Objective: To elucidate the clinical characteristics and treatment strategies for acute appendicitis in pediatric patients with cancer. Methods: A retrospective analysis was conducted on the clinical data of 31 pediatric patients with cancer who were diagnosed and treated for acute appendicitis at Beijing Children’s Hospital from March 2007 to October 2023. Results: The cohort comprised 31 patients with a mean age of 5.2 years (range 13 months to 15.3 years) and a male-to-female ratio of 4.2:1. The most prevalent underlying malignancy was acute lymphoblastic leukemia (22, 71%). The most common clinical manifestations were abdominal pain (23, 74%) and fever (27, 87%). Neutropenia was present in 81% of the patients. Nine patients underwent initial surgical treatment, while 22 received conservative management. The proportion of complicated appendicitis was significantly higher in the surgical group compared to the conservative treatment group (78% vs 23%, p = 0.012). However, the absolute neutrophil count was lower in the conservative treatment group compared to the surgical group (0.06 vs 0.35 × 109/L, p = 0.006). The length of hospital stay was significantly shorter for patients who underwent laparoscopic surgery compared to the conservative treatment group (5 vs 9.0 days; p = 0.037). All patients were successfully treated for acute appendicitis with no mortality. Conclusion: Both surgical and conservative management are safe and effective treatment options for acute appendicitis in cancer children. Laparoscopic appendectomy may be a more advantageous approach, reducing hospital stay and potentially benefitting the management of the underlying malignancy.

Objective:To explore the clinical characteristics of chronic mesenteric ischemia in children and to improve the diagnosis and treatment of this disease by pediatricians.Methods:A retrospective review was performed for a 12-year-old girl with acute intestinal necrosis due to chronic mesenteric ischemia. With a weight of 14 kg and a height of 115 cm, there was a 6-year history of postprandial pain with a 3-day history of severe abdominal pain and vomiting. With a preoperative diagnosis of intestinal perforation, an emergency laparotomy revealed that the total length of jejunum and ileum (non-malrotation) was around 150 cm and the distal 80-cm of ileum became gangrenous with 2 perforations. Gangrenous ileum was resected and distal jejunostomy performed. After her condition stablized, duplex ultrasonography, computed tomography angiography and digital subtraction angiography(DSA) were performed successively. The diameter of superior mesenteric artery was small with a slow blood flow. At Month 1 post-operation, stoma was closed and she was discharged 14 days later with a semi-liquid diet. At Month 1 follow-up, she resumed an ordinary diet. However, the symptoms of postprandial abdominal pain were not relieved and there was no weight gain. At Month 6 after discharge, post-prandial abdominal pain was relieved without gaining weight. Base on imaging studies, acute intestinal ischemic necrosis was probably caused by chronic mesenteric ischemia. And the relevant literature reports were retrieved from the databases of PubMed, Springer Link, China National Knowledge Infrastructure (CNKI) and WanFang prior to October 2019.Results:A total of 59 children of chronic mesenteric ischemia were reported. The major symptoms included discomfort or abdominal pain (n=19, 51.4%), growth arrest or weight loss (n=5, 13.5%), hypertension or malignant hypertension (n=3, 8.1%), gastrointestinal bleeding with hemorrhagic colitis (n=1, 2.7%), ischemic gastritis with ulcer (n=1, 2.7%) and no definite symptoms (n=17, 45.9%). The vessels involved in stenosis included celiac trunk, superior mesenteric artery, inferior mesenteric artery, renal artery, external iliac artery and anterior branch aorta. Treatments included open abdominal angioplasty and balloon angioplasty under interventional therapy. For most symptomatic children, the symptoms became relieved after one or more treatments.Conclusions:The diagnosis of chronic mesenteric ischemia in children is rather difficult. If the diagnosis and treatment are timely, the prognosis is generally decent. Otherwise severe complications may occur.

目的 探讨儿童自发性胆道穿孔(spontaneous perforation of the bile duct,SPBD)的临床特点、诊断及治疗.方法 回顾性分析首都医科大学附属北京儿童医院2007年6月至2020年8月收治的36例SPBD患儿的临床资料,评价腹部超声和腹腔穿刺的诊断价值,比较胆囊置管引流、穿孔部位置管引流和胆总管囊肿切开置管引流3种主要手术方式的治疗效果.结果 本研究中患儿中位年龄为1.68(1.11,3.04)岁,其中男14例,女22例,男女比例1:1.57.腹部超声对本病的诊断敏感度为61.8％(21/34);20例行诊断性腹腔穿刺穿刺液为胆汁样腹水的患儿,后续手术证实均为胆道穿孔,诊断特异度为100％.首次治疗:6例非手术治疗,30例手术治疗.3种手术方式:胆囊置管+腹腔引流(13例),穿孔部位置管+腹腔引流(8例),胆总管囊肿切开置管+腹腔引流(3例).术后症状缓解时间3组无统计学差异(P>0.05),但穿孔部位置管+腹腔引流术组术后腹腔引流管的拔管时间[(6.60±1.67)d]显著短于胆囊置管+腹腔引流术组[(11.22±3.77)d,P<0.05],胆总管囊肿切开置管+腹腔引流术组和穿孔部位置管+腹腔引流组的术后住院时间[(8.00±2.65)d和(10.14±2.15)d]显著短于胆囊置管+腹腔引流术组[(15.08±5.50)d,P<0.05].随访发现,31例患儿合并胆总管囊肿,行胆总管囊肿根治手术(其中2例为外院手术);胆总管囊肿根治术距前次胆道穿孔引流手术或保守治疗时间间隔1～19个月.结论 腹部超声检查和诊断性腹腔穿刺目前是儿童SPBD的主要诊断方法 .虽然部分病例可以通过保守治疗痊愈,但联合胆道引流的腹腔引流术仍是SPBD重要的治疗手段.

Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.

目的 总结需要手术治疗的儿童腹部消化道异物的临床诊治经验.方法 回顾性分析首都医科大学附属北京儿童医院2007年5月至2017年8月收治的21例行腹部手术的儿童消化道异物患者资料,其中男17例,女4例,平均年龄(3.15±2.89)岁,年龄范围10个月至11岁4个月.结果 哭闹、腹痛(11例,68.8％)和呕吐(10例,62.5％)是需手术治疗的儿童腹部消化道异物患者的主要症状.所有患者中,X线平片检查提示消化道异物阳性者13例,包括尖锐性金属异物3例、硬币1例、纽扣电池1例、单个磁性异物1例、多个磁性异物6例;X线平片检查提示消化道异物阴性者8例,包括泡发球5例、枣核2例、棒棒糖棍1例.超声检查对腹部消化道异物的诊断准确率为100％,而X线平片诊断准确率仅61.9％.所有患者接受开腹手术治疗;5例无消化道并发症患者中,4例行消化道切开异物取出术,1例(异物为钢针)开腹手术时发现钢针位于腹股沟疝囊,予以取出.16例存在消化道并发症的患者(胃穿孔1例,肠穿孔10例,肠梗阻5例)中,除1例泡发球致肠梗阻患者行开腹手术肠外手法捏碎异物外,其余均行穿孔修补、肠切开或肠切除吻合术.术后随访3～6个月,均恢复良好.结论 儿童消化道异物可引起较为严重的并发症.吞食多个磁性异物及泡发球易引起消化道并发症,需要患者家长及儿科医生重点关注.

Purpose: To review our experience with pediatric congenital buttock sinus tract, and to conclude the clinical characteristics and management of the disease. Methods: Twenty-two pediatric patients diagnosed with congenital buttock sinus tract were included. Medical records were reviewed, and the patients were followed up. Continuous variables were presented by median and range. Categorical variables were presented as frequencies and percentages. Results: Among the 22 patients, there were 8 boys (36.4%) and 14 girls (63.6%). The median first onset age was 42 months, and the range was 5 months to 12 years old. Admission age was 69.5 months, with a range from 14 months to 12 years old. Overall prior treatment time was 11 months, ranging from 3 months to 11 years. Twenty-one patients had definite congenital dimples since birth, and later manifested with infection through the dimple. All patients came to the doctor with complaint of the infection. The number of invasive procedures ranged from 0 to 5, with an average of 2. Radiology could exactly display the morphology and show the termination as a retrorectal cyst. The surgical procedure was adopted trans-fistula tract, and the pathological results showed a dermoid cyst in 11 patients and an epidermoid cyst in 10 patients. During the follow-up period of 34.5 months (range, 2 months to 8 years), 19 patients were uneventful and 3 patients suffered recurrence. Two of them underwent a second operation and had no recurrence ever since. The third patient did not receive a second operation, and the refractory infection was still present. Conclusions: Pediatric congenital buttock sinus tract is rare and has a female predominance in the morbidity. Patients have a distinctive congenital dimple on the buttock with recurrent infection, and there usually exists a congenital sinus tract from the dimple to the retrorectal space. Total excision is the only method for the cure. The nature of the disease is a retrorectal developing dermoid cyst or epidermoid cyst. Keywords: Pediatric, Buttock sinus tract, Retrorectal cyst, Treatment, Prognosis

Objective: To investigate the clinical data of children with inflammatory bowel disease (IBD) retrospectively, including Crohn's disease (CD) and ulcerative colitis (UC) and identify the clinical characteristics and trends of change. Method: Clinical data of hospitalized patients diagnosed as IBD in Beijing Children's Hospital from January 2000 to December 2014 were collected and retrospectively analyzed. Patients were divided into six groups based on type of disease and year of admission: Group A1(CD, 2000-2004) included 12 patients, Group B1(CD, 2005-2009) included 11, Group C1(CD, 2010-2014) included 51; Group A2(UC, 2000-2004) included 17, Group B2(UC, 2005-2009) included 25, Group C2(UC, 2010-2014) included 68. Result: A total of 184 IBD patients were included in the study, 74 had CD and 110 had UC. The hospitalization constituent ratio of CD increased from 0.6/10 000 in Year 2000 to 2.9/10 000 in Year 2014. The hospitalization constituent ratio of UC increased from 0.5/10 000 in Year 2001 to 3.9/10 000 in Year 2014. The hospitalization constituent ratios of CD and UC both increased gradually(P<0.05). Up to 61.4%(113/184) of IBD patients belong to early onset IBD, furthermore the very early onset IBD and infantile IBD accounted for 41.8%(77/184) and 26.6%(49/184) respectively. For CD, ileocolonic type(47.3%, 35/74) and non-structuring, non-penetrating type (67.6%, 50/74) were more common. Perianal disease occured in 31.1%(23/74) of CD patients; 81.1%(60/74) of CD patients had moderate/severe activity. For UC, pancolitis type(59.1%, 65/110) was more common. There were no significant changes for location of pathological change, disease behavior, activity degree of CD, extent of UC lesion and incidence of surgery, intestinal perforation and hemorrhage of gastrointestinal tract for IBD in the past 15 years(P>0.05). Severe UC(S3) was more common in Group A2(64.7%, 11/17), but moderate UC(S2) was more common in Group C2(48.5%, 33/68), the difference was statistically significant (P=0.001 7). Conclusion: During the past 15 years, the hospitalization constituent ratio for IBD in our hospital showed a growing trend. The ratio of infantile IBD and very early onset IBD was high. For CD, perianal disease was commonly seen and most patients had moderate/severe activity. The surgery rate and incidence of intestinal obstruction and perforation were higher in the CD patients than UC patients. For UC, the lesions were more extensively combined with higher disease activity.

目的总结空肠间置肝门十二指肠吻合加矩形瓣治疗先天性胆道扩张症的手术经验、优缺点及远期随诊.方法对1983～2001年确诊为先天性胆道扩张症267例行空肠间置代胆道加矩形瓣手术的患儿进行研究.为预防吻合口狭窄、返流、癌变,总结了手术操作经验并对该术式的优缺点进行了评价.并随机给202例患儿发随访信,回信61例,术后最长15年,平均10.15年.结果近期效果满意,共死亡2例.61例患儿生长发育良好,生活质量同正常儿.极少数患儿钡餐返流至间置空肠,多在30分钟～1小时排空.结论空肠间置代胆道术虽操作复杂,手术时间长,打击大,须一定的手术熟练程度,但仍不失其治疗先天性胆道扩张症的优越性.

患儿：男，11岁。第一胎足月顺产。生后无异常，约1岁半断奶后，患儿食欲差、腹部逐渐膨隆，生长发育明显较同龄儿差；懒动、面色黄、浮肿；无腹痛、呕吐及便秘。在当地医院求治，未确诊。7岁时因腹痛在当地医院诊断为“肠扭转、肠梗阻”，行手术探查（手术不详），术后仍腹胀。10岁时再次因腹痛诊为“乙状结肠扭转、侏儒症”行“乙状结肠造瘘术”。术后腹胀如前。当地考虑为“巨结肠”转来我院。经内外科会诊，见患儿矮小，身高100 cm，体重17 kg，上部量大于下部量，贫血貌，水肿；心肺无异常，腹部明显膨隆。查T3、T4明显低于正常，TSH明显高于正常。拍左腕骨片：骨龄1岁水平。诊断：克汀病。门诊服用甲状腺素片半年。

随着小儿外科手术技术的进步,手术器械也在不断地改进.50年代至60年代初笔者主要采用Duhamel术式治疗先天性巨结肠,有遗留盲囊和闸门的问题.60年代中后期笔者对Duhamel术式进行了改良,并设计了环钳,结肠从直肠后隧道拖出后将直肠残端翻转拖出肛门,套入环钳使直肠前壁与结肠前壁用环钳吻合,吻合口为斜吻合,无盲囊和闸门,但钳柄留置在肛门口外,钳柄对肛门口皮肤及括约肌有慢性刺激及压迫,造成皮肤及括约肌损伤,导致术后暂时性大便失禁,同时给肛门部护理带来诸多不便.

自1987～1996年8月采用联合断流术(门奇静脉断流+胃底楔形切除),治疗了18例患儿, 取得满意效果.