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.

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>

Research progress in genetic abnormalities and etiological factors of congenital anorectal malformation / 中华胃肠外科杂志

Congenital anorectal malformation (ARM) is one of the most common gastrointestinal congenital diseases, accounting for 1/4 in digestive tract malformation, and is one of the congenital malformations in routine surveillance by the World Health Organization. Because of the variety of risk factors and the complexity of the pathological changes, etiology of ARM is still not clear. It is mostly considered that ARM is resulted from hereditary factors and environmental factors in the development of embryogenesis. Through animal experiments, scholars have found that Hox, Shh, Fgf, Wnt, Cdx and TCF4, Eph and ephrin play crucial role during the development of digestive tract. When the genes/signaling pathway dysfunction occurs, ARM may happen. In addition, ARM is related to the external factors in pregnancy. Because of the complexity of related factors in the development of human embryogenesis, the research progress of human ARM is very slow. This paper reviews relevant literatures in genetic factors and environmental factors, in order to provide the theoretical basis for the treatment and prevention of ARM.

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>

Application of improved insulin injections abdomen locator card in the empty nest elderly diabetic patients / 中国实用护理杂志

Objective To compare the differences in the use of effects of improved and traditional abdominal positioning locator card in the empty nest elderly diabetic patients with insulin pen injection. Methods 100 discharged cases of empty nest elderly diabetic patients with insulin treated were enrolled. They were divided into two groups by random digital table method, 50 cases in traditional positioning card injection group and 50 cases in improved positioning card injection group. Usage rate of two sets of locator cart, adverse reactions in local skin injection and blood glucose control were observed for 12 months. Results After 12 months, 44 cases occupied 88%in improved positioning card injection group were not about using positioning card while 30 cases occupied 60%in traditional positioning card injection group. The difference was statistical significance (P<0.05). After 12 months, only 3 cases in improved positioning card injection group appeared local injection site reactions which was significantly lower than 31 cases in the traditional positioning card injection group, and the difference was statistically significant (P<0.05);12 months later, fasting blood glucose (FBG), 2 hour postprandial blood glucose (2 h PBG), glycosylated hemoglobin (HbA 1c) of improved positioning card injection group and traditional positioning card injection group [(7.0 ±1.5) mmol/L and(7.8±1.9)mmol/L,(10.7±2.1)mmol/L and(12.3±2.2)mmol/L,(7.1±1.3)% and(7.7±1.5)%] were all decreased significantly than before. The difference was statistically significant (P<0.05). FBG,2 h PBG, HbA1c of improved positioning card injection group were decreased more significantly than that in traditional positioning card injection group and the difference was statistically significant (P<0.05). The standard rate of HbA1c [64% (32/50)] in improved positioning card injection group was higher than that in traditional positioning card injection group [42%(21/50)]. The difference was statistically significant (P<0.05). Conclusions The modified abdominal injection locator card can improve patients′positioning card usage rate, optimize insulin injection technique, reduce the occurrence of adverse reactions in local skin injection and improve the control of blood glucose.

Two-port laparoscopic pyloromyotomy for congenital hypertrophi cpyloric stenosis / 中国微创外科杂志

Objective To explore the feasibility of tw o- port laparoscopy in the treatment of congenital hypertrophic pyloric stenosis. Methods A total of 21 infants with confirmatively diagnosed con genital hypertrophic pyloric stenosis were given a two-port laparoscopic pylorom yotomy. The procedure was performed using two trocars: a 5 mm trocar at the lowe r border of the umbilical ring was placed for the insertion of camera, and a 3 m m trocar was introduced below the costal margin at the midclavicular line to pas s the hook electrode and curved forceps. Results No conversion s to open surgery were required. The operation time was 23~65 min (mean, 31.3 mi n). The patients were discharged from hospital at 4~6 postoperative days. No com plications occurred. Follow-up for 2~7 months (mean, 3.2 months) showed a norma l development in all the 21 patients. Conclusions Two-port lap aroscopic treameat for congenital hypertrophic pyloric stenosis in infants is ef fective.

Laparoscopic techniques in the diagnosis and treatment of bile duct diseases in newborns and infants / 中国微创外科杂志

Objective To investigate the value of lapa ro scopic surgery in the diagnosis and treatment of bile duct diseases in newborns and infants. Methods Clinical records of 9 newborns or infants with bile duct diseases diagnosed and treated under laparoscope from January 20 03 to August 2004 in this hospital were reviewed retrospectively. Resul ts Laparoscopic exploration in the 9 cases found 2 cases of congenital choledochal cyst, 5 cases of biliary atresia, 1 case of cholestasis, and 1 case of congenital bile duct hypoplasia. Cholangiography was successfully performed i n 8 cases. Two patients with choledochal cyst received an excision of the cyst a nd Roux-en-Y hepatico-jejunostomy. Among the 5 patients with biliary atresia, he patic porto-enterostomy was performed via open approach in 3 patients and via la paroscopic approach in 1, and surgery was refused in 1 patient. Open hepatic por to-enterostomy was also used in the patient with bile duct hypoplasia. The patie nt with cholestasis underwent a biliary tract irrigation. Conclusions Laparoscopy is simple and reliable in the diagnosis of bile duct disease s in newborns and infants. For the treatment of bile duct diseases, laparoscopic techniques have advantages of minimal invasion, good cosmetic results, less blo od loss, quick recovery, and reliable clinical effects.

Complications after Laparoscopic Surgeries in Newborn and Infant / 中国微创外科杂志

Objective To explore the causes and treatment of the complications after laparoscopic surgery in neonate and infants.Methods From January 2003 to June 2007,totally 287 neonates and infants received laparoscopic surgeries in our hospital, 10 of them developed postoperative complications.Results The complications included 7 cases of gastric mucosa rupture during pyloric resection,1 case of delayed rupture of the pylorus,1 case of intestinal malrotation complicated with duodenal stenosis,and 1 case of incisional hernia.The former 9 cases were cured by open surgery,and the last one recovered spontaneously in 4 months. Conclusions Mucosarupture caused by pyloric resection is the most common complication after laparoscopic surgery in neonates and infants,open surgery should be performed in such a situation.Delayed rupture of the bowel after laparoscopic surgery can be potentially fatal,and should be treated as soon as possible.Intestinal malrotation may lead to a high rate of malformation,which can be avoided by early diagnosis and treatment.