全肺切除术在小儿患者中实施较少，其安全性及预后尚需进一步探究。本文通过回顾性分析2016年8月至2022年8月在我院行全肺切除术的9例患儿，并查阅相关文献。结果显示全组患儿手术顺利，无术中并发症，无围手术期死亡。术后随访2~74个月，1例肺转移瘤因肿瘤复发转移死亡；1例术后出现脊柱侧弯、患侧胸廓稍塌陷以及胃食管反流；余患儿无明显不适。本研究表明小儿能很好的耐受全肺切除手术，总体预后良好。

Objective:To explore the approach and clinical effiacay of thoracoscopic patch repair of posterolateral diaphragmatic hernia in children.Methods:Clinical data were retrospectively reviewed for 16 children undergoing thoracoscopic patch repair of posterolateral diaphragmatic from March 2016 to May 2021.There were 9 boys and 7 girls with an average age of 22(1-132) month.During repairing, patch was sutured and fixed on chest wall with a hernia needle.And the other edge of patch was continuously sutured with the corresponding edge of diaphragm defect for a complete closure.Clinical characteristics, operative duration, volume of blood loss, retention time of thoracic drainage tube, length of stay in intensive care unit (ICU) and clinical outcomes were summarized.Results:The involved side was right (n=5) and left (n=11). And there were hernia sac (n=12) and without hernia sac (n=4). According to the classification scheme of Congenital Diaphragmatic Hernia Study Group (CDHSG), the clinical types were B (n=13) and C (n=3). All of them underwent thoracoscopy without any conversion into thoracotomy.The longest operative duration was 110 min and the longest 255 min.There was minimal intraoperative hemorrhage.The postoperative thoracic drainage tube was placed for (0-10) day and the length of stay in ICU (0-11) day.All of them were discharged smoothly.One case recurred at 2 years postoperatively.During a follow-up period of (7-69) month, there was no chest wall malformation and growth and development were decent.Conclusions:Thoracoscopic patch repair of diaphragmatic hernia is feasible.And hernia needle may simplify the operation and continuous suturing shortens operative duration.

Objective:Mediastinal tumor invades spinal canal and results in spinal cord compression. Some patients develop severe spinal deformities after a decompression of spinal cord. The optimal therapeutic strategy for mediastinal tumor with intraspinal extension remains elusive. Our study was to assess the clinical characteristics and therapeutic strategies for mediastinal tumor with intraspinal extension.Methods:From January 2011 to May 2020, 117 children of mediastinal tumors with intraspinal extension were recruited. Clinical features, personal demographics, neurologic recovery and survival rate were assessed.Results:Among 117 children with mediastinal tumors with intraspinal extension, there were neuroblastoma (n=46) , ganglioneuroblastoma (n=21) , gangliobastoma (n=10) , primitive neuroectodermal tumor (PNET, n=5) , lymphoma (n=8) , teratoma (n=5) , rhabdomyoid tumor (n=5) , rhabdomyosarcoma (n=3) and miscellaneous (n=14) . Initial neurological symptoms were present in 63 children. In chemotherapy group, neurological deficits improved (13/23, 56. 5%) ; in those undergoing neurosurgical intervention, neurological deficits improved (30/40, 75%) . In children with moderate-to-severe neurological deficits, compression manifestations of ≤4 weeks duration showed an improved outcome compared to a longer compression time, with complete recovery of neurological function in 66. 7% of children versus 8. 7% for those with a longer symptom duration ( P<0. 001) . Conclusions:Symptoms of posterior mediastinal tumors are nonspecific and spinal cord compression is evident in some patients. Neurological recovery is correlated with the type of initial treatment and duration of neurological symptoms.

Objective:To explore the application of three-dimensional reconstruction plus indocyanine green fluorescent navigation during segmental pulmonary resection in children with congenital pulmonary airway malformation (CPAM).Methods:From March 2019 to June 2020, 28 CPAM children underwent preoperative three-dimensional (3D) computed tomography (CT) reconstruction and indocyanine green fluorescent staining during operation. There were 18 boys and 10 girls with a median age of 1.2(5/12-2.5) years. Preoperative surgical planning was performed for determining the range of pulmonary segmental resection and the level/sequence of ligating bronchus, arteries and veins. Pulmonary arteries and veins were dissected by the method of "dimensionless anatomy" .Results:Indocyanine green was injected intravenously at 0.25 mg/kg. Staining was effective (82.14%, 23/28) and ineffective (17.86%, 5/28). Two cases of lung tissue leakage healed spontaneously after conservative measures. Routine CT examination was performed at 3 months postoperatively and there was no residual lesion.Conclusions:3D CT reconstruction plus indocyane green fluorescent staining and sound surgical planning can improve the accuracy and safety of CPAM surgery in children and has a great real-time guiding significance.

回顾2008年2月至2018年2月18例先天性膈疝合并肺隔离症患儿临床资料，总结其临床特征，并探讨诊断和治疗方法。全组后外侧膈疝17例，食管裂孔疝1例；肺隔离症叶外型15例，叶内型3例。仅1例术前诊断先天性膈疝合并肺隔离症，余17例术前仅诊断膈疝或膈膨升，术中或术后确诊肺隔离症。18例均同期行隔离肺切除、膈疝修补术。术后1例因肺炎死亡；17例恢复顺利出院，随访10～26个月生长发育正常。合并先天性膈疝的肺隔离症容易漏诊，同期行隔离肺切除以及膈疝修补术，效果满意。

目的:比较对胆总管囊状扩张症患儿进行3D腹腔镜手术与2D腹腔镜手术的效果.方法:将2014年1月至2019年1月广州市妇女儿童医疗中心收治的354例胆总管囊状扩张症患儿随机分为对照组(n=211)与观察组(n=143).对对照组患儿与观察组患儿分别进行2D腹腔镜手术与3D腹腔镜手术,然后比较两组患儿手术的时间、术后住院的时间及术后并发症的发生率.结果:观察组患儿手术的时间短于对照组患儿,P<0.05.两组患儿术后住院的时间及术后并发症的发生率相比,P>0.05.结论:与对胆总管囊状扩张症患儿进行2D腹腔镜手术相比,对其进行3D腹腔镜手术可缩短手术的时间.与对此病患儿进行2D腹腔镜手术相比,对其进行3D腹腔镜手术在降低其术后并发症的发生率和缩短其术后住院的时间方面并没有明显的优势.

Objective To explore the surgical approaches and efficacies for mediastinal lymphatic malformations(MLM)in children.Methods The clinical data were retrospectively analyzed for 25 MLM children from February 1,2012 to February 28,2017.There were 17 boys and 8 girls with an average age of 15 months.The lesion sites were right upper mediastinum(4/8 involving neck region)(n=8),left upper mediastinum(6/7 involving neck region)(n=7),posterior mediastinum(n=2),anterior mediastinum(n=5)and two or more regions(n=3).There were vascular wrapping(n=17)and airway compressing(n=14).The procedures were video-assisted thoracoscopy(n=4)and conventional thoracotomy(n=21).And the latter included cervical incision(n=2),cervical thoracic incision(n=8),posterolateral thoracic incision(n=8)and median sternotomy(n=3).Besides surgery,18 cases received drug therapy.Results Innominate vein(n=1)and phrenic nerve(n=1)were injured intraoperatively.All lymphatic malformations were confirmed by histological examinations.And the histological types were macrocystic(n=14),microcystic(n=4)and combined(n=7).Two cases were lost to follow-ups while the remainders were followed for 5-56 months.Recurrence occurred in 2 cases while another one required re-operatioa And 3/6 cases of lymph leakage underwent puncture and drainage.Among 9 cases of diaphragmatic eventration,3 were surgically repaired by lifting 1-2 intercostal spaces while the remainders self-restored within 1-6 months.There was 1 case of chest wall deformity.Conclusions Surgery is efficacious for mediastinal lymphatic malformations in children.

Objective To discuss the approach of imaging diagnosis and the result of minimally invasive surgery for neonatal duodenal obstruction. Methods From January, 2014 to January, 2019, 207 children with neonatal duodenal obstruction treated by laparoscopic surgery were chosen for the paper; of whom, 138 were male and 69 female. The age of surgery was 1 to 28 d, with an average of (7.41±7.81) d. The positive rates of antenatal diagnosis, abdominal X-ray, B-ultrasound, and upper gastrointestinal contrast of neonatal duodenal obstruction were compared. Minimally invasive surgery: diaphragm excision was adopted for duodenal septum, duodenal diamond anastomosis or side-to-side anastomosis for duodenal atresia and annular pancreas, and Ladd's surgery for malrotation. The patients were followed up for 2 months to 5 years. The hospital stay and incidence of postoperative complications were compared. Results The positive rates of antenatal diagnosis, abdominal X-ray, B-mode ultrasound, and upper gastrointestinal contrast were 35.3％, 55.1％, 86.5％, and 92.9％, respectively, with statistical differences (P < 0.05). The hospital stay of the malrotation group, the duodenal septum or atresia group, and the annular pancreas group were (16.03±7.39) d, (21.96±10.58) d, and (20.77±10.42) d, respectively; that of the malrotation group was statistically different from those of the other two groups (P < 0.05). 1 case(0.48％) had postoperative anastomotic fistula; 16 (7.73％) intestinal obstruction at different stages after surgery, of which 9 were malrotation (5 cases reoperated); 6 duodenal septum and atresia (4 cases reoperated); and 1 annular pancreas (reoperated). There was no statistical difference in complications among the three groups (P > 0.05). Conclusion The positive rate of upper gastrointestinal contrast of neonatal duodenal obstruction is the highest; B-ultrasound remains the preferred diagnostic approach; and an increasing number of child patients can be diagnosed before birth. Minimally invasive surgery is a growing trend of pediatric surgery, while laparoscopic surgery is an effective approach for neonatal duodenal obstruction. Anastomotic obstruction is the main complication of duodenal septum or atresia and annular pancreas after surgery, while the recurrence of volvulus caused by postoperative adhesion is the main complication of Ladd's surgery.

Objective To explore the timing and method of laparoscopic surgery for newborns with congenital cystic dilatation. Methods One hundred and forty nine 0-12 months old children with congenital cystic dilatation treated by laparoscopic surgery at our center from December, 2011 to December, 2018 were selected, and were divided in a newborn group (age < 28 days), a small infant group (28 days ≤ age < 90 days), and a big infant group (90 days ≤ age ≤12 months). The operation time, relative bleeding volume during operation, postoperative complications, hospitalization time, and liver function before operation were compared among these 3 groups. According to the postoperative pathological results, the incidences of inflammation and cirrhosis were compared. Results There were no statistical differences in the operation time among these 3 groups (P >0.05). The bleeding volume of the big infant group was statistically different from those of the rest two groups (P< 0.05). The hospitalization time in the newborn group was longer than those in the other two groups (P < 0.05). The level of alanine aminotransferase (ALT) in the newborn group was statistically different from those of the rest two groups (P < 0.05). There was statistical difference in the level of glutamic-oxalacetic transaminase (AST) between the newborn group and the small infant group (P < 0.05), but not between the newborn group and the big infant group and not between the small infant group and the big infant group (P > 0.05). The incidences of obstructive jaundice, complications, and cirrhosis were 75.6％, 7.3％, and 17.1％ in the newborn group, which were higher than those in the infant group (all P < 0.05). The incidencea of choledochal calculus and inflammation were higher in the big infant group than in the rest two groups (P < 0.05). Conclusion Early surgery for neonates with choledochal cyst may reduce the incidences of obstructive jaundice, choledochal inflammation, choledochal calculus, and cirrhosis. If the technical conditions permit, laparoscopic choledochal cyst resection should be performed in infancy, so as to lower the incidence of postoperative complications. Laparoscopic choledochal cyst resection and Roux-Y hepaticojejunostomy in treatment of infancy congenital cystic dilatation have a good effect.

Objective To investigate the application of 3-D scanning in the diagnosis and evaluation of pectus excava-tum.Methods From July 2016 to June 2017, chest CT concomitant 3-D scanning were performed in 90 pectus excavatum pa-tients before Nuss procudure.Another 30 cases underwent chest CT scanning for non-chest deformity causes were chosen as a control group.The transverse and anterior-posterior maximum diameter through the deepest point of chest wall deformity were measured.The surface topography index and Haller index were calculated respectively .Results There was a positive correla-tion between CT and 3-D scanning diameters of the transverse and anterior-posterior maximum diameters, and consistency rates were 94% and 82%, respectively.There was significant difference between pectus excavatum group 1.82 ±0.21 and control group 1.41 ±0.07 in the STI(P<0.001).There was a positive correlation between Haller index 5.12 ±3.36 and STI 1.82 ± 0.21, and consistency rate was 89%.The Delong's test showed no significant difference between ROC of HI and STI(Z =1.18, P=0.28).Conclusion 3-D scanning and STI of pectus excavatum is a validated alternative for CT and Haller index, especially in the infant and non-surgical treatment PE cases.

Objective To explore the application and practicality of hernia -repair needle for repairing diaphragmatic hernia. Methods Three children underwent thoracoscopic diaphragmatic operations from No-vember 2015 to December 2015.All of them were diagnosed as diaphragmatic hernia with chest wall diaphragm-defective.And one case required patching.Results All operations were successful.The operative duration was 85 -120 minutes and postoperative mechanical ventilation time 4 -92 hours.Two cases required 2 -day chest tube drainage.Radiography and ultrasound showed no abnormalities before discharge.And there was no recurrence during a follow-up period of 3 months. Conclusions Diaphragmatic hernia with chest wall dia-phragm -defective may be more readily and securely repaired thoracoscopically with a hernia-repair needle.

目的 探讨食管闭锁Ⅰ期吻合术后吻合口漏发生的相关因素及治疗方法.方法 回顾性研究2007年1月～2017年1月我中心Ⅰ期行食管吻合/气管食管瘘修补术168例的临床资料,对吻合口漏发生的相关因素及愈合时间进行分析.结果 术后吻合口漏36例(21.43％),出现时间＜5 d者8例(22.22％),5～10 d者26例(72.22％),＞10 d者2例(5.56％)(P＜0.05).19例(52.78％)吻合口漏于1～2周愈合,11例(30.56％)2～4周愈合,4例(11.11％)4～6周愈合(P＜0.05).Ⅲa型43例,发生吻合口漏22例(51.16％),Ⅲb型117例,发生吻合口漏14例(11.97％),两者比较差异有统计学意义(P＜0.05).而出生体重、心脏畸形、胃食管反流及食管狭窄各组吻合口漏的发生率比较,差异无统计学意义(P＞0.05).结论 食管吻合口漏多发生于术后5～10 d.食管闭锁分型是Ⅰ期吻合术后吻合口漏发生的影响因素之一.术后吻合口漏经保守大多可在4周内愈合.

Objective To explore the application skills and practicality of the hernia needle in diaphragm surgery. Methods Thoracoscopic diaphragmatic surgery was conducted in 4 cases of diaphragmatic hernia with chest wall diaphragmatic defect and 2 cases of diaphragmatic eventration from November 2015 to February 2016 in our hospital.By using the hernia needle, direct suture close, patch repair,or diaphragmatic folding and interrupted suture were carried out. Results All the operations were successful, with a postoperative mechanical ventilation time of 4 -92 hours(median,5 h).The chest tube drainage was applied in 2 cases, and was removed after 2 days.Mild pleural effusion happened in 1 case of diaphragmatic eventration.The X-ray and ultrasound showed no abnormalities before discharge.Follow-ups for 1-3 months showed no recurrence. Conclusion Thoracoscopic repair with hernia needle for chest wall diaphragmatic defect diaphragmatic hernia and diaphragmatic plication is simple to perform.

Objetive This study aimed to analyze the treatment experience of Nuss procedure combined with simultaneous thoracic procedures. Methods A total of 501 patients,who underwent minimally invasive pectus repair in Nuss technique over 8 years,from 2007 to 2015,were retrospectively analyzed. Results 5 patients (3 male and 2 female;age:4 —months,8 —months,3 —years,1 —years and 9 months,11years)under-went the Nuss procedure with concomitant thoracic lobectomy for congenital cystic lung lesion.The mean Haller index:5.12 (range,3,57 ~7.19).The pathology results showed that:1 case with congenital lobar emphyse-ma,and 4 cases with congenital adenomatoid cystic malformation,one of which combined with bronchogenic cysts.All patients underwent a 1-stage procedure with subsequent simultaneous Nuss procedure.The average operating time was 176mins(90 ~300),the blood loss 80ml (30 ~120),the weaning mechanical ventilation time 8.2h(3 ~19).The post-operative complication was observed in 1 case with subcutaneous emphysema.At follow-up (1 ~26 months),5 patients had excellent cosmetic results and good quality of life confirmed by a questionnaire. Conclusions Thoracic lobectomy and subsequent Nuss procedure can be performed simultane-ously with a satisfactory short and moderate-term effect.One-stage operation helps patients with pectus excava-tum concomitant congenital cystic lung lesion recover.

Objetive To enhance the awareness of pulmonary sequestration. Methods Twenty cases of pulmonary sequestration in children between March 2008 and October 2014 were analyzed retrospectively. And their clinical characteristics,diagnosis and treatment were analyzed. Results Pulmonary sequestration in children was not easily diagnosed because of complications with other congenital malformations.Segmentomy to intralobar pulmonary sequestration and sequestrectomy to extralobar pulmonary sequestration were generally ef-fective without operative complication or death. Conclusions Pulmonary sequestration in children are easily misdiagnosed prior to operation.Once definitely diagnosed,optimal choice is a removal of sequestration.

Objetive To determine the clinical manifestations,the surgical approach and management outcomes of paediatric patients with primary tumours of the mediastinum who underwent surgery. Methods A retrospective single-centre study was undertaken into patients with primary tumour of the mediastinum who un-derwent surgery between January 2010 and December 2014.We analysed demographic data,clinical presenta-tion,surgery procedure,lesion location and histological diagnosis. Results 58 patients underwent surgery,to-tal excision was performed in 52 patients,subtotal resection in 6 patients.33male (56.9%)and 25 female (43.1%).Mean age was 4.5 months (15 days ~12 months).The primary tumours included neurogenic tumours (51.7%),germ cell tumours (24.1%),thymic neoplasms (3.4%),and a miscellaneous group (20.7%).Malignant neoplasms were present in 34 patients (58.6%).Symptoms were present in 74.3% of the patients and included polypnea (46.5%),fever (8.6%),cough (8.6%),and respiratory distress syn-drome (5.2%).There was no postoperative death.Follow-up was available in all 58 patients and ranged from 2 months to 5 years.Complementary treatment with chemo therapy was provided in 1 patient.no patient died of their disease during the follow-up period. Conclusions The early diagnosis of mediastinal mass is difficult, and depends on clinical manifestations and computerised tomography (CT)scan.Surgical excision is safe and effective treatment for mediastinal mass.