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Objective:To investigate the treatment of preterm and low birth weight infants with congenital diaphragmatic hernia (CDH) and to share the experience.Methods:This retrospective study enrolled 117 newborns with CDH who underwent major surgery at Children's Hospital, Capital Institute of Pediatrics from May 1, 2011, to March 31, 2022. Based on gestational age and birth weight, the infants were divided into the preterm and/or low birth weight group (gestational age < 37 weeks and/or birth weight less than 2 500 g, n=41) and the control group (gestational age ≥ 37 weeks and birth weight ≥ 2 500 g, n=76). Furthermore, the preterm and/or low birth weight infants were divided into the thoracoscopic surgery subgroup ( n=31) and the open surgery subgroup ( n=10) according to the surgical approach. Statistical analysis of the data was performed using two independent sample t-tests, rank sum tests, Chi-square test, or Fisher's exact probability test. Results:Preoperative data showed that the Apgar scores at 1 min [7.0 (6.0-8.0) vs 9.0 (8.0-9.8), Z=－4.03] and 5 min [9.0 (8.0-10.0) vs 9.0 (9.0-10.0), Z=－2.13] of the preterm and/or low birth weight infants were both lower than those in the control group (both P<0.05), while the proportion of infants with moderate to severe pulmonary hypertension was higher [68.3% (28/41) vs 38.2% (29/76), χ 2=9.68, P<0.05]. There were no statistically significant differences between the two groups in terms of the proportion of thoracoscopic surgery, operation time, right diaphragmatic hernia, presence of hernia sac, grading of the defect, presence of liver herniation, and application of mesh (all P>0.05). Regarding the postoperative outcomes, the death rate in the preterm and/or low birth weiht group was higher compared to the control group [36.6% (15/41) vs 13.2% (10/76), χ 2=8.70, P<0.05]. Additionally, the time required to resume full enteral nutrition after surgery was longer in the preterm and/or low birth weight group than that in the control group [25 d (18-29 d) vs 16 d (10-25 d), Z=2.31, P<0.05]. The thoracoscopic subgroup had a lower mortality compared to the open surgery subgroup [25.8% (8/31) vs 7/10, P<0.05]. The thoracoscopic surgery subgroup had a higher Apgar score at 1 min after birth [(7.4±1.6) vs (6.0±2.2), t=2.20, P<0.05], later age at operation (hours after birth) [31.0 h (23.0-48.0 h) vs 17.0 h (4.7-24.5 h), Z=2.57, P<0.05], a lower proportion of infants operated within 24 hours after birth [32.3% (10/31) vs 8/10, P<0.05], and longer duration of operation [170.0 min (122.0-200.0 min) vs 110.0 min (87.3-120.0 min), Z=3.65, P<0.05]. Conclusions:In this study, a higher mortality in the preterm and/or low birth weight group compared to the control group was observed, which may be attributed to the higher proportion of neonates with moderate-severe pulmonary hypertension. The thoracoscopic diaphragmatic repair can be attempted for preterm and low birth weight infants who have relatively stable respiratory and circulatory functions.
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Objective The Rex shunt has been used to treat children with extrahepatic portal hypertension by creating a venous bypass between the superior mesenteric vein and the left portal vein to circumvent the extrahepatic portal venous obstruction.This retrospective study aimed to analyse our results in the use of this novel approach.Methods 52 patients with cavernous transformation and obstructed main portal veins were treated by Rex shunts.Results The age of children was 1.4 ～ 12 year,the mean age was 3.7 years.The patients were followed up from 1.5 to 5 years.In 48 patients,there was no recurrence of gastrointestinal bleeding after surgery making an efficacy rate of 92.3％.In the recurrence group,the postoperative venous pressure in the superior mesenteric vein was (27.6 ± 3.2) cmH2O (1 cmH2O =0.098kPa) which was significantly higher than the non-recurrence group (23.5 ± 3.1)cmH2O.The difference between the pre-and post-Rex shunting was significantly lower in the recurrence group (5.7 ± 1.8)cmH2O than the non-recurrence group (11.7 ± 3.3) cmH2 O,P ＜ 0.05.Thus,a low reduction in postoperative pressure was an early manifestation of poor prognosis.Conclusions The Rex shunt was safe and efficacious.The degree of reduction in postoperative venous pressure in the superior mesenteric vein could be used to predict recurrence of gastrointestinal bleeding.
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Objective To establish a new rat model of biliary atresia by pure ethanol injection into the common bile duct.Methods A catheter was inserted and fixed in the common bile duct in male SD rats .Saline (8 rats) or pure ethanol (16 rats) was injected through the catheter ,respectively, and the biochemical and pathological changes in the rats were examined .Results SD rats in the experimental group were divided into a persistent injury and a restoration of liver dysfunction groups according to pathological and biochemical detection .In the persistent injury group , biochemical impair-ments were significantly higher at 8 weeks after ethanol injection than those in the control group and restoration group .Dis-tinct pathological changes in the liver were observed using HE , SMA, and Masson staining .Conclusions It is a reliable animal model of biliary atresia induced by injection of pure ethanol into the common bile duct in the rat .It will provide a useful tool in future studies of biliary atresia .