Clinical characteristics and prognostic factors of neonatal gastric perforation / 中华围产医学杂志

Objective:To investigate the clinical characteristics and experience in the diagnosis and treatment of neonatal gastric perforation, and the factors influencing prognosis.Methods:This was a retrospective analysis involving 49 neonatal gastric perforation cases who underwent surgical treatment in the Neonatal Surgery Department of Shanxi Children's Hospital from January 2008 to December 2017. Their clinical data, including manifestations, auxiliary examinations, operations, and prognosis, were analyzed. According to the prognosis, these patients were divided into two groups, survival group, and fatality group. Independent sample t-test or continuity correction Chi-square (or Fisher's exact) test was used for statistical analysis. Results:(1) Of the 49 cases, 29 (59.2%) were boys, and 20 (40.8%) were girls. There were 30 (61.2%) premature and 19 (38.8%) full-term babies. Their birth weight ranged between 1 010 and 5 000 g with an average of (2 450±700) g. Low birth weight infants accounted for 59.2% (29/49). There were 11 cases (22.4%) having perinatal adverse events, 17 (34.7%) complicated by septic shock before the operation, and six (12.2%) with digestive tract malformation. Two cases (4.1%) underwent resuscitation due to postnatal asphyxia; two (4.1%) received mechanical ventilation due to respiratory distress syndrome; 12 (24.5%) received indwelling were indwelled gastric tube or gastric lavage. (2) The average onset time of neonatal gastric perforation in the 49 cases was (3.8±2.0) d after birth, and 47(95.9%) of them presented initial symptoms within one week, including 36 within four days. Twenty-five cases (51.0%) were operated within 12 h after the onset. (3) The common first symptoms include abdominal distention [69.4% (34/49)] and abdominal distension complicated with vomiting (24.5%, 12/49). Thirty-nine cases (79.6%) showed a large amount of free gas under the diaphragm, compressed and down-moving liver, and decreased or disappeared stomach bubble in the preoperative abdominal radiograph. (4) All cases received emergency laparotomy and primary gastric wall repair after admission. During the operation, 27 (55.1%) of all the cases had perforation at the greater curvature, five (10.2%) at the lesser curvature, 14 (28.6%) at the anterior wall, and three (6.1%) at the posterior wall. Perforation larger than 3 cm in diameter was found in 33 cases (67.3%). Three cases (6.1%) had postoperative wound infection; two (4.1%) developed anastomotic leakage; one was complicated by pneumohydrothorax 48 h after the operation due to esophageal duplication and perforation, which was confirmed by a second operation. (5) Of the 49 cases, 35 (71.4%) were due to congenital gastric wall muscular defect, four (8.2%) were caused by iatrogenic injury, and 10 (20.4%) were spontaneous perforation. (6) Among all cases, 36 (73.5%) survived, while eight (16.3%) died, and five (10.2%) withdraw treatment after the operation. After excluding the five cases giving up treatment after the operation, the proportion of patients who underwent operation within 12 h after onset or had the perforation <3 cm in diameter was higher in the survival group than in the fatality group [61.1% (22/36) vs. 1/8, χ2=4.404, P<0.05; 41.7% (15/36) vs. 0/8, P<0.05], and the incidence of septic shock before the operation was lower [22.2% (8/36) vs. 6/8, χ2=6.147, P<0.05]. Conclusions:Neonatal gastric perforation shows a high mortality rate, and its underlying pathologic etiology is congenital gastric wall muscle defect. Abrupt abdominal distension is the main clinical manifestation. Early operation is critical to improving neonatal prognosis.

Clincal value of NSE in the diagnosis of neuroblastoma in children / 中国基层医药

Objective:To evaluate the application value of serum neuron-specific enolase(NSE) in the diagnosis of neuroblastoma in children.Methods:The clinical data of 98 children with neuroblastoma admitted to Children's Hospital of Shanxi Province from January 2010 to January 2018 were retrospectively analyzed(study group), and 40 healthy children with physical examination during the same period were selected as control group.The serum NSE levels were detected in the study group at the time of diagnosis and after treatment, and in the control group at the time of physical examination, to evaluate the effectiveness of NSE level changes in the diagnosis of neuroblastoma in children.Results:The serum NSE level in the study group[(98.61±10.42)μg/L] was higher than that in the control group[(15.31±1.16)μg/L]( t=50.325, P<0.05). At the time of diagnosis, the serum NSE levels of stage II, III and IV were (31.56±12.82)μg/L, (78.65±20.1)μg/L and (127.45±32.48)μg/L, respectively, showed an increasing trend( F=111.556, P=0.000). The serum NSE level of the study group after treatment[(62.48±7.46)μg/L] was lower than that before treatment[(98.61±10.42)μg/L]( t=27.910, P<0.05), and the serum NSE levels of children at different stages were lower than those before treatment(all P<0.05). The receiver operating characteristic (ROC) curve was drawn with serum NSE as the variable, showed the area under the curve of 0.815, the Yoden index of 0.534, the sensitivity of 71.43%, and the specificity of 90.82%. Conclusion:Serum NSE detection plays an important role in the diagnosis of neuroblastoma in children, and is conducive to the judgment of the severity of the disease, the treatment effect, with high diagnostic performance.It is worthy of clinical promotion.

Laparoscopic Malone antegrade continence enema / 中华普通外科杂志

Objective To evaluate laparoscopic appendicostomy in Malone antegrade continence enema (MACE).Methods 25 children with fecal incontinence undergoing MACE were divided into by laparoscopic technique (14 cases) and by laparotomy (11 patients).Results The operation time [(38.3 ±2.5) min vs.(60.5 ±3.6) min,t =13.7,P =0.00] was shorter in the laparoscopy group.All patients were followed up for 6 months to 3 years.No intestinal obstruction,fecal leakage in stoma and anal fecal incontinence or soiling happened.In laparoscopy group,the stomal stricture developed in 1 patient.The mucosa prolapse developed in 2 patients.In the laparotomy group,the stomal stricture developed in 2 patients.The mucosa prolapse in 1 patient.The symptom severity scoring for constipation and fecal incontinence after operation decreased in the laparoscopy group (12.1 ± 1.4 vs.33.7 ± 1.5,t =28.4,P =0.00),laparotomy group (12.5 ± 1.6 vs.33.3 ± 1.7,t =25.36,P =0.00).While the irrigation volume [(607±151) mlvs.(594±161) ml,t=0.17,P=0.87],MACE scoring (22.1 ±1.4vs.22.0±1.7,t =0.18,P =0.86) and symptom severity scoring for constipation and fecal incontinence (12.1 ± 1.4 vs.12.5 ± 1.6,t =0.46,P =0.65) were not statistically different.Conclusions The laparoscopic technique can make the MACE easier to operate and less traumatic.

Meta analysis of incidence of postoperative complications for the modified posterior sagittal anorectoplasty treatment of intermediate or high anorectal malformations / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the incidence of postoperative complications of children with intermediate or high anorectal malformations treated by one-stage modified posterior sagittal anorectoplasty(PSARP) by meta-analysis.</p><p><b>METHODS</b>Cases with intermediate or high anorectal malformations treated by one-stage modified PSARP nearly a decade at home and abroad were collected by searching in Wanfang Data, CNKI, and PubMed database, then all the papers that recorded the number of cases of postoperative complications were screened out according to inclusion and exclusion criteria. Meta package in RevMan 3.2.5 software was used to perform the meta analysis for rate, and logit conversion method was applied to calculate the merger of the rates. Firstly, heterogeneity inspection was carried out. If the result was P>0.05, it was the homogeneity between the instructions included in the literatures, the fixed effect model was chosen. If the results was P<0.05, the random effect model was chosen. Then rank correlation test was used to estimate the number of research to evaluate publication bias. If P was 0.05 or less, the difference was statistically significant.</p><p><b>RESULTS</b>Thirteen related articles were selected and added up to 566 cases with intermediate or high anorectal malformations treated by one-stage modified PSARP. The merged rate of the complications was 28%(95%CI: 19% to 40%). The three highest rate of complications were 8%(95%CI:4% ~ 14%) of corrupt dung, 7%(95%CI:5% ~11%)of fecal incontinence and 5%(95%CI:3% ~ 10%) of rectal mucosa prolapse.</p><p><b>CONCLUSION</b>The most common postoperative complications of children with intermediate or high anorectal malformations treated by one-stage modified PSARP are rectal corrupt dung and fecal incontinence.</p>

Complication analysis of endorectal pull-through radical operation for Hirschsprung disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the complications after endorectal pull-through radical operation, Soave procedure, for Hirschsprung disease.</p><p><b>METHODS</b>Clinical data of 286 cases with Hirschsprung disease who received Soave procedure and were proved by postoperative pathology in our hospital from February 2003 to February 2010 were analyzed retrospectively. All the patients were diagnosed with barium enema and anorectal manometry. Among them, 233 cases(81.5%) were identified during neonatal period. All the patients underwent cleansing enema and anus dilation immediately after definite diagnosis. Radical operation with Soave endorectal pull-through procedure, including simple transanal endorectal pull-through in 251 cases(87.8%), transabdominal approach in 17 cases (5.9%), laparoscopy-assisted endorectal pull-through in 18 cases (6.3%). The operations were performed in 54 cases (18.9%) within 3 months of age, in 183 cases (64.1%) between 3 and 6 months, in 38 cases(13.3%) between 6 months and one year, in 10 cases (3.5%) older than 1 year. The rectosigmoid was resected in 259 cases. Subtotal colectomy was performed in 25 cases, and total colectomy in 2 cases. Postoperative regular anal dilation lasted for 6 months. A total of 286 cases (male:250, female:36) were followed up for 2 to 5 years.</p><p><b>RESULTS</b>There was wound infection in 1 case, ileus in 1 cases, anastomotic stricture in 1 case, which was cured by continuous anal dilation. Two cases had constipation and received re-operation because of refractory to conservative therapy for 6 months. Perianal erosion was found in 63 cases(22.0%) and was healed within 3 months, except 2 children undergoing total colectomy. During follow-up, enterocolitis occurred in 11 cases(3.8%), including healing in 8 cases with conservative therapy, death in 1 case, and recurrent attacks in 2 cases. Soiling occurred in 45 cases(15.7%), among them, 5 cases presented in kindergarten and primary school. Morbidities of perianal erosion, enterocolitis and soiling were higher in infants undergoing operation within 3 months as compared to those more than 3 months [90.7%(49/63) vs. 6.0%(14/63), P=0.000; 9.3%(5/54) vs. 2.6%(6/232), P=0.022; 25.9%(14/54) vs. 13.4%(31/232), P=0.022]. Morbidity of perianal erosion enterocolitis was higher in infants undergoing subtotal or total colectomy as compared to those partial colon resection[51.9%(14/27) vs. 18.9%(49/259), P=0.000; 18.5%(5/27) vs. 2.3%(6/259), P=0.000].</p><p><b>CONCLUSIONS</b>Primary transanal endorental pull-through procedure can be performed in most children with Hirschsprung disease. Postoperative short-term complications are mainly perianal erosion and long-term ones are enterocolitis and soiling. Early diagnosis, colon irrigation, avoiding premature operation and anal dilation can decrease the morbidities of enterocolitis and soiling.</p>

Evaluation of sphincter damage degree with anal endosonography for children with fecal incontinence / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the application of anal endosonography in the morphology of internal anal sphincter (IAS), external anal sphincter (EAS) and puborectalis (PR) in order to provide necessary information for analysis of the etiology of fecal incontinence and formulation of the therapeutic schedule.</p><p><b>METHODS</b>From December 2010 to November 2012, 18 children of anorectal malformation (n=14) or Hirschsprung's disease(n=4) with fecal incontinence received anal endosonography. The morphology of IAS, EAS and PR was observed. The damage of anal sphincter was classified according to Starck criteria. Anorectal mamometry and anal clinical score were measured simultaneously. Spearman analysis was performed to examine the correlation of anal sphincter damage with anorectal mamometric score and anal clinical score.</p><p><b>RESULTS</b>According to Starck criteria, anal sphincter damage was small in 11 children, moderate in 6, and severe in 1. PR damage was found in 4 cases. Starck score was positively correlated with manometric score(P<0.05), while not correlated with anal clinical score(P>0.05).</p><p><b>CONCLUSIONS</b>Anal endosonography can clearly display the morphology of IAS, EAS and PR, and their integrity and damage degree. It is a very valuable technique to evaluate the anal sphincter of the children with fecal incontinence, which however can not reflect the function of anal sphincter and anal continence thoroughly.</p>

Diagnostic Value of Osteopontin for Ovarian Cancer:a Meta-Analysis / 现代检验医学杂志

Objective To evaluate the diagnostic performance of osteopontin (OPN)for ovarian cancer.Methods Wanfang, CQVIP and CNKI were retrieved to identify eligible studies on diagnostic value of OPN for ovarian cancer that published be-fore May,2014.The quality of the studies was evaluated by QUADAS tools.The diagnostic sensitivity,specificity,negative and positive likelihood ratios and diagnostic odds ratio (DOR)were pooled by random-effects models.The overall diagnostic performance was estimated by summary receiver operating characteristic (SROC)curves approaches.Results Six studies met the included criteria.The summary estimates for OPN in the diagnosis of ovarian cancer in the studies included were as follows:sensitivity 0.83 [(95% confidence interval(CI):0.78~0.87)],specificity 0.91 (95% CI,0.88~0.94),positive likelihood ratio 9.00 (95% CI,5.91~13.71),negative likelihood ratio 0.19 (95% CI,0.15~0.25),and DOR 47.58 (95%CI,27.93~81.05).The area under curve (AUC)for OPN was 0.87 with Q value of 0.80.Conclusion OPN has high diag-nostic value for ovarian cancer.

Biofeedback therapy combinell with electrical stimulation in the treatment of traumatic faecal incontinence / 中华物理医学与康复杂志

Objective To observe the effect of biofeedback therapy combined with electrical stimulation in patients with traumatic faecal incontinence.Methods Eishty-two patients with traumatic faecal incontinence were treated once daily with electric stimulation delivered via an intra-anal electrode.They also followed a biofeedback regimen including strengthening,sensory and coordination biofeedback.The whole progrtun consisted of 3 sessions of supervised treatment in hospital followed by 3 sessions of home therapy(10 days per session with an interval of 7days between the sessions).Clinical scores and anorectal function were assessed before and after the program.Results Before treatment,there were 9 patients with good clinical scores,and the general rate of fair and poor clinical scores Was 89%.After therapy,61 patients had good scores,and the general rate of fair and poor Was 26%.Anorectal squeeze pressure and sphincter electromyographic amplitude had improved significantly,the rectal sensory threshold Was decreased significantly,and 76%of the patients who had no external anal sphincter reflex recovered.At the two years follow-up,68% of the patients had maintained the clinical outcomes.Conclusion Biofeedback therapy in conjunction with electrical stimulation has significant therapeutic effects on patients with traumatic faecal incontinence.

Recent outcome of bladder augmentation using deepithelialiezed segment of small intestine lined with urothelium / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate urodynamically and clinically bladder augmentation using double-deepithelialized segment of the small intestine lined with urothelium to analyse the recent outcome to treatment of hyperreflexia neurogenical bladder.</p><p><b>METHODS</b>25 patients with neurogenical bladder underwent bladder augmentation using deepithelialized segment of the small intestine lined with urothelium (4 - 14 years old, 16 males and 9 females) from October 1998 to October 2000. 21 patients were followed up. Voiding cystoureterography and urodynamic and clinical evaluation were performed, and serum electrolyte, urea nitrogen and creatinine were tested before and 6 months to 2 years after operation.</p><p><b>RESULTS</b>After operation, bladder volume, maximum urine flow rate and compliance were increased, but residual urine/bladder volume and detrusor pressure decreased. Uninhibitory contraction decreased in 15 patients. In 12 patients associated vesicoureteral reflux, clinical evaluation revealed poor outcomes before operation, but excellent (4 patients), good (9), effective (4), poor outcomes (4) after operation. Seven patients had urinary sensation recovered. Vesicoureteral reflux decreased in 9 patients. There were no electrolyte unbalance and abnormal renal function in all patients.</p><p><b>CONCLUSIONS</b>Bladder augmentation using double-deepithelialized segment of the small intestine lined with urothelium shows a better result currently.</p>

Clinical management of anuria caused by congenital bilateral ureteral stenotic obstruction / 中华泌尿外科杂志

Objective To investigate the clinical features of anuria caused by pediatric congenital bilateral ureteral stenotic obstruction,and to improve the diagnosis and treatment of the disease.Methods This series included 7 infants(2 males and 5 females;age range,35-57 d) with congenital bilateral ureteral stenotic obstruction.The clinical presentations were characterized by sudden anuria or oliguria.B-ultrasound,cystography and puncture pyelography were performed in all of them,and magnetic resonance urography(MRU) in 3.Based on the definite diagnosis,resection of stenotic segment of the ureter or ureteral implantation was performed on them.Results The diagnosis was confirmed by puncture pyelography in all of the 7 cases.Six cases underwent phase I surgery and recovered.No ureteral stenosis and cystoureteral reflux occurred during a follow-up of 2-4 years.The renal function was normalized in them.One case had stenosis recurrence due to scar formation,and was cured by the second operation.Conclusions Anuria caused by pediatric congenital bilateral ureteral stenosis should be diagnosed and treated as early as possible.Definite diagnosis can be established by puncture pyelography and MRU.Resection of the obstructive segment of the ureter,protection of renal function,and ureteral implantation are the main therapies.

The urodynamic evaluation of bladder augmentation using de-epithelialized segment of small intestine lined with urothelium / 中华泌尿外科杂志

Objective To evaluate the urodynamic outcome after bladder augmentation using double de-epithelialized segment of small intestine lined with urothelium. Methods Twenty-five children with neurogenical bladder (age range,4 to 14 years;16 males and 9 females) underwent bladder augmentation using de-epithelialized segment of small intestine lined with urothelium.Pre- and post-operative voiding cystoureterography,urodynamic and clinical evaluation were performed on them.Of them 21 cases were followed up for 6 to 24 months after operation. Results Bladder volume was increased from pre-operative (142.14?45.88)ml to post-operative (242.62?60.04) ml,compliance from (3.26?1.57) ml/cmH 2O (1 cmH 2O=0.098 kPa) to(8.10?3.00)ml/cmH 2O,and maximum urine flow rate from (3.00?1.00) ml/s to (7.60?2.90)ml/s,respectively(P

Treatment of perforated congenital choledochal cyst / 中国普通外科杂志

Objective　To study the diagnosis and treatment of perforated congenital choledochal cyst(PTCC). Methods　The clinical data of 10 children with PTCC were retrospectively analysed.Results　6 males, 4 females, average age 4.5 years old. The cyst perforted time within 12 hours was in 4 cases, 12～72 hours in 3, and more than 72 hours in 3. Of these cases, 2 had infection and the others had no obvious discomfort before perforation. Of 7 cases undergoing cyst excision and biliary reconstruction, 5 cases were recovered without complications; 2 occurred anastomostic leakaged(1 case had infection before perforation and the other with perforcted time more than 72 hours). 3 cases subjected to external drainage at first, and cyst excision and biliary reconstruction were performed on three months later. Conclusions　If PTCC is treated earlier, cyst excision and biliary reconstruction can be performed as a primary operation.

Evaluation of the anal sphincter function by vector manometry in congenital anorectal malformation / 中国现代普通外科进展

Objective: To evaluate the anal sphincter function of congenital anorectal malforotation retrospectively.Methods: With continuous pull through technique, the manometry of 22 congenital anorectal malforotation patients and 24 controls were studied and the results were analysed with their clinical scores. Results: Anal resting pressure in the children with neurogenic anorectum induced by myelodysplasia(21.3?3.4) mmHg was lower than that in normal children(66.7?24.0) mmHg.The maximum contractive pressure of anus in the patients(22.4?3.3) mmHg was lower than that in normal children(129.0?18.8) mmHg. The length of high pressure zone in the patients(12.3?4.6 mm) was lower than that in normal children(23.6?4.6 mm). Rectoanal inhibitory reflex was identified in both patients and normal children. Conclusion:Anorectal manometry might be an effective parameter to evaluate the anal sphincter function of congenital anorectal malformation.