IntroductionPneumatosis cystoides intestinalis (PCI) in children is a disorder characterized by gas-filled cystic lesions located in the submucosa and subserosa of any segment of the gastrointestinal tract, with pneumoperitoneum occurring in partial cases. This disease is well recognized as an early imaging sign of necrotizing enterocolitis secondary to intestinal ischemia in preterm neonates, yet PCI is rare in older children. Unlike pneumatosis intestinalis associated with life-threatening conditions such as neonatal necrotizing enterocolitis and mesenteric ischemia, PCI is generally regarded as a benign disorder. Conservative non-surgical management is indicated for PCI patients without critical life-threatening complications.Case presentationWe present the case of a 11-year-old female patient presenting with recurrent vomiting and abdominal distension for 9 years. She was diagnosed with congenital congenital duodenal membranous stenosis and underwent laparoscopic surgery at our hospital. Intraoperative findings included congenital duodenal membranous stenosis, extensive pneumatosis involving the lesser curvature of the stomach and ileal wall with alveolar air cysts of variable morphology, as well as intestinal contents extravasated secondary to intestinal perforation. Congenital malrotation of the intestine was also identified. The patient received laparoscopic resection of duodenal web combined with duodenal longitudinal incision and transverse plasty, plus reduction of intestinal malrotation; no specific intervention was performed for the intestinal gas cysts. Postoperative diagnoses: congenital duodenal membranous stenosis, pneumatosis cystoides intestinalis, congenital intestinal malrotation. The patient was followed up for 29 months postoperatively. At present, she has no special discomforts such as abdominal pain or vomiting, with markedly relieved abdominal distension, and remains under regular follow-up.DiscussionWe discussed whether the lesion distribution of pediatric PCI is correlated with elevated intraluminal gastrointestinal pressure. Pediatric PCI carries a risk of intestinal perforation; non-surgical management can be adopted after exclusion of life-threatening critical conditions.ConclusionThe diagnosis and management of pediatric pci are clinically challenging due to the potential risk of perforation, while most concurrent pneumoperitoneum is benign. its pathogenesis may be associated with partial gastrointestinal obstruction and increased intraluminal pressure. regular follow-up and reexamination are recommended for children without life-threatening manifestations, and non-surgical treatment is preferred in the absence of acute abdomen.

BACKGROUND:Background: Unplanned Extubation(UEX) is a critical indicator of nursing quality.Existing research primarily focuses on pediatric intensive care units (PICUs),with limited data from general pediatric surgery.Currently, research on this project is mainly focused on pediatric intensive care units, and there is a lack of general surgical research data. Therefore, project research should be conducted based on this characteristic. OBJECTIVE:Objective: To analyze the high-risk factors for unplanned extubation in children and implement appropriate nursing strategies to reduce its incidence. ensuring clinical safety of pediatric patients. METHODS:Methods: A retrospective study included pediatric patients(January 2018-December 2023)with indwelling catheters in general surgery.Exclusion criteria:mental disorders or abnormal Glasgow Coma Scale scores.Data on catheter days,UEX incidents,and risk factors were analyzed. RESULTS:Results:A total of 1,977 catheter days were recorded during the perioperative period, comprising 1,079 days with urinary catheters, 768 days with postoperative wound drainage tubes, 68 days with gastric tubes, 46 days with peripheral central venous catheters (PCVCs), and 8 days with central venous catheters (CVCs). Among these, 13 incidents of unplanned extubation (UEX) occurred, yielding an overall UEX rate of 6.58 per 1,000 catheter days. Urinary catheters accounted for the highest proportion of UEX incidents (61.5%, 8/13), followed by gastric tubes (23.1%, 3/13) and postoperative wound drainage tubes (15.4%, 2/13). The reintubation rate following UEX was 15.38% (2/13). Further analysis identified significant risk factors associated with UEX: Patient characteristics: Age ≤3 years (61.5%, 8/13) and male gender (76.9%, 10/13) Clinical management: Absence of physical restraints (76.9%, 10/13) Temporal factors: Incidents occurring during holidays (69.2%, 9/13) Multivariate analysis revealed that UEX risk was influenced by interrelated factors, including pediatric physiological characteristics (e.g., limited self-regulation capacity), suboptimal catheter fixation methods, positional discomfort during patient movement, and variations in nursing interventions (e.g., frequency of rounds and caregiver education). CONCLUSIONS:Unplanned extubation (UEX) in pediatric inpatients represents a critical clinical complication that may compromise treatment efficacy and prolong hospitalization. Our findings highlight the multifactorial etiology of UEX events, with risk determinants spanning patient characteristics, care protocols, and environmental factors. To mitigate these risks, we propose implementing evidence-based multidisciplinary preventive strategies, including: 1) Standardized risk assessment protocols for high-risk subgroups (e.g., males ≤3 years), 2) Enhanced staff training on age-appropriate restraint techniques and securement device utilization, 3) Dynamic adjustment of nursing surveillance frequency during peak risk periods (e.g., holidays/postural changes). This systematic approach demonstrates potential to reduce UEX-associated adverse events by 42-68% according to benchmark studies (Author et al., 2023), ultimately improving pediatric care quality. CLINICALTRIAL:

To investigate the clinical characteristics and treatment outcomes of acute appendicitis in children with malignant tumors, with special attention to neutropenic status. We retrospectively analyzed the clinical data of 31 children with malignant tumors who were diagnosed with acute appendicitis at the Beijing Children’s Hospital from March 2007 to October 2023. Patients were grouped according to treatment modality (surgical vs. conservative management) and neutropenia status. The median age was 5.2 (3.1, 8.8) years, and the male-to-female ratio was 4.2:1. The most common malignant tumor was acute lymphoblastic leukemia (22, 71

Background:Unplanned extubation (UEX) is a critical indicator of nursing care quality. Existing research primarily focuses on pediatric intensive care units (PICUs), with limited data available from general pediatric surgery. Currently, most studies on this topic are mainly focused on PICUs, and there is a lack of research data regarding general pediatric surgery. Therefore, further research should be conducted based on this consideration. Objective:This study aimed to analyze the high-risk factors for UEX in children and implement appropriate nursing strategies to reduce its incidence, ensuring clinical safety of pediatric patients. Methods:A retrospective study (January 2018 - December 2023) included pediatric patients with indwelling catheters in general surgery. Exclusion criteria included mental disorders or abnormal Glasgow Coma Scale scores. Data on catheter days, UEX incidents, and risk factors were analyzed. Results:A total of 1977 catheter days were recorded during the perioperative period, comprising 1079 days with urinary catheters, 768 days with postoperative wound drainage tubes, 68 days with gastric tubes, 46 days with peripheral central venous catheters, and 8 days with central venous catheters. During this period, 13 incidents of UEX occurred, yielding an overall UEX rate of 6.58 per 1000 catheter days. Urinary catheters accounted for the highest proportion of UEX incidents (8/13, 61.5%), followed by gastric tubes (3/13, 21.3%) and postoperative wound drainage tubes (2/13, 15.4%). The reintubation rate following UEX was 15.38% (2/13). Further analysis identified significant risk factors associated with UEX: (1) patient characteristics: age ≤3 years (8/13, 61.5%) and male sex (10/13, 76.9%); (2) clinical management: absence of physical restraints (10/13, 76.9%); and (3) temporal factors: incidents occurring during holidays (9/13, 69.2%). Multivariate analysis revealed that UEX risk was influenced by inter-related factors, including pediatric physiological characteristics (eg, limited self-regulation capacity), suboptimal catheter fixation methods, positional discomfort during patient movement, and variations in nursing interventions (eg, frequency of rounds and caregiver education). Conclusions:Unplanned extubation in pediatric inpatients represents a critical clinical complication that may compromise treatment efficacy and prolong hospitalization. Our findings highlight the multifactorial etiology of UEX events, with risk determinants spanning patient characteristics, care protocols, and environmental factors. To mitigate these risks, we propose implementing evidence-based multidisciplinary preventive strategies, including standardized risk assessment protocols for high-risk subgroups (eg, male patients aged ≤3 years), enhanced staff training on age-appropriate restraint techniques and securement device utilization, and dynamic adjustment of nursing surveillance frequency during peak risk periods (eg, holidays or postural changes). This systematic approach demonstrates potential to reduce UEX-associated adverse events by 42%-68%, according to benchmark studies, ultimately improving pediatric care quality.

Objective:To investigate the treatment of acute appendicitis in children with malignant tumors. Methods: We retrospectively analyzed the clinical data of 31 children with malignant tumors who were diagnosed with acute appendicitis at the Beijing Children's Hospital from March 2007 to October 2023. Results: The mean age was 5.2 (3.1, 8.8) years, and the male-to-female ratio was 4.2:1. The most common malignant tumor was acute lymphoblastic leukemia (22, 71%). The main clinical manifestations of acute appendicitis were abdominal pain (23, 74%) and fever (27, 87%). Neutropenia was present in 25 (81%) patients. Surgical treatment was initially chosen for 9 patients, and conservative treatment was chosen for 22 patients. The proportion of complicated appendicitis in the surgical group was significantly higher than that in the conservative treatment group (78% vs 23%, p = 0.012). However, the absolute neutrophil count in the conservative treatment group was lower than that in the surgical group (0.06109/L vs 0.35109/L, p = 0.006). There was no difference in the formation of intra-abdominal abscess or adhesive intestinal obstruction caused by appendicitis between the surgical and conservative treatment groups, or between the severe neutropenia and non-severe neutropenia groups. The length of hospital stay (5.0 (2.5, 7.5) days) for patients who underwent laparoscopic surgery was significantly shorter than that for the conservative treatment group (9.0 (6.0, 12.5) days) (p = 0.037). All patients were cured of acute appendicitis, and there were no deaths. Conclusion: Both surgical treatment and conservative treatment with broad-spectrum antibiotics are safe and effective for acute appendicitis in children with malignant tumors. Laparoscopic appendectomy can shorten the length of hospital stay and may be more beneficial for the treatment of the underlying malignant disease in these patients.

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.

Background Pancreaticobiliary maljunction is a congenital anatomical abnorma l junction of the pancreatic duct and bile duct into a common channel outside the duodenal wall. Pancreas divisum is also a congenital anatomical abnormality characterized by unfused pancreatic ducts. Intestinal malrotation is caused by the failure of bowel rotation and fixation. We reported an optimal surgical intervention for the rare case of pancreaticobiliary maljunction and pancreas divisum accompanied intestinal malrotation. Case presentation A 2-year-old female presented with fever and jaundice. Abdominal ultrasound showed dilated common bile duct and intrahepatic bile ducts; MRCP showed pancreaticobiliary maljunction, pancreas divisum, and dilated biliary system; Abdominal contrast-enhanced CT showed a reversed relationship between the superior mesenteric artery and the superior mesenteric vein. An operation of laparoscopic resection of the extrahepatic bile duct, Roux-en-Y hepaticojejunostomy, and Ladd’s procedure was performed after the inflammation of the biliary system was treated. The post-operative follow-up period was uneventful. Conclusions The management of pancreas divisum can be conservative. We present an optimal pattern of Roux-en-Y hepaticojejunostomy to deal with pancreaticobiliary maljunction associated with intestinal malrotation.

ANZ Journal of SurgeryEarly View IMAGES FOR SURGEONS Congenital solitary intrahepatic biliary cyst Wei Chen MD, Wei Chen MD orcid.org/0000-0002-2649-6062 Department of General Surgery, Beijing Children's Hospital, Capital Medical University, Children's National Medical Center, Beijing, China Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Methodology, Resources, Writing - original draft, Writing - review & editingSearch for more papers by this authorTingchong Zhang MD, Tingchong Zhang MD Department of General Surgery, Beijing Children's Hospital, Capital Medical University, Children's National Medical Center, Beijing, China Contribution: Funding acquisition, Project administration, Supervision, Writing - review & editingSearch for more papers by this authorLu Liu MD, Lu Liu MD Department of General Surgery, Beijing Children's Hospital, Capital Medical University, Children's National Medical Center, Beijing, China Contribution: Methodology, Writing - review & editingSearch for more papers by this author Wei Chen MD, Wei Chen MD orcid.org/0000-0002-2649-6062 Department of General Surgery, Beijing Children's Hospital, Capital Medical University, Children's National Medical Center, Beijing, China Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Methodology, Resources, Writing - original draft, Writing - review & editingSearch for more papers by this authorTingchong Zhang MD, Tingchong Zhang MD Department of General Surgery, Beijing Children's Hospital, Capital Medical University, Children's National Medical Center, Beijing, China Contribution: Funding acquisition, Project administration, Supervision, Writing - review & editingSearch for more papers by this authorLu Liu MD, Lu Liu MD Department of General Surgery, Beijing Children's Hospital, Capital Medical University, Children's National Medical Center, Beijing, China Contribution: Methodology, Writing - review & editingSearch for more papers by this author First published: 23 July 2022 https://doi.org/10.1111/ans.17944Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

A 13-year-old boy had 2 years history of intermittent abdominal pain. His abdominal pain has no obvious inducement, paroxysmal attacking. There was no relief from changing body position. The symptom improved after acid suppression treatment, but it still continued to attack. The boy did not have previous history of peptic ulcer. Ultrasound found that there was an abnormal channel between the stomach and duodenal bulb, which had the structure of digestive tract wall. Upper gastrointestinal angiography showed that there was a sinus tract communication between the lesser curvature of the stomach and the duodenal bulb (Fig. 1c). The contrast medium entered the duodenum through the sinus tract and pyloric canal at the same time. The abnormal channel can also be seen on enhanced CT (Fig. 2d). Gastroscopy revealed that an abnormal opening with a diameter of about 1 cm could be seen near the gastric horn on the lesser curvature side of the lower gastric body (Fig. 2a). Another abnormal opening can be seen in the duodenal bulb, which was connected with the one of the gastric body (Fig. 2b,c). Laparoscopy was performed, and a tubular channel with a diameter of about 1 cm was found between the lesser curvature of the

Objective:To explore the application value of sound touch elastography (STE) technology plus serum gamma-glutamyl transpeptidase (GGT) in the diagnosis of biliary atresia (BA) in infants.Methods:A total of 196 cases of neonates and toddlers with clinical manifestations of hyperbilirubinemia were measured for liver stiffness measurement (LSM) by STE and liver function parameters examined at the same time.They were divided into BA ( n=75) and non-BA ( n=121) groups.And receiver operating characteristic curve (ROC) was utilized for evaluating the diagnostic efficacy of each index for BA. Results:Statistically significant inter-group differences existed in LSM, GGT, direct bilirubin (DBIL) and total bilirubin (TBIL) (all P<0.01). No significant inter-group differences existed in alanine aminotransferase (ALT), aspartate aminotransferase (AST) or indirect bilirubin (IBIL) (all P>0.05). ROC analysis revealed that LSM had the highest diagnostic efficiency.Its optimal cut-off value was 10.95 Kpa and the area under the ROC curve (AUC) 0.926.And the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were 77.3%, 95.9%, 90.6%, 87.1% and 88.3% respectively.The next was GGT with an optimal cutoff value of 187.7 U/L and an AUC of 0.831.And sensitivity, specificity, PPV, NPV and accuracy rate were 80.0%, 75.2%, 66.7%, 85.8% and 77.0% respectively.In parallel test, the sensitivity of LSM plus GGT jumped to 94.7%.In serial test, the specificity rose to 100%. Conclusion:Both STE and GGT can help to differentiate BA from children with hyperbilirubinemia.The combination of two parameters can improve the diagnostic sensitivity or specificity to a certain extent, thereby reducing missed diagnosis or misdiagnosis as much as possible.

Purpose Alimentary tract duplication involving the rectum (ATD-R) is rare. The purpose of the study was to describe the features of pediatric ATD-R patients and propose a surgical management strategy.Methods Nine consecutive children operated on for ATD-R at a tertiary center for pediatrics from January 2010 to June 2021 were retrospectively reviewed and followed up. Eighty-six children with the same diagnosis from the literature were reviewed to assist the investigation. Classifications of ATD-R consisted of cystic, tubular, and diverticular.Results Surgical treatment and histopathological examination identified six females and three males with ATD-R. Initial clinical symptoms included perianal lesions, abnormal discharge, and anorectal malformation (ARM). Apart from one tubular ATD-R patient with cloaca malformation, the other eight patients had normal-developed anorectum. Complete or partial lesion resection maintaining the integrity of the proper colorectum was a principle of surgery. Six patients were followed up for a median time of 71 (range 12-121) months with good prognoses. A surgical management strategy of ATD-R in children was proposed.Conclusions ATD-R commonly occurred concurrently with normal-developed anorectum, seldom combined with ARM. ATD-R should be considered as a differential diagnosis in anorectal symptoms. The timely and appropriate operation was curative.

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 通过回顾性分析先天性胆道扩张症(CBD)临床病例资料,比较合并胰胆管合流异常(PBM)与无合流异常病例的临床特征之间的差异,探讨PBM以及共同管长度与CBD的发病、临床症状、相关实验室检查结果的相关性,为CBD的发病机理和诊断治疗提供新的理论依据.方法 回顾性总结2017年1月至2019年12月首都医科大学附属北京儿童医院普外科收治的胆道扩张症病例临床资料,83例胆道扩张症患儿纳入研究,以MRCP中胰胆管共同管长度为分组标准,分为合流异常组(共同管长度≥5 mm,n=47)与非合流异常组(共同管长度<5 mm,n=36),研究指标包括发病年龄、性别、临床症状、相关实验室检查、共同管长度、胆道结石以及胆总管囊肿大小,研究结果采用非参数检验和χ2检验.结果 在临床症状中,发热、黄疸、白色大便及胆道结石两组间无统计学差异(P>0.05),腹痛症状合流异常组多于无合流组(P<0.05);实验室检查结果AST、ALT、TBIL、DBIL及IBIL两组间无统计学差异(P>0.05),血清淀粉酶检测合流异常组高于无合流异常组(P<0.05);合流异常组胆总管呈囊肿型32例(38.6％),梭型15例(18.1％),无合流异常组胆总管呈囊肿型26例(31.3％),梭型10例(12.0％),两组间无统计学差异(P>0.05),但胆总管囊肿体积合流异常组小于无合流异常组(P=0.02).结论 先天性胆道扩张症合并胰胆管合流异常的患儿出现腹痛症状较早、较严重,同时血清淀粉酶较高,合并胰腺炎较常见,故易于做出早期诊断,可能也是本组胆总管囊肿体积较小的原因.本研究胰胆管共同管长短与先天性胆道扩张症的临床症状、肝功能、胆红素及血清淀粉酶等水平无明确相关性,故不能单纯以胰胆管共同管长度判断病情轻重.

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.

Introduction Transanal Soave pull through (PT) with or without assistance can be performed as a redo procedure for Hirschsprung disease (HD). In this study, we reviewed the indications and clinical outcomes of redo transanal Soave with or without assistance. Materials and Methods A retrospective analysis was performed on patients who underwent redo transanal Soave with or without assistance in our hospital from 2004 to 2016, and did not have rectourethral fistula or rectovaginal fistula. The Krickenbeck classification system was used to evaluate postoperative bowel function. We analyzed the associated factors of the two main indications. Results In this study, 46 patients were included, representing 5.6% of all HD PTs; 42 patients were initially operated elsewhere and 4 at our hospital. Primary PT surgeries included 38 transanal Soave, 2 Rehbein, 1 Martin, and 5 unknown procedures. The indications for redo PT were residual aganglionosis/transition zone PT (RA/TZPT) (27, 58.7%), anastomotic complication (14, 30.4%), and dilated distal segment (5, 10.9%). The median age of these 46 patients at primary and redo PT was 7.0 months (range, 0.4-137 months) and 45.5 months (range, 7-172 months), respectively. All 46 patients underwent redo transanal Soave PT; 43 patients (93.5%) underwent transanal Soave with laparotomy ( n =42) or laparoscopy ( n =1), and another 3 patients underwent transanal Soave PT. Six patients (13%) experienced complications within 30 days after redo surgery. A total of 43 patients were followed up, and the median follow-up period was 100 months (range, 35-180 months). Two patients could not hold back defecation in some inconvenient conditions. Sixteen patients (37.2%) had soiling, and 8 (18.6%) of 16 patients complained frequent soiling occurrence (more than 1/week). Only one patient complained of constipation (grade 1). Patients with anastomotic complication had more early postoperative complication and higher rate of soiling than patients with RA/TZPT, but there was no statistical difference ( p =0.672 and p =0.105). Conclusion Transanal Soave PT with or without assistance was effective in resolving different problems after initial PT, while soiling was the most common postoperative problem, especially patients with anastomotic complication.

Objective:To evaluate the feasibility of endoscopic selective esophagogastric variceal devascularization (ESVD).Methods:ESVD was performed for 4 children with esophagogastric varices caused by cavernous transformation of portal vein and portal hypertension. The clinical characteristics, intraoperative doses of sclerosing agent, tissue glue and postoperative recovery status were analyzed.Results:There were 1 boy (25%) and 3 girls (75%) with an average age of (6.70±1.41)(4-7) years. The diameter of portal vein trunk was (8.25±2.63)(6-11) mm, hepatic elasticity (7.57±3.63)(4.08-10.9) kPa and the lowest Hb (59.25±8.50)(51-68) g/L. The extents of esophageal varices were F1 (n=1), F2 (n=2) and F3 (n=1); gastric varices F1 (n=1) and F2 (n=3). The dose of esophageal sclerosing agent was (11.0±2.0)(10-14) ml and that of gastric tissue glue (6.5±4.1)(3.5-12.5) ml. At Week 1 postoperatively, all cases showed partial atrophy of circuitous veins, thrombosis of esophageal varices, glue ulcer in gastric fundus and no re-bleeding. One case showed bleeding of varicose veins around glue ulcer at 1 month postoperatively and tissue glue was re-applied. The remaining 3 cases hinted at wilting atrophy of esophageal varices and glue ulcers in gastric fundus. At 6 months after esophagogastric operation, ulcer healed basically without re-bleeding.Conclusions:ESVD may be employed for plugging esophagogastric varices caused by portal hypertension without open surgery or endoscopy. It lowers the life-threatening risk of upper gastrointestinal bleeding in children. For rebleeding after REX shunting, esophagogastric venous devascularization and splenectomy are efficacious.

Objective:To explore the diagnosis and treatment of intestinal atresia (IA) associated with Hirschsprung's disease (HD).Methods:From June 2007 to June 2019, clinical data were retrospectively reviewed for 4 cases with IA complicated with HD. All cases underwent laparotomy within 3 days of birth due to intestinal obstruction. They were confirmed intraoperatively as colonic atresia, ileal atresia, jejunal atresia and ileal atresia respectively. However, 3 children were re-admitted due to a recurrence of intestinal obstruction after operation for IA while another one underwent enterostomy after postoperative intestinal perforation. In the literature review, "intestinal atresia" complicated with "Hirschsprung's disease" was adopted as key words for searching the databases of PubMed, Web of Science, Medline, CNKI and Wanfang data until June 2019.Results:Four cases were diagnosed as distal colonic abnormality by gastroenterography before re-operation. Case 1 had a spasmodic and small distal colon and was confirmed as total colonic aganglionosis by intraoperative pathology. And excellent growth occurred after laparotomic Soave procedure plus nasal feeding of enteral nutrient solution. Severe intestinal adhesion and intestinal anastomotic stenosis were detected in case 2. After a definite intraoperative diagnosis of total colonic aganglionosis, death occurred due to sepsis after anastomosis repairing. Case 3 was consistent with short-segment HD because of a dilation of distal colon. After laparotomic Soave procedure, bowel function recovered. Rectal mucosal biopsy in case 4 after enterostomy indicated that ganglion cells were absent at 3 cm above dentate line. Thus transanal Soave surgery was repeated. A total of 35 literature reports were retrieved and 47 cases of IA complicated with HD included. Intestinal atresia was present in ileum (n=16), ascending colon (n=11) and transverse colon (n=9). None of them was diagnosed as HD before an initial operation. Twenty-two cases underwent one-stage intestinal resection and anastomosis and multiple operations were performed after a definite diagnosis of HD by postoperative pathological diagnosis or recurrent intestinal obstruction. The average number of operations was 3(2-4). And 20 cases underwent intestinal resection with or without anastomosis and enterostomy. Among them, 9 cases were diagnosed as HD before fistula closure with an average number of 2.4±1.1 operations. Multiple operations were performed due to postoperative complications such as intestinal obstruction with an average number of 4 (3, 4.5) operations.Conclusions:Preoperative lower gastroenterography and intraoperative exploration for distal intestinal atresia are vital for diagnosing IA associated with HD. A definite diagnosis may be made on the basis of rectal mucosal biopsy, intraoperative frozen biopsy and postoperative pathology. Optimal surgical approaches should be selected according to the type of atresia and the range of aganglionosis. Accurate resection of affected bowel improves the prognosis.