Objective: Open Ladd's procedure remains the gold standard for intestinal malrotation correction, while laparoscopic techniques have advanced significantly. However, reports on robot-assisted surgery for this condition are lacking. This study evaluates our experience with robot-assisted surgery for malrotation, focusing on its feasibility, safety, and effectiveness. Methods: We performed a retrospective analysis of patients who underwent robot-assisted surgery for intestinal malrotation at our hospital from January 2019 to December 2022. Data on surgical procedures, perioperative management, and follow-up outcomes were collected. Results: A total of 45 patients (mean age: 11.7 days) underwent robot-assisted surgery without conversion to open procedures. All patients were symptomatic, with surgeries completed in an average of 57 min (range: 42-78). The intra-abdominal pressure (IAP) was 5.6 mmHg (range: 5-7), and the endtidal carbon dioxide (ETCO2) was 38.4 mmHg (range: 35-45). Mechanical ventilation lasted an average of 5.2 h (range: 4-9). Initial oral feeding commenced at 3.1 days (range: 2-6) post-surgery, with sufficient feeding achieved by 7.2 days (range: 5-18). The average hospital stay was 12.1 days (range: 9 -27). One patient experienced prolonged hospitalization (27 days) due to abnormal intestinal motility. At an average follow-up of 11 months (range: 6-18), one (2.2 %) patient required redo surgery for obstruction, and three (6.7 %) had incision infections. The remaining 41 patients recovered without complications such as vomiting or abdominal distension. Conclusion: Robot-assisted surgery for intestinal malrotation is a reliable and feasible approach, yielding favorable surgical outcomes. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

The purpose of this study was to retrospectively compare the short-term outcomes of robotic- (RAD) and laparoscopic-assisted duodenal diamond-shaped anastomosis (LAD) in neonates. Neonates who underwent RAD (n = 30) or LAD (n = 38) between January 2019 and December 2022 were analyzed retrospectively. Major patient data were collected, including preoperative, intraoperative, and postoperative information. All patients were neonates below the age of 30 days weighing 4 kg. Thirty (44.1

Objective:To summarize the clinical characteristics of congenital intestinal atresia (CIA) complicating Hirschsprung's disease (HD) and review its diagnostic and surgical experiences.Methods:From May 2016 to August 2021, 5 children were diagnosed as CIA combined with HD at Children's Hospital of Zhejiang University School of Medicine.Retrospective review was conducted for the relevant clinical data.Laparotomy was performed for intestinal obstruction.There were ileal atresia ( n=4) and ascending colon atresia ( n=1). Two children of ileal atresia underwent atresia intestinal resection with primary anastomosis.Another 2 children of ileal atresia and 1 child of colonic atresia underwent atresia intestinal resection and enterostomy. Results:Two children of primary anastomosis underwent a second laparotomy for postoperative intestinal obstruction.Enterostomy was performed for patent anastomosis and microcolon.An association of HD was confirmed by multiple biopsies of distal intestine.Two children of ileal atresia and enterostomy showed abnormal barium enema and both were diagnosed as HD after rectal biopsy.One child of ascending colonic atresia was diagnosed as HD by intraoperative sigmoid biopsy and rectal biopsy.After modified Swenson procedure, all of them survived and recovered well.Total colonic HD ( n=3), total intestinal aganglionosis ( n=1) and long segment HD ( n=1) were confirmed. Conclusion:Identification of colonic morphology, length of sigmoid and intestinal biopsy are essential for surgical correction of intestinal atresia.For lowering the possibility of laparotomy, enterostomy is recommended when colonic function is in doubt.Barium enema and rectal biopsy are important tools for ascertaining the morphologies and functions of colon.

Annular pancreas means that the pancreas head tissue is ring-shaped or pincer-like surrounding and compressing the descending part of the duodenum, causing duodenal obstruction. It accounts for about 15% of cases of duodenal obstruction, and the ratio of men to women is similar. The disease is mainly seen in the neonatal period, and a few cases occur in infants or older children. The pancreatic tissue in the circular pancreas surrounding the duodenum can cause exogenous incomplete duodenal obstruction. If combined with duodenal stenosis and atresia, the lesion is often under the annular pancreas. The anatomical structure of the pancreas changes, and the main pancreatic duct traverses the annular part.

Objective:To summarize the outcomes of robotic-assisted surgical system for congenital intestinal malrotation (CIM).Methods:From August 2020 to June 2021, 15 CIM neonates underwent robotic-assisted surgery.The relevant clinical data、Surgery-related data, postoperative recovery were collected retrospectively.By analyzing the preoperative, intraoperative and prognosis of the children, The robotic-assisted surgical system for congenital intestinal malrotation was summarized.Results:Of the 15 children, 13 were male and 2 female; gestational age 36+ 2 to 40+ 4 weeks; 2 premature infants, 13 term infants; 7 caesarean section, 8 vaginal delivery; operation age (11.7±5.9) d; weight (3 065±377) g; Preoperative ultrasound test showed that 7 cases with volvulus 720, 5 cases with volvulus 540, 3 cases with volvulus 360; 12 cases with biliary vomiting, 3 cases with non-biliary vomiting; 4 cases with combined atrial septal defect, 2 cases with complicated patent artery duct, 2 cases with combined ventricular septal defect and the remaining 7 cases without cardiac malformation. All of them underwent robotic-assisted procedures without any conversion into open surgery.The average operative duration was (57±8) min, the average system installation time (14±3) min, the average intra-abdominal pressure (IAP)(5.6±0.3)mmHg and the average end-tidal carbon dioxide (38.4±4.3) mmHg.The intra-operative bleeding volume was from 1 to 3 ml, the average mechanical ventilation time (5.2±1.8) hours, the average Initial oral feeding time (3.1±1.2) days, the average sufficient feeding time (7.2±1.8) days and the average hospitalization time (12.1±2.7) days.One child was re-operated due to an obstruction of focal intestinal adhesion.Another case was hospitalized for 27 days and it was significantly longer than other children due to abnormal intestinal motility.The remainders recovered well with no postoperative complications such as vomiting, abdominal distension or incision infection.During postoperative follow-ups, all of them were well fed with satisfactory surgical incision healing and normal growth and development.Conclusion:Robot-assisted surgery is both safe and feasible for neonatal CIM and offers excellent outcomes.

Objective:To summarize the major causes of death for congenital omphalocele so as to optimize its treatments in children.Methods:Retrospective review was performed for the clinical data of 15 children dying from omphalocele from June 2015 to June 2022.There were 8 boys and 7 girls.Term was premature (n=5) and mature (n=10). Gestational week, gender, weight, somatotype, complicated malformations and causes were analyzed.Results:Size was giant (n=13) and small (n=2). The associated conditions were pulmonary hypertension (n=13), patent ductus arteriosus (n=13), atrial septal defect (n=15), ventricular septal defect (n=9), congenital diaphragmatic hernia (n=1), non-compaction of ventricular myocardium, bronchopulmonary dysplasia (n=4), Merkel's diverticulum (n=3) and congenital intestinal malrotation (n=9). Neonatal necrotizing enterocolitis (n=1), respiratory syncytial virus infection (n=2) and pneumorrhagia (n=2) occurred during treatment.Eight deaths were due to pulmonary hypertension.Two cases were abandoned due to complicated malformations, one death occurred without repairing congenital diaphragmatic hernia, two deaths were caused by respiratory syncytial virus infection, one child died from heart failure due to non-compaction of ventricular myocardium and another from heart failure after double-outlet RV surgery.Conclusions:Children with congenital omphalocele may die from various causes.And pulmonary hypertension is a major cause.Other diseases and complications should be aggressively managed during hospitalization.

Objective To investigate the expression of Smad3 (mothers against decapentaplegic homolog 3) protein in postnecrotizing enterocolitis stricture and its possible mechanism of action. Methods We used immunohistochemistry to detect the expression characteristics of Smad3 and nuclear factor kappa B (NF-κB) proteins in human postnecrotizing enterocolitis stricture. We cultured IEC-6 (crypt epithelial cells of rat small intestine) in vitro and inhibited the expression of Smad3 using siRNA technique. Quantitative PCR, western blotting, and ELISA were used to detect the changes in transforming growth factor-β1 (TGF-β1), NF-κB, tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and zonula occludens-1 (ZO-1) messenger RNA (mRNA) and protein expressions in IEC-6 cells. CCK8 kit and Transwell cellular migration were used to detect cell proliferation and migration. Changes in epithelial–mesenchymal transition (EMT) markers (E-cadherin and vimentin) in IEC-6 cells were detected by immunofluorescence technique. Results The results showed that Smad3 protein and NF-κB protein were overexpressed in narrow intestinal tissues and that Smad3 protein expression was positively correlated with NF-κB protein expression. After inhibiting the expression of Smad3 in IEC-6 cells, the mRNA expressions of NF-κB, TGF-β1, ZO-1, and VEGF decreased, whereas the mRNA expression of TNF-α did not significantly change. TGF-β1, NF-κB, and TNF-α protein expressions in IEC-6 cells decreased, whereas ZO-1 and intracellular VEGF protein expressions increased. IEC-6 cell proliferation and migration capacity decreased. There was no significant change in protein expression levels of EMT markers E-cadherin and vimentin and also extracellular VEGF protein expression. Conclusions We suspect that the high expression of Smad3 protein in postnecrotizing enterocolitis stricture may promote the occurrence and development of secondary intestinal stenosis. The mechanism may be related to the regulation of TGF-β1, NF-κB, TNF-α, ZO-1, and VEGF mRNA and protein expression. This may also be related to the ability of Smad3 to promote epithelial cell proliferation and migration.

PurposeTo investigate the expression and possible role of Sirtuin1 or Silent mating–type information regulation 2 homolog-1 (SIRT1) in post-necrotizing enterocolitis stricture.Materials and MethodsThe expression characteristics of SIRT1 and TGF-β1 in post-necrotizing enterocolitis stricture were detected by immunohistochemistry. The siRNA-SIRT1 was used to inhibit the expression of SIRT1 in intestinal epithelial cells-6 (IEC-6), and qRT-PCR, WB, and ELISA were utilized to detect the changes of Transforming growth factor-β1 (TGF-β1), nuclear factor (NF)-κB, tumor necrosis factor-α (TNF-α), tight junction protein-1 (ZO-1), and vascular endothelial growth factor (VEGF) expressions. The IEC-6 cell proliferation and migration ability were tested via CCK8 kit and Transwell test. The expression of E-cadherin and Vimentin in cells was detected by immunofluorescence.ResultsThe CRP, IL-6, IL-10, and IFN-γ in the serum of Necrotizing enterocolitis (NEC) intestinal stenosis patients were significantly higher than the reference values. The SIRT1 protein was under-expressed and the TGF-β1 protein was overexpressed in NEC intestinal stenosis tissue. And the expression of SIRT1 was negatively correlated with TGF-β1. At the time of diagnosis of NEC, the expression of SIRT1 decreased in children with respiratory distress syndrome and CRP level increased. After inhibiting the expression of SIRT1 in IEC6 cells, the expression levels of TGF-β1, Smad3, and NF-κB were decreased, and the expression of ZO-1 was also decreased. The proliferation and migration ability of IEC6 cells was decreased significantly, and the expression of E-cadherin and Vimentin proteins in IEC6 cells did not change significantly.ConclusionPromotion of intestinal fibrosis by inflammation may be the mechanism of post-necrotizing enterocolitis stricture. SIRT1 may be a protective protein of NEC. The probable mechanism is that SIRT1 can regulate intestinal fibrosis and can protect the intestinal mucosal barrier function to participate in the process of post-necrotizing enterocolitis stricture.

Objective:To explore the effects of different anesthetic methods on early outcomes of distal radius fracture in children.Methods:For this single-center, prospective, randomized controlled study, 90 children aged 6-12 years undergoing open reduction and internal fixation of distal radius fractures were randomly divided into two groups of nerve block anesthesia (RA, n=45) and general anesthesia (GA, n=45). GA group received routine general anesthesia while RA group ultrasound-guided subclavian brachial plexus block.The major outcomes were range-of-motion score, grip strength test score, 40-item recovery quality score and patient-rated wrist evaluation at Month 1 post-operation.The secondary outcomes were pain scores at preoperative, immediately post-operation, 2/8/24/48/72 h, 2 weeks and 1 month post-operation.Tme and intensity of postoperative peak pain; consumption of paracetamol and codeine tablets at Day 1 (P 1), Day 2 (P 2) and Day 3 (P 3) post-operation, cumulative consumption of paracetamol and codeine tablets 1-3 (T 1-3) post-operation and time of initial dosing of paracetamol and codeine tablets; incidence of nausea and vomiting within 24 h post-operation, incidence of unplanned postoperative hospital admission and anesthetic satisfaction. Results:Finally 44 cases in GA group and 43 cases in RA group completed the data collection at all timepoints.No inter-group statistical significance existed in general profiles ( P>0.05). Pain scores of RA group were lower than those of GA group at immediately post-operation and 2/8h post-operation.And the difference was statistically significant ( P<0.05). Pain score at 24 h post-operation in RA group was higher than that in GA group and the difference was statistically significant ( P<0.05). Peak time of postoperative pain was later in RA group than that in GA group.And the difference was statistically significant ( P<0.05). The consumption of paracetamol and codeine tablets at Day 1 post-operation in RA group was significantly lower than that in GA group ( P<0.05). And cumulative consumption of paracetamol and codeine tablets at Day 1 to Day 3 post-operation was significantly lower in RA group than that in GA group ( P<0.05). Time of initial oral administration of paracetamol and codeine tablets was significantly later in RA group than that in GA group ( P<0.05). No significant inter-group difference existed in joint range-of-motion score or grip strength test score.Patient-rated wrist evaluation score was lower in RA group than that in GA group at Month 1 post-operation ( P<0.05). Total scores of QOR-40, emotional state, physical comfort and psychological support items at Month 1 post-operation were all higher in RA group than those in GA group ( P<0.05). Conclusion:Brachial plexus block anesthesia is more effective than general anesthesia in relieving early postoperative pain, reducing dependence on analgesics and lowering the incidence of nausea and vomiting.More importantly, brachial plexus block anesthesia offers better recovery quality and patient-rated wrist evaluation scores than general anesthesia at Month 1 post-operation.And the application of nerve block technology is promising in pediatric orthopedics

Objective:To explore the options of umbilical localization in abdominal wall reconstruction for umbilical omphalocele in infants.Methods:From January to December 2019, clinical data were reviewed for 55 infants with omphalocele. There were 35 boys and 20 girls with a birth weight range of 1,800 to 3,920 g. There were small omphalocele (n=16), giant omphalocele (n=34) and abdominal hernia after giant omphalocele (n=5). Clinical data were collected from 150 children with normal abdominal wall. Based upon age, they were divided into 6 groups of premature infants, full-term infants, 3-month-old, 6-month-old, 1-year-old and 2-year-old. Each group consisted of 12 boys and 13 girls. By measuring the distance from xiphoid-center of umbilicus (XU) and xiphoid-pubic symphsis (XP) in different age groups, the characteristics of XU/XP in normal children were counted as the basis for guiding umbilical localization and 55 children selected for different surgical approaches according to the size of abdominal wall defects, abdominal wall muscle development and bulge size.Results:XU/XP values of normal abdominal wall children in different age groups had a mean value of 0.54(0.53-0.56). All operations were successful. Umbilical reconstruction was performed for small omphalocele abdominal wall defect (1-2 cm) (n=10) and slightly larger (3-5 cm) in lower edge defect (n=6); giant omphalocele in XU/XP 0.54 (n=29); giant omphalocele due to poor development of abdominal wall muscular layer (n=5). Only abdominal wall skin and fascia layer were sutured without umbilical reconstruction; giant omphalocele after abdominal hernia in XU/XP 0.54 (n=5) and postoperative umbilical position was decent.Conclusions:The position of XU/XP at 0.53~0.56 is an ideal choice for umbilical reconstructing different sizes of omphalocele.

Objective:To explore the regulation of group 2 innate lymphoid cells (ILC2) recruitment by interleukin-33 (IL-33) , to examine the effect of ILC2 on macrophages during peritoneal infection in sepsis and to further elucidate the immune regulatory mechanism of peritoneal infection.Methods:Forty healthy 6 to 8 week-old male C57BL/6 wild-type mice, twenty Il-33 -/- mice on a C57BL/6 background, and ten IL-33 receptor ST2 knockout (Il1rl1 -/-) mice were bred and housed in the SPF Medical Animal Center of Zhejiang University and the University of Pittsburgh, USA. Receipts of sham surgery were designated as controls and underwent identical surgical procedures were septic mice. IL-33 protein was administered to rmIL-33 group via an exogenous intraperitoneal injection and the changes of ILC2 and its intracellular cytokine levels in peritoneal lavage fluid were detected by flow cytometry. The effects of IL-9 and IL-13 secreted by ILC2 on phagocytic ability of macrophages were confirmed by in vitro experiments. Statistical analysis was performed with t-test or one-way ANOVA test. Results:Compared with ILC2 before/after IL-33 stimulation, the proportion of ILC2 in Lin-CD45 + cells of abdominal cavity increased [(9.90±0.80) vs. (18.43±0.46) ]and the proportion of ILC2 in abdominal cavity jumped after IL-33 stimulation and the difference was statistically significant ( P<0.001). The number of ILC2 in abdominal cavity was [(5 786.00±289.50) vs. (17 820.00±324.30) ]and the number of ILC2 spiked in abdominal cavity after IL-33 stimulation and the difference was statistically significant ( P<0.001). C57BL/6 wild-type mice had a marked increase of peritoneal ILC2 recruitment as compared with control group at 24 h postoperatively [(20.50±0.59) vs. (10.83±1.01) ]and the difference was statistically significant ( P=0.001). However, ILC2 in peritoneal cavity of Il-33 -/- and Il1rl1 -/- mice showed no change at 24 h postoperatively. Moreover, the proportion of ILC2 in Il-33 -/- mice were significantly increased after IL-33 stimulation compared to non-stimulation group (10.53±0.47 vs. 19.43±0.87, P<0.001) , so as in the CLP induced septic mice (10.13±0.57 vs. 21.37±0.86, P<0.001). The study of cytokine levels secreted by ILC2 recruited from abdominal cavity showed that the levels of IL-9 and IL-13 secreted by ILC2 in abdominal cavity increased markedly at 12 h postoperatively and the contents of IL-9 before/after operation were [(16.53±0.74) vs. (24.67±1.45) ]and the differences were statistically significant ( P= 0.007). The proportions of IL-13 at pre/post-operation were [(15.40±0.87) vs. (29.40±0.95) ]and the differences were statistically significant ( P<0.001) while the contents of IL-4 were [(6.14±0.59) vs. (5.89±1.05) ]and the differences were not statistically significant ( P=0.836). An intraperitoneal injection of recombinant IL-33 protein promoted the recruitment of CD45 +F4/80 + macrophages in peritoneal cavity and the proportions before/after injection were [(52.40±1.70) vs. (72.40±2.02) ]and the difference was statistically significant ( P=0.002). Under the action of IL-9/13 secreted by ILC2, phagocytic ability of macrophages was markedly elevated as compared with control group. Phagocytic ability of macrophages under the action of IL-9 was [(61.27±1.46) vs. (48.30±1.65) ]and phagocytic ability of macrophages under the action of IL-13 was [(61.63±2.03) vs. (48.30±1.65) ]and the difference was statistically significant ( P=0.007). Conclusions:IL-33 promotes ILC2 and macrophage recruitment during peritoneal sepsis. And the recruitment of peritoneal ILC2 depends on IL-33/ST2 signaling pathway. Peritoneal ILC2 derived cytokines IL-9 and IL-13 enhance the phagocytosis of macrophages.

目的 探讨谷氨酰转肽酶(GGT)联合直接胆红素(DBIL)、天冬氨酸转氨酶/血小板指数(APRI)诊断胆道闭锁(BA)的价值.方法 回顾性分析283例婴儿胆汁淤积性肝病患者的临床资料,经胆道探查、胆道造影及肝活检确诊为BA者138例为BA组,术中排除或内科治疗后黄疸消退者145例为Non-BA组.收集患者首次入院的一般资料、首次同期血液学检查结果,包括日龄、性别、体质量、GGT、DBIL、间接胆红素(IBIL)、总胆汁酸(TBA)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血小板计数(PLT);并计算APRI.采用ROC曲线评价各指标对BA的诊断价值.结果 BA组患者体质量、GGT、TBA、DBIL、IBIL、AST、ALT、APRI水平均显著高于Non-BA组(P<0.05).ROC曲线显示,GGT诊断BA的曲线下面积(AUC)最大,为0.845(95％CI:0.801～0.890),当GGT为临界值264 U/L时,其敏感度和特异度分别为0.732和0.814;GGT+DBIL、GGT+APRI联合诊断BA的AUC分别为0.880(95％CI:0.840～0.919)和0.871(95％CI:0.830～0.912).结论 GGT对BA具有较好的诊断价值,GGT联合DBIL、APRI对BA的诊断价值优于GGT单独诊断.

目的 分析不同出生体重十二指肠梗阻新生儿腹腔镜手术治疗过程中的临床资料,为腹腔镜手术治疗新生儿十二指肠梗阻的安全性和可行性提供参考依据.方法 回顾性分析浙江大学医学院附属儿童医院新生儿外科2017年6月至2019年6月收治的42例因十二指肠梗阻接受腹腔镜手术治疗的新生儿病例资料,根据体重分为正常出生体重组、低出生体重组和极低出生体重组,监测手术相关指标以及CO2气腹前后的血气指标.结果 低出生体重组16例(男4例,女12例),极低出生体重组6例(男4例,女2例),正常出生体重组20例(男10例,女10例).三组术中出血量(F=0.1,P=0.905)、手术时间(F=0.636,P=0.535)、术后拔管时间(F=1.244,P=0.299)、术中体温(F=1.303,P=0.283)差异均无统计学意义;出血量/出生体重(F=5.681,P=0.007)、初次喂养到全量喂养时间(F=11.638,P<0.001)、术中体温波动(F=18.09,P<0.001)差异有统计学意义.血气分析结果显示,各组患儿CO2气腹建立前后血气中pH值、PaCO2、PaO2、SO2、HCO3-、SBE值均有变化.气腹建立后,患儿血气中pH值均降低,PaCO2均上升.结论 腹腔镜技术在不同出生体重新生儿十二指肠梗阻中的应用是安全可行的,术中要尤其关注出血量,加强体温监测,关注CO2气腹对血气的影响并及时调整.

Objective:To explore current status of pediatric ambulatory surgery in mainland China and provide references for formulating an expert consensus.Methods:The literatures with such keywords as ambulatory surgery, one-day surgery and one-day operation for pediatrics were retrieved from the databases of Wanfang DATA, VIP Database for Chinese Technical Periodicals and CNKI (China National Knowledge Infrastructure). Based upon the outstanding issues, a questionnaire was designed and completed via a WeChat link. Data analysis was performed with Excel and IBM SPSS 22.0 statistical software.Results:A total of 151 articles were published by 108 organizations, including 1 (0.7%) guideline, 21 (13.9%) reviews, 123 (81.5% ) clinical trials, 3 (2.0%) dissertations and 3 (2.0%) popular science articles. However, there was no multi-center research. Since the first paper was published in 1996, 74 articles (49%) were published in recent 3 years. For institutions, 115 (76.2%) from class IIIA hospitals and 93 (61.6%) from general hospitals; For research areas, nursing (37), anesthesia (48), clinical summary (43) and management (20), especially psychology (3) and ERAS (14). A total of 72 questionnaires were received. There were 64 class IIIA hospitals (88.9%) and 43 at general hospitals (59.7%). Moreover, 59 (81.9%) hospitals set up day surgery management committees or working groups, 49(68.1%) surgeons acted as the directors of day surgery centers, 34 (47.2%) hospitals were independent day surgery centers and 58 (80.6%) operated anesthesia clinics. For management, preoperative evaluation plans were conducted at 70 (97.2%) hospitals, perioperative patient education was implemented at 69 (81.9%) hospitals, surgeon admission standards were applied at 61 (84.7%) hospitals, 62 (86.1%) operated follow-up systems, 59 (81.9%) implemented day surgery performance assessment programs, 51 (70.8%) had quality assessment program and 46 (63.9%) operated day surgery information management systems.Conclusions:With a rapid development of pediatric ambulatory surgery, safety always comes first. The system of ambulatory surgery should be strictly formulated and implemented. Class IIIA hospitals are major institutions for practicing ambulatory surgery for pediatrics. More multi-center studies and ERAS during ambulatory surgery are recommended. Promoting the formulation of standards for ambulatory surgery for pediatrics may contribute to its expansion at primary hospitals.

BackgroundIntussusception secondary to pathologic lead points (PLPs) is a potential surgical emergency and almost all cases need surgery. The aim of this study was to evaluate the clinical manifestations, physical examinations and surgical outcomes of secondary intussusception (SI) caused by PLPs, as well as to improve the diagnosis and treatment of PLPs in children and infants.Materials and methodsWe retrospectively reviewed the records of 83 children and infants who were diagnosed with intussusception secondary to PLPs in our institution. The ultimate diagnosis was dependent on histopathological findings under a microscope by a pathologist. Patients were divided into a younger group (<2years old) and the older group (>2years old) according to age. Patient demographics, clinical manifestations, duration of symptoms, auxiliary examinations, and the presence of pathological lead point were recorded.ResultsA total of 83 patients were found with intussusception secondary to PLPs in this study. Patients were aged from 4days to 14 years, with a mean age of 3.8years (median 1.5; range 0-14years). There were 47 cases in the younger group and 36 cases in the older group. The main clinical symptoms were intermittent crying or abdominal pain. PLPs were observed in only ten patients on US (12%). Ten patients underwent enteroscopy examination for further diagnosis, and all the patients had positive findings including seven cases of Peutz-Jeghers syndrome and three cases of benign polyps. Technetium-99m pertechnetate scans were performed in ten patients and five patients had positive results (50%). Based on the surgical findings, complex/compound is the most common type of intussusception, followed by small intestinal and ileo-colic type. The main types of PLPs were Meckel's diverticulum (n=31), duplication cyst (n=19) and benign polyps (n=13). Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among children younger than 2years, accounting for 81% (38/47) of the cases. The most common causes of secondary intussusception in children older than 2years were intestinal polyps, Meckel's diverticulum and Peutz-Jeghers syndrome, accounting for 72% (26/36) of the cases.ConclusionsThe presence of a pathological lead point is more likely in older children. The most common types of intussusception secondary to PLPs are complex/compound and small intestinal. Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among younger children and Peutz-Jeghers syndrome and intestinal polyps were commonly seen in older children.

Objective To evaluate the application of multidisciplinary treatment (MDT) and Double Sinks (DS ,top-down hospital & talent services) policy during enhanced recovery after surgery (ERAS) for perioperative management of congenital hypertrophic pyloric stenosis (CHPS) .Methods From January 2015 to December 2018 ,a total of 230 CHPS infants received traditional model (traditional group ,n= 178) and ERAS model (ERAS group ,n= 52) during perioperative management .Age at admission ,time of disease course ,nutritional status ,incidence of preoperative respiratory infection ,blood gas electrolyte analysis at admission , preoperative length of stay , leucocyte counts (WBC ) and C-reactive protein (CRP ) at postoperative Day 1 , postoperative length of stay , hospitalization expenses and age at discharge were recorded and compared .Results Age at admission [(32 .9 ± 8 .4) vs .(41 .4 ± 18 .2) days] ,total length of stay [(9 .2 ± 5 .0) vs .(13 .7 ± 10 .8) days] ,incidence of preoperative respiratory infection [3 .85％ vs . 15 .19％ ] ,preoperative length of stay [(3 .91 ± 1 .13) vs .(7 .21 ± 2 .81) days] ,postoperative length of stay [(3 .91 ± 1 .13 ) vs . (7 .21 ± 2 .81 ) days ] , hospitalization expenses [(11290 .13 ± 1725 .19 ) vs . (14676 .21 ± 4620 .72) RMB] and age at discharge [(39 .4 ± 9 .6) vs .(52 .4 ± 18 .2) days] in ERAS group were superior to those in traditional group and there were significant inter-group differences (P≤ 0 .001 or <0 .05) .No significant inter-group difference existed in WBC /CRP at postoperative Day 1 .MDT and DS were co-correlated with age at admission ( -0 .273 ,P< 0 .001) ,preoperative length of stay (0 .324 ,P< 0 .001) , postoperative length of stay (0 .205 ,P= 0 .006) ,hospitalization expenses (0 .399 , P< 0 .001) and age at discharge ( - 0 .201 ,P= 0 .007) .Conclusions ERAS model may promote postoperative recovery and reduce hospitalization expenses .And MDT helps to shorten preoperative length of stay and DS may reduce age at admission and lower the incidence of preoperative respiratory infection .Both are indispensable and important components of ERAS measures during perioperative management of infantile CHPS .

Objective To explore the clinical characteristics and prognoses of neonatal alimentary tract perforation.Methods Retrospective review was conducted for 65 neonatal cases with alimentary tract perforation confirmed intraoperatively from January 2015 to December 2016.There were 43 boys and 22 girls.They were premature (n =45) and full-term (n =20).The perforations were gastric (n=7,group A),intestinal (n=34,group B),colonic (n=22,group C) and biliary tract (n=1,group D).The major clinical manifestations were abdominal distention and pneumoperitoneum.Results Gastric perforation tended to occur at the age of ＜5 days.Premature alimentary tract perforation was located in small intestine (n =29,64.4％).And the causes were neonatal necrotizing enterocolitis (NEC,n=26,57.8％),H irschsprung's disease (HSCR,n =5,11.1％) and idiopathic intestinal perforation (n =4,8.9 ％).For term infants,alimentary tract perforation was predominantly located in colon (n =11,55.0％).And the causes were Hirschsprung's disease (n =4,20.0％),congenital defects of gastric musculature (n=4,20.0％) and neonatal necrotizing enterocolitis (n =3,15.0％) respectively.No significant difference existed in distribution among groups A,B and C according to birth weight (P＞0.05).Preoperative pH value of group B (7.31 ± 0.10) was significantly lower than that of group C (7.38 ± 0.12) and preoperative hemoglobin of group C (117.6 ± 31.2) g/L was significantly lower than that of group A (161.1 ± 32.9) g/L and B (137.8 ± 34.5) g/L.No significant difference existed in preoperative levels of lactic acid or albumin (P＞0.05) among groups A,B and C.And 4/65(6.2％) died and no significant difference existed in mortality rate with regards to gestational age,birth weight or perforation site.Eight (13.1％) cases had incision infections.Conclusions Neonatal alimentary tract perforation occurs frequently in premature boys.Premature alimentary tract perforation is located predominantly in small intestine and the etiology is NEC.For term infants,alimentary tract perforation is found predominantly in colon and the etiologies include HSCR and congenital defects of gastric musculature.A better prognosis of alimentary tract perforation may be achieved after active,timely and standardized treatments.

目的:探讨先天性腹裂的产前诊断、一期手术的效果和术后腹腔压力的变化特点.方法:回顾分析浙江大学医学院附属儿童医院2014年1月至2018年12月期间收治15例先天性腹裂患儿的产前B超、诊治过程和预后的临床资料.结果:产前B超最早在孕10周发现腹壁异常,孕18～24周明确诊断.15例患儿中,1例伴发复杂畸形放弃治疗,余14例均行一期手术治疗.术后腹腔压力最高不高于15 mmHg,术后3 d降至正常范围.1例患儿术后2月因肺炎、呕吐窒息死亡,余13例存活患儿生长发育情况正常.结论:先天性腹裂是新生儿一种严重的先天性畸形,产前B超可早期发现,一期手术后腹腔压力很快恢复正常范围.术后监护、合理的营养支持可以取得良好的治疗效果.

BACKGROUND This study aimed to investigate the effects of maresin-1 (MaR1) in a mouse model of caerulein-induced acute pancreatitis (AP). MATERIAL AND METHODS Fifty C57BL/6 mice with caerulein-induced AP were divided into the untreated control group (N=10), the untreated AP model group (N=10), the MaR1-treated (low-dose, 0.1 μg) AP model group (N=10), the MaR1-treated (middle-dose, 0.5 μg) AP model group (N=10), and the MaR1-treated (high-dose, 1 μg) AP model group (N=10). Enzyme-linked immunoassay (ELISA) measured serum levels of amylase, lipase, tumor necrosis factor-alpha (TNF-alpha), interleukin-1ß (IL-1ß), and IL-6 and mRNA was measured by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Malondialdehyde (MDA), protein carbonyls, superoxide dismutase (SOD), and the ratio of reduced glutathione/oxidized glutathione (GSH/GSSG) were measured. Histology of the pancreas included measurement of acinar cell apoptosis using the terminal-deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL) assay. Western blot measured Toll-like receptor 4 (TLR4), MyD88, and phospho-NF-kappaB p65, and apoptosis-associated proteins Bcl-2, Bax, cleaved caspase-3, and cleaved caspase-9. RESULTS Following treatment with MaR1, serum levels of amylase, lipase, TNF-alpha, IL-1ß, and IL-6 decreased, MDA and protein carbonyl levels decreased, SOD and the GSH/GSSG ratio increased in a dose-dependent manner. In the MaR1-treated AP mice, inflammation of the pancreas and the expression of inflammatory cytokines, pancreatic acinar cell apoptosis, Bcl-2 expression, and expression of TLR4, MyD88, and p-NF-kappaB p65 were reduced, but Bax, cleaved caspase-3, and cleaved caspase-9 expression increased. CONCLUSIONS In a mouse model of caerulein-induced AP, treatment with MaR1 reduced oxidative stress and inflammation and reduced apoptosis.

目的 探讨加速康复外科理念指导下日间手术模式治疗小于1岁腹股沟斜疝患儿的价值.方法 收集浙江大学医学院附属儿童医院2015年2月至2018年11月收治的小于1岁的腹股沟斜疝患儿571例作为研究对象.根据是否采用日间手术模式治疗将患儿分为日间组和对照组(常规住院流程治疗),进一步根据是否采用腹腔镜手术分为腔镜日间组(n=41)、腔镜对照组(n=211)、开放日间组(n=192)和开放对照组(n=127).腔镜日间组和腔镜传统组患儿平均年龄分别为(8.2±2.6)个月和(8.9±2.4)个月,差异无统计学意义(t=-1.536,P=0.126);双侧腹股沟斜疝比例分别为34.14％(14/41)和40.76％(86/211),差异无统计学意义(χ2=0.627,P=0.428).开放日间组和开放传统组患儿平均年龄分别为(8.7±2.8)个月和(7.1±3.6)个月,差异有统计学意义(t=-4.126,P<0.001),双侧腹股沟斜疝的比例分别为16.67％(32/192)和21.26％(27/127),差异无统计学意义(χ2=1.070,P=0.301).比较加速康复外科理念指导的日间手术模式和传统住院手术模式在住院时间、住院费用、术后并发症发生率、非计划再次就诊率、非计划再次入院率和日间手术延迟出院率等方面的差异.结果 日间组在住院时间和住院费用上优于对照组(P<0.05).日间组当日手术取消率为4.72％(11/233),低于对照组的13.31％(45/338),差异有统计学意义(χ2=11.512,P=0.001).日间组术前禁清饮时间(132±5)min,短于对照组的(148±13)min,差异有统计学意义(t=19.483,P<0.001).日间组术后初次进食清饮和奶的时间分别为(49±7)min和(124±12)min,短于对照组的(124±12)min和(305±35)min,差异均有统计学意义(P<0.001).2018年10月起日间流程患儿术前予右美托咪定滴鼻镇静,进入手术室的哭吵发生率为22.2％(6/27),低于对照组的73.33％(33/45),差异有统计学意义(χ2=17.757,P<0.001).日间组术后哭吵发生率为30.39％(31/102),低于对照组的61.80％(55/89),差异有统计学意义(χ2=18.939,P<0.001).在并发症方面,日间组术后发热和呕吐的发生率分别为5.15％和3.00％,低于对照组的10.36％和11.83％,差异有统计学意义(P<0.05);而非计划就诊率日间组为2.15％,与对照组(2.07％)比较差异无统计学意义(χ2=0.004,P=0.951).两组患儿均无非计划入院患儿,日间组有3例(1.29％)延迟出院,对照组有1例腹股沟斜疝复发.结论加速康复外科理念指导下日间手术模式治疗小于1岁腹股沟斜疝安全可行,并优于传统住院手术模式.