Pathology,sex,age,clinical characteristics,diagnosis and treatment were analysed respectively.Results The most frequent histological types were malignant lymphoma,Wilms tumor,neuroblastoma and malignant germ cell tumor.There was a male prevalence with a sex-ratio of 1.99 ∶ 1.The peak incidence in embryo tumor was under 3 years,and epithelium cancer was between the ages of 10-13 years.The main symptoms were palpable mass (56.3) and a few were found in health examination ;64.2％ of the pediatric malignant solid tumor was of stage Ⅲ or Ⅳ ;the complete tumor resection rate was 78.4％.Conclusions The characteristics of pediatric malignant solid tumor is different from those of adults.To detect as soon as possible and treat the pediatric malignant tumor as soon as possible depends on screening.Combined modality therapy can improve the patients complete resection rate and survival quality of the patients.

Modified Mathieu urethroplasty for failed hypospadias repair / 中华男科学杂志

<p><b>OBJECTIVE</b>To review the indications, techniques and complications of reoperation for failed hypospadias repair using modified Mathieu urethroplasty.</p><p><b>METHODS</b>Using modified Mathieu urethroplasty, we treated 24 hypospadias patients aged 3-12 (mean 4.5) years for whom the first (n = 20) or the second hypospadias repair (n = 4) had failed, including 13 cases of large coronary sulcus urethrocutaneous fistula, 5 cases of urethral meatus retraction and 6 cases of anterior urethra dehiscence. The modified procedure involved median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.</p><p><b>RESULTS</b>Of the 24 patients, 19 (79.2%) were successfully treated by the first operation, which achieved desirable straightness, good cosmetic appearance and normal urethral meatus of the penis, without postoperative complications. Small urethrocutaneous fistula developed in 4 cases, of which 3 were cured by fistula repair and 1 self-healed. Urethral meatus stenosis occurred in 1 case, which was restored by meatal dilation. Urethrocele and urethrostenosis were not found in any of the cases. Two cases received urethroscopy postoperatively, which revealed no hypertrophic cicatrix at the site of median longitudinal incision in the urethral posterior wall.</p><p><b>CONCLUSION</b>Modified Mathieu urethroplasty can be applied to hypospadias reoperation, particularly in such cases as large coronary sulcus urethrocutaneous fistula, urethral meatus retraction and anterior urethra dehiscence. The modified procedure includes median longitudinal incision of the urethral posterior wall, dorsal tunica albuginea plication under the vascular and nerve bundle, and double dartos flap protection of the neourethra.</p>

Treatment and outcome of 14 children with hepatoblastoma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To assess the outcome of childhood hepatoblastoma after a combination therapy of resection and chemotherapy.</p><p><b>METHODS</b>The clinical data of 14 children with hepatoblastoma was retrospectively reviewed. Their long-term survival was followed-up.</p><p><b>RESULTS</b>Twelve cases received surgery and planned chemotherapy. The follow-up duration averaged 18 months (range 1.5-74 months). Nine survived free of events, 1 died, 1 survived with multiple lung metastases, and 1 with increased alpha-fetoprotein (AFP) content but without residual tumor.</p><p><b>CONCLUSIONS</b>Surgery assisted with chemotherapy can improve the outcome of hepatoblastoma.</p>

Snodgrass Operation for Hypospadias Repairment in 22 Children / 实用儿科临床杂志

Objective To explore the indication,technique and complications of Snodgrass operation in hypospadias repairment.Methods From Sep.2005 to Nov.2006,22 boys from 2 to 18 years old with hypospadias were treated with Snodgrass modification.The procedure was performed in 16 patients as a primary repairment and in 6 patients as the 2-stage repairment.The entire length of the urethral plate was incised along the midline in primary repairment,and the skin flaps and residual urethral plate were incised in the 2-stage repairment.The length of neourethra was from 1 to 10 cm.The neourethra was tubularized over a F 6 or F 8 catheter.The urethral stent was removed in 10 to 14 days pos-toperatively.Results Of the 22 patients,18(81.8%) required no other surgery as the repairment provided a normal appearing penis(straight,terminal meatus, cosmetics) without complications.Fistul aoccurred in 4 patients(18.2%) and meatal stenosis in 1 patient.Conclusion Snodgrass operation creates a vertical slit-like neomeatus.The procedures restores good function and normal appearance to the penis.