Objective To compare perioperative outcomes between robotic liver resection (RLR) and laparoscopic liver resection (LLR) in pediatric patients undergoing hepatectomy for liver tumors. Methods This multicenter retrospective study included 77 pediatric patients who underwent RLR or LLR for liver tumors located in anterolateral (segments II, III, IVb, V, VI) or posterior (segments IVa, VII) segments between January 2015 and January 2025 across four tertiary centers. Baseline demographics, tumor characteristics, and perioperative outcomes were analyzed. Propensity score matching (PSM) was performed to minimize selection bias. Results A total of 77 cases met the study criteria, of which 30 underwent RLR (39.0%) and 47 (61.0%) underwent LLR. After 1:1 PSM was performed (30 RLR vs. 30 LLR). RLR was associated with a shorter operative time [175 min (IQR:120, 256) vs. 245 min (IQR:180, 295) ; P < 0.05], lower rates of Intraoperative blood transfusion[8 of 30(26.7%) vs. 16 of 30(53,3%); P < 0.05], less blood loss [30.0 mL (IQR:18.8, 82.5) vs. 50 mL (IQR:30, 120); P < 0.05], and lower rates of Pringle maneuver application [6 of 30(20.0%) vs. 17 of 30(56.7%); P < 0.05]. On subset analysis of 38 patients with hepatoblastoma, of which 13 underwent RLR (34.2%) and 25 (65.8%) underwent LLR. After 1:1 PSM was performed (13 RLR vs. 13 LLR). RLR was associated with significantly shorter operative time [185 min (IQR:170, 210) vs. 270 min (IQR:255, 283); P < 0.05], less blood loss [40 mL (IQR:25, 58) vs. 100 mL (IQR:75, 125); P < 0.05], and lower rates of Pringle maneuver application [2 of 13(15.4%) vs. 9 of 13(69.2%); P < 0.05] compared to LLR group. On the open conversion rates, post operative stay, postoperative complications, morbidity, mortality, and oncological outcomes were similar between RLR and LLR groups in the overall PSM cohort (P > 0.05). Conclusion For hepatectomy in children with liver tumors such as hepatoblastoma, RLR is noninferior to LLR, with potential advantages in selected outcomes. Its benefits are manifested by shorter operative times, less blood loss, and a reduced need for intraoperative blood transfusion and vascular occlusion of hepatic portal.

Sirtuin-6 (SIRT6) has a pivotal role in a wide array of cellular biological functions and is linked to the progression of various diseases. Previous findings have identified SIRT6 as a protective modulator against numerous diabetic complications. However, whether SIRT6 exerts a protective role in diabetic foot ulcer (DFU) remains unstudied. This work established a rat model of DFU and evaluated the possible role of SIRT6 in mediating the wound healing in DFU. Marked reductions in SIRT6 levels were observed in wound samples from DFU patients and rats. Increasing SIRT6 expression in wound tissues remarkably decreased wound area, accelerated epithelialisation, increased collagen deposition and improved angiogenesis. Moreover, up-modulation of SIRT6 relieved the oxidative stress and inflammation in DFU rats. The increase of SIRT6 in cultured vascular endothelial cells restrained cell apoptosis, oxidative stress and inflammation elicited by high glucose (HG). HG-impaired migration capacity and angiogenesis of vascular endothelial cells was also recovered by increasing SIRT6 expression. Mechanism research revealed that SIRT6 overexpression reinforced the activation of the Nrf2 pathway in wound tissues of DFU rats and HG-exposed vascular endothelial cells. Pharmacological suppression of Nrf2 reversed the protective effect of SIRT6 overexpression on HG-triggered endothelial dysfunction. The findings of this work indicate that the positive role of SIRT6 in DFU wound healing is related to Nrf2 activation which contributes to the suppression of oxidative stress and inflammation and the improvement of angiogenesis in vascular endothelial cells. This study highlights the previously unaddressed role of SIRT6 in DFU wound healing, providing novel insights into its protective functions. The findings hold significant clinical value by identifying SIRT6 as a promising therapeutic target for improving DFU wound healing.

OBJECTIVE:To explore the efficacy of robotic-assisted anorectoplasty (RAARP) and laparoscopic-assisted anorectoplasty (LAARP) in children with high and intermediate -type anorectal malformations (ARMs). METHODS:This is a post hoc analysis of a multicenter database of high and intermediate -type ARMs patients undergoing RAARP or LAARP at four centers from April 2011 to April 2024. Data on patients' demographics, perioperative outcomes, and postoperative complications were collected. And postoperative defecation function was evaluated by kelly score. Both 1:1 propensity-score matched (PSM) analysis was performed to minimize selection bias between both groups. RESULTS:A total of 135 cases met the study criteria, of which 48 underwent RAARP and 87 underwent LAARP. Both 1:1 PSM (48 RAARP vs. 48 LAARP) were performed. Both groups were well balanced in the age at anorectoplasty, body weight, type of ARMs, accompanying malformation, and sacral ratio in the matched cohorts by PSM. RAARP group was associated with a significantly shorter operative time compared with LAARP group, less blood loss, and shorter postoperative hospital stay (P < 0.05). There were no significant differences in terms of postoperative complications and defecation function Kelly score between two groups (P > 0.05). On subset analysis of 93 patients with rectourethral fistula and 53 patients with rectobulbar fistula, RAARP was associated with significantly shorter operation time, less blood loss compared to LAARP group (P < 0.05), and better soiling control effect in rectourethral fistula and enhanced superior Kelly scores for defecatory function in rectobulbar fistula incompared to LAARP group (P < 0.05). CONCLUSION:RAARP is a safe and effective operation for the treatment of high and intermediate-type anorectal malformation, which may be more suitable for rectourethral fistula.

Preoperative undernutrition is prevalent among children with Hirschsprung disease (HSCR). To evaluate whether preoperative nutritional support reduces the incidence of postoperative HSCR-associated enterocolitis (HAEC), we conducted a prospective, multicenter, open-label randomized controlled trial. The trial was initiated on January 1, 2021 and completed on October 31, 2022. It was carried out across seven tertiary hospitals in China. A total of 110 patients admitted for pull-through surgery for HSCR were enrolled. Eligible participants were randomly assigned 1:1 via a centralized web-based randomization system ( www.cbdps.com ), which generated the allocation sequence. Specifically, 55 patients were allocated to the preoperative nutritional support (PNS) group and 55 to the standard medical care (SMC) group. Surgeons and patients were not blinded to group assignment. The primary outcome was the incidence of HAEC at 3 months after surgery. At 3 months postoperatively, the incidence of HAEC in the PNS group was significantly lower compared to the SMC group. Specifically, the HAEC incidence was 7.27% (4/55) for the PNS group versus 29.09% (16/55) for the SMC group. This resulted in an absolute risk reduction of 21.82% (95% confidence interval: -35.64% to -7.99%; p = 0.003). No adverse events were documented. These results demonstrate that preoperative nutritional support substantially reduces early HAEC incidence in pediatric HSCR patients following pull-through surgery. Trial Registration: ClinicalTrials.gov NCT04598841.

Investigate the safety and efficacy of preoperative atomization inhalation of indocyanine green (ICG) solution in precise lesion resection of pediatric thoracoscopic intralobar pulmonary sequestration. A multicenter 1:1 matched case-control study was adopted, to compare the safety and efficacy of the ICG group (preoperative atomization inhalation of 0.5 mg/kg ICG solution) with traditional group (no preoperative atomization inhalation of ICG solution). The baseline, intraoperative, and postoperative recovery conditions of the two groups were observed. Outpatient follow-up visits were conducted 3 to 6 months after surgery, including lung CT scans and pulmonary ventilation function tests. 134 patients were included in the study. The ICG group included 67 patients, and the traditional surgery group included 67 patients matched at a ratio of 1:1 according to age and lesion location. There were no reports of deaths or adverse reactions. The postoperative chest drainage tube indwelling time [(53.19 ± 8.15) hours vs. (73.25 ± 15.51) hours, P < 0.001] and postoperative hospital stay [(4.81 ± 1.84) days vs. (6.72 ± 1.31) days, P < 0.001] were shorter in the ICG group than in the traditional group. More importantly, the postoperative pulmonary function in the ICG group was better than that in the traditional group. No residual lesions were found in the postoperative CT examination of both groups. The innovative application of atomization inhalation of ICG provides the possibility for precise localization and lesion resection of pediatric thoracoscopic intralobar pulmonary sequestration. This maximizes the preservation of normal lung parenchyma, better improves postoperative pulmonary function, and shortens postoperative recovery time.

Objective:To systematically review the safety and feasibility of perioperative application of enhanced recovery after surgery (ERAS) for children with congenital choledochal cyst.Methods:The literatures about the application of ERAS in pediatric congenital choledochal cyst were searched in Chinese and English databases including Wanfang Medical Network, CNKI, PubMed, Web of Science and EBSCO.Only Chinese and English literatures were searched from January 1, 2000 to August 31, 2021.English and Chinese keywords included enhanced recovery after surgery, fast track surgery, ERAS, FTS, choledochal cysts, choledochocyst, bile duct cyst, biliary dilatation and surgery.Two researchers were selected to complete data entry, including case load, perioperative interventional measures, initial postoperative exhaust and defecation time, postoperative length of stay and complications.Meta-analysis was performed with Stata 13.0 software.And I2 test was utilized for examining the heterogeneity between the eligible studies.And fixed/random-effect model was employed according to the test results.Publication bias was assessed by Begg's test.Sensitivity analysis was performed for initial postoperative defecation time and postoperative hospitalization stay.Results:Seven articles with a total of 478 cases were retrieved.As compared with conventional group, ERAS group had significantly shorter initial postoperative defecation (SMD=1.19, 95% CI: 0.86-1.52, P<0.001) and postoperative length of hospitalization stay (SMD=1.97, 95% CI: 1.55-2.38, P<0.001). ERAS group had a lower incidence of postoperative incision infection ( OR=0.32, 95% CI: 0.10-0.98, P<0.05), postoperative anastomotic leakage ( OR=0.16, 95% CI: 0.03-0.91, P<0.05) and postoperative respiratory tract infection ( OR=0.19, 95% CI: 0.06-0.60, P<0.05). Conclusions:For children with choledochal cyst, application of ERAS concept in perioperative period is both safe and feasible.It may accelerate the recovery of postoperative intestinal function, shorten postoperative length of stay and lower the occurrence of postoperative complications.

BACKGROUND:Cholangitis is common in patients with biliary atresia following Kasai portoenterostomy (KPE). The prompt use of empiric antibiotics is essential due to the lack of identified microorganisms. The authors aimed to validate a severity grading system to guide empiric antibiotic therapy in the management of post-KPE cholangitis.MATERIALS AND METHODS:This multicenter, prospective, randomized, open-label study recruited patients with post-KPE cholangitis and was conducted from January 2018 to December 2019. On admission, patients were categorized into mild, moderate, and severe cholangitis according to the severity grading system. Patients in the mild cholangitis group were randomized to receive cefoperazone sodium tazobactam sodium (CSTS) or meropenem (MEPM). Patients with severe cholangitis were randomized to treatment with MEPM or a combination of MEPM plus immunoglobulin (MEPM+IVIG). Patients with moderate cholangitis received MEPM.RESULTS:The primary endpoint was duration of fever (DOF). Secondary outcomes included blood culture, length of hospital stay, incidence of recurrent cholangitis, jaundice clearance rate, and native liver survival (NLS). For mild cholangitis, DOF, and length of hospital stay were similar between those treated with CSTS or MEPM (all P >0.05). In addition, no significant difference in recurrence rate, jaundice clearance rate, and NLS was observed between patients treated with CSTS and MEPM at 1-month, 3-month, and 6-month follow-up. In patients with moderate cholangitis, the DOF was 36.00 (interquartile range: 24.00-48.00) h. In severe cholangitis, compared with MEPM, MEPM+IVIG decreased DOF and improved liver function by reducing alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase, and direct bilirubin at 1-month follow-up. However, recurrence rate, jaundice clearance rate, and NLS did not differ significantly between MEPM+IVIG and MEPM at 1-month, 3-month, and 6-month follow-up.CONCLUSIONS:In patients with post-KPE cholangitis, MEPM is not superior to CSTS for the treatment of mild cholangitis. However, MEPM+IVIG treatment was associated with better short-term clinical outcomes in patients with severe cholangitis.

目的:探讨女童阑尾炎术后发生输卵管脓肿的病因、诊断及治疗.方法:回顾性分析郑州大学第一附属医院2017年1月至2020年1月收治的3例阑尾炎术后并发输卵管脓肿女童的临床资料,3例女童明确诊断后均行彩超引导下穿刺置管术,给予脓腔冲洗引流,同时静脉输注三代头孢类抗生素和奥硝唑针.文献检索女童阑尾炎术后并发输卵管脓肿的诊治病例.结果:3例女童经治疗后均痊愈出院,出院时血常规正常,有1例CRP稍高,出院后随访12个月,无腹痛、发热症状,无脓肿复发.文献检索共发现5例女童,年龄14～17岁,化脓性阑尾炎4例,坏疽性阑尾炎1例,均有穿孔;阑尾炎术后时间2个月～3a;入院均有腹痛,伴发热2例,伴排尿困难2例;右侧输卵管脓肿3例,右侧输卵管积脓并输卵管炎2例.5例均手术治疗;2例术后病理分别示化脓性输卵管炎及输卵管内部分钙化的粪石、慢性滤泡性输卵管炎.结论:女童阑尾炎术后,出现腹痛、发热,要警惕输卵管脓肿发生可能,尤其是青春期的女孩.超声结合盆腔CT或MRI可以明确诊断,彩超引导下脓肿穿刺置管外引流可以取得满意的疗效,避免盲目二次手术.

Objective:To evaluate endoscopic retrograde appendicitis therapy in treatment of children with acute uncomplicated appendicitis.Methods:Sixty children patients were admitted at the Affiliated Hospital of Zhengzhou University from Oct 2019 to Jun 2021 and were divided into ERAT group ( n=30) and LA group ( n=30). Results:All operations were successfully performed . ERAT children started oral feeding earlier [(6.8±2.0) h vs. (12.3±2.0) h, t=-10.636, P<0.001], postoperative hospital stay was shorter [(3.2±1.3) d vs. (5.0±1.3) d, t=-5.360, P<0.001]. After 14 months follow up, the recurrence rate in the ERAT group was 6%. The complication rate of LA was 10%. Conclusion:ERAT is a safe and effective therapy in treating children with acute uncomplicated appendicitis with low,acceptable recurrence rate.

目的 总结儿童胃石症的临床特点及治疗经验.方法 回顾性分析郑州大学第一附属医院2009年6月至2020年6月收治的9例胃石症患儿临床资料.结果 9例胃石症患儿均为女性,年龄为4～13岁,其中8例有异食癖,1例发病前曾大量进食柿子.7例经内镜检查确诊,1例经CT确诊,1例经消化道造影确诊.4例经内镜取石治疗,5例经外科手术治疗,最终8例确诊为毛发性胃石症,1例为植物性胃石症.随访1～2 a,9例患儿均恢复良好,胃石症未复发,贫血及营养不良状况均有不同程度改善.结论 儿童胃石症常见于女童,多伴有异食癖,一经诊断应及时治疗,首选内镜取石,内镜取出失败可考虑外科手术治疗,治疗效果及患儿预后好.

本研究收集3例小儿肠道血管瘤患者的临床资料，生长方式为小肠单发包块型、小肠结肠多发型、直肠肛管弥漫型，分别接受手术治疗、手术联合内镜治疗、介入治疗，取得良好效果。小儿肠道血管瘤表现多样，应采取个体化治疗。

女，3岁。因"确诊急性髓系白血病M5 1年余，转移性右下腹痛4天"于2020年5月11日转入郑州大学第一附属医院。2019年3月曾在郑州大学第一附属医院小儿内科确诊急性髓系白血病M5型，经规律化学药物治疗后获得完全缓解。2020年3月患儿复查骨穿结果提示AML-M5复发，入院续行DAH方案化学药物治疗。4 d前，患儿化学药物治疗期间出现脐周疼痛，而后疼痛转移至右下腹，伴发热，热峰38. 4 ℃，腹泻2次，大便呈稀糊状，无恶心、呕吐等不适。腹部彩色多普勒超声提示：右下腹阑尾区盲管样回声（考虑阑尾炎）。给予美罗培南及奥硝唑治疗后体温恢复正常，腹痛仍持续。经会诊后转入小儿外科。体格检查：体温36. 4℃，脉搏108次/min，呼吸27次/min，血压98/52 mmHg(1 mmHg=0. 133 kPa）。神志清，精神可。腹部平坦，脐周及右下腹压痛明显，无腹肌紧张、反跳痛，移动性浊音阴性，听诊肠鸣音3次/min，心肺体格检查未见异常。血常规结果：白细胞3. 79×10 9/L，血小板100×10 9/L，中性粒细胞百分数57. 7%，C反应蛋白20. 9 mg/L。超声提示：右下腹可见约18 mm×7. 7 mm的阑尾管状回声，壁厚约2. 7 mm，直径约6. 6 mm，其旁肠管增宽，内透声差，肠壁结构不清晰。右下腹肠间隙见明显不规则液性暗区。CT提示：阑尾增粗，内见钙化灶。

A 7-year-old girl presented with a 2-day history of abdominal pain and vomiting. After admission, blood tests revealed a white blood cell count of 11.15 (cid:1) 10 9 /L (reference range, 3.5 – 9.5 (cid:1) 10 12 /L), alanine transaminase level of 75 U/L (0 – 40 U/L), aspartate transaminase level of 56 U/L (0 – 40 U/L)

目的 运用Meta分析方法评价经肛穴肛门成形术(anal dimple anorectoplasty,ADARP)、前矢状入路肛门成形术(anterior sagittal anorectoplasty,ASARP)、后矢状入路肛门成形术(posterior sagittal anorectoplasty,PSARP)治疗先天性肛门闭锁伴直肠前庭屡的临床效果.方法 计算机检索万方数据库、中国知网等中文数据库(检索式:直肠前庭瘘、肛门前庭瘘、前庭屡、舟状窝屡)和PubMed、Web of Science 等英文数据库(检索式:vestibular fistula,rectovestibular fistula,anovestibular fistula),收集 2002-2020年公开发表的关于ASARP、PSARP、ADARP治疗先天性肛门闭锁伴直肠前庭瘘的文献.通过阅读文献标题及摘要进行初步筛查,再进行二次筛选.用Stata 13.0对文献数据进行Meta分析,主要包括术后近期并发症(伤口感染、伤口裂开、直肠回缩、肛门狭窄、直肠脱垂和瘘口复发)和远期并发症(便秘和污粪)的发生率.结果 共纳入文献21篇,有效病例数776例.其中行ADARP术式4篇,ASARP术式8篇,PSARP术式11篇.ADARP术式分别在以下方面优于其他两种术式:切口感染发生率(ADARP:4％,95％CI:-0.02～0.10;ASARP:17％,95％CI:0.11～0.22;PSARP:9％,95％CI:0.04～0.14)、直肠回缩发生率(ADARP:4％,95％CI:-0.02～0.09;ASARP:5％,95％CI:0.01～0.10;PSARP:4％,95％CI:-0.04～0.13);直肠脱垂发生率(ADARP:4％,95％CI:-0.04～0.11;ASARP:8％,95％CI:0.03～0.13;PSARP:8％,95％CI:0.05～0.12);术后便秘发生率[AD ARP:8％(95％CI:-0.03～0.18)、ASARP:18％(95％CI:0.10～0.26)、PSARP:17％(95％CI:0.10～0.23)];污粪发生率[ADARP 4％(95％CI:-0.04～0.11)、ASARP 13％(95％CI:0.05～0.21)、PSARP 17％(95％CI:0.10～0.25)].在减少肛门狭窄及瘘口复发上,ADARP稍逊于其他两种术式.结论 与前矢状入路肛门成形术和后矢状入路肛门成形术相比,经肛穴肛门成形术治疗先天性肛门闭锁伴直肠前庭瘘术后切口感染、直肠回缩、直肠脱垂以及远期并发症的发生率较低,但肛门狭窄以及瘘口复发发生率稍高.

目的 探讨在先天性胆总管囊肿围手术期采用加速康复外科(enhanced recovery after surgery,ERAS)理念管理的疗效.方法 210例先天性胆总管囊肿患儿均行手术治疗,其中按照ERAS理念进行围手术期管理者106例为ERAS组,按照传统理念进行围手术期管理者104例为对照组.比较2组年龄、性别比例、体质量,手术时间、术中出血量、术中输血比率,术后首次排气时间、术后住院时间、术后并发症发生率及并发症Clavien-Dindo分级等临床资料.结果 2组年龄、性别比例、体质量、手术时间、术中出血量、术中输血比率比较差异均无统计学意义(P＞0.05);ERAS组术后首次排气时间[(40.74±21.25)h]早于对照组[(68.21±25.26)h](t=-8.494,P＜0.001),术后住院时间[(8.89±3.31)d]短于对照组[(10.86±4.67)d](t=-3.522,P＜0.001);2组术后并发症发生率、并发症Clavien-Dindo分级比较差异均无统计学意义(P＞0.05).结论 小儿先天性胆总管囊肿围手术期采用ERAS理念管理可加速胃肠道功能恢复,缩短术后住院时间,不增加术后并发症发生.