腹内疝是指腹腔内的脏器(多为小肠),通过腹腔内正常或异常孔道进入其他位置,引起腹痛、肠梗阻等临床症状[1] . 胆总管囊肿切除,胆管空肠Roux-en-Y吻合术后出现腹内疝症状,比较罕见[2] . 腹内疝临床症状多不典型,缺乏特异性,容易漏诊误诊[3] . 原则上一经确诊,需要及时手术治疗,否则会有肠管绞窄坏死风险,危及生命[2,4] . 现将我科收治的一例胆总管囊肿术后横结肠系膜裂孔疝患者病例报道如下.

目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在儿童日间急性单纯性阑尾炎围手术期的应用效果.方法 回顾性分析十堰市太和医院小儿外科自2019年6月至2021年9月收治的120例急性单纯性阑尾炎患儿资料,患儿均采用日间模式行腹腔镜阑尾切除术治疗,采用数字表法随机分为ERAS组和对照组,每组各60例,比较两组患儿的一般资料和手术时间、术中出血量、饥饿评分、疼痛评分、住院时间、术后首次排便时间、并发症及满意度.结果 两组患儿的年龄、性别、体重、术前白细胞(leukocyte,white blood cell,WBC)及手术时间、术中出血量比较,差异均无统计学意义(P>0.05).两组患儿的住院时间、术后首次排便时间明显短于对照组(P<0.001).两组患儿的饥饿评分、疼痛评分、并发症及满意度与对照组比较,差异均有统计学意义(P<0.05).结论 通过优化传统围手术期流程,将ERAS理念应用于儿童日间急性单纯性阑尾术的术前、术中及术后,ERAS路径在围手术期的住院时间、术后首次排便时间、饥饿评分、疼痛评分、并发症及满意度方面更优,安全可行,效果确切且保障了儿童日间急性单纯性阑尾术安全可行性.

目的探讨lncRNA SNHG16是否可通过靶向miR-22-3p调控肾母细胞瘤WIT49细胞增殖、迁移、侵袭及凋亡。方法采用qRT-PCR法检测肾母细胞瘤组织、癌旁组织中SNHG16、miR-22-3p的表达水平;体外培养人肾母细胞瘤WIT49细胞,分别将si-NC、si-SNHG16、miR-NC、miR-22-3p mmics、si-SNHG16与anti-miR-NC、si-SNHG16与anti-miR-22-3p转染至WIT49细胞;采用qRT-PCR法检测细胞中SNHG16、miR-22-3p的表达水平;采用CCK-8法检测细胞增殖;采用Transwell小室实验检测细胞迁移及侵袭;采用流式细胞术检测细胞凋亡率;双荧光素酶报告实验检测SNHG16、miR-22-3p的靶向关系;Western blot法检测CyclinD1、MMP-2、MMP-9、Bcl-2、p21、Bax蛋白表达量。结果与癌旁组织比较,肾母细胞瘤组织中SNHG16的表达水平显著升高（P＜0.05）,miR-22-3p的表达水平显著降低（P＜0.05）;转染si-SNHG16或转染miR-22-3p mimics可明显降低吸光度值及CyclinD1、MMP-2、MMP-9、Bcl-2蛋白水平（P＜0.05）,减少迁移及侵袭细胞数（P＜0.05）,提高凋亡率及p21、Bax蛋白水平（P＜0.05）;双荧光素酶实验证实SNHG16可靶向结合miR-22-3p;下调miR-22-3p表达可明显逆转抑制SNHG16表达对肾母细胞瘤WIT49细胞增殖、迁移侵袭和凋亡的作用。结论抑制SNHG16表达可通过上调miR-22-3p的表达从而减弱肾母细胞瘤WIT49细胞增殖、迁移及侵袭能力,诱导细胞凋亡。

患 者 男,3岁 10个 月,以"活 动 后 乏 力 1年 余,加 重 伴 口唇 紫 绀 7天"就 诊;既 往 史:患 者 系 同 卵 双 胎,胞 胎 哥 哥 体 健;查 体:一 般 情 况 可,唇 周 及 甲 床 紫 绀,双 肺 呼 吸 音 粗;舌 乳 头多 发 出 血 点,咽 红,充 血 明 显,双 下 肢 可 见 数 个 陈 旧 性 瘀 斑,未 见 肝 掌、蜘 蛛 痣;心 音 有 力,律 不 齐;腹 部 无 膨 隆,未 见 明 显静 脉 曲 张,肝 肋 下 未 触 及,脾 肋 下 1 cm可 触 及,肝 肾 叩 击 痛阴 性,移 动 性 浊 音 阴 性.辅 助 检 查:血 小 板 66 × 109/L;总 胆汁 酸 109.4 umol/L,肌 酸 激 酶 同 工 酶 61 IU/L,肝 胆 酸 77.71 mg/L,血 氨 正 常;病 毒 筛 查:柯 萨 奇 病 毒 IgM阳 性,流 感 病 毒-IgM阳 性.

目的 探讨完全腹腔镜下保留脾脏胰体尾切除术在治疗儿童胰体尾良性、交界性肿瘤中的安全性、可行性及疗效.方法 回顾性分析2017年6月至2018年3月十堰市太和医院收治的3例儿童胰体尾肿瘤患儿(年龄分别为10岁、9岁、12岁)行完全腹腔镜下保留脾脏胰体尾切除术的临床资料.结果 3例患儿均在全腹腔镜下完成保留脾脏胰体尾切除术,1例采用Warshaw法,2例采用Kimura法,手术时间分别为210 min、180 min、210 min,术中出血量分别为200 mL、50 mL、50 mL,术后平均住院时间为11 d,3例患儿术后病理诊断均为胰腺实性假乳头状瘤,术后均无再次手术,无腹腔出血、消化道出血、胃瘫等并发症发生,其中1例术后并发A级胰瘘,经积极保守治疗后治愈.术后随访31～40个月,效果良好,无肿瘤复发,均未出现糖尿病和慢性腹泻等并发症.结论 对于儿童胰体尾良性、交界性肿瘤,腹腔镜下保留脾脏的胰体尾肿瘤切除术是相对安全、有效、可行的,具有创伤小、恢复快等优势,保留脾脏可使患儿更多获益,值得在儿童病人中选择应用.

目的:对比口服普萘洛尔同时联合局部涂抹0.5％马来酸噻吗洛尔滴眼液与单纯口服普萘洛尔治疗婴幼儿血管瘤的效果.方法:选择2016年9月-2018年10月笔者医院收治的符合纳入标准的增生期婴幼儿血管瘤144例,通过随机数字表法分成A、B两组,A组仅口服普萘洛尔,共70例;B组口服普萘洛尔并局部涂抹0.5％马来酸噻吗洛尔滴眼液,共74例.治疗持续时间均6个月,比较两组的治疗效果、不良反应的差异及治愈停药3个月后复发率.结果:A组有效率为85.7％,不良反应发生率为12.9％,停药3个月复发率为12.9％;B组有效率为86.5％,不良反应发生率为10.8％,停药3个月复发率为9.5％.两组有效率比较,差异无统计学意义(χ2=0.018,P>0.05);不良反应发生率比较,差异无统计学意义(χ2=0.145,P>0.05);停药3个月复发率比较,差异无统计学意义(χ2=0.420,P>0.05).结论:口服普萘洛尔治疗婴幼儿血管瘤联合局部外用0.5％马来酸噻吗洛尔滴眼液并不会提高近期疗效.

胃重复畸形是先天性消化道畸形中的一种,临床上非常罕见,约占全部消化道重复畸形的9％,多见于女性婴儿,临床表现各异,实验室检查和影像学表现也缺乏特异性,在临床上很容易造成漏诊、误诊,大多数经开腹手术证实[1].本文将报道十堰市太和医院小儿外科收治的一例胃重复畸形病例.

目的:分析腹腔镜辅助下经肛门巨结肠根治术对先天性巨结肠(HSCR)患儿术后肛门功能和炎症反应的影响.方法:收集2013年1月至2018年1月湖北省十堰市太和医院收治的107例HSCR患儿,按手术方式不同分为A组(腹腔镜辅助下经肛门巨结肠根治术,n=57)和B组(常规经肛门Soave术,n=50).比较两组一般手术情况、术后肛门功能、炎症反应指标及并发症发生率.结果:两组手术时间、麻醉时间及切除肠管长度比较,差异无统计学意义(P＞0.05).A组出血量和排便频次少于B组,住院时间短于B组,Krickenbeck评分显著高于B组,术后3h、12h、24 h的C反应蛋白(CRP)水平及并发症发生率显著低于B组(均P＜0.05).结论:腹腔镜辅助下经肛门巨结肠根治术治疗HSCR更利于患儿肛门功能改善,能减轻炎症反应,减少并发症发生,值得临床推广.

Objective To compare the effect of pneumatic lithotripsy and holmium laser lithotripsy for the treatment of upper urinary tract calculi in children.Methods A total of 80 children with upper urinary tract calculi in our hospital from May 2013 to February 2016 were selected and randomly divided into observation group and control group,40 cases in each group..The control group was treated with pneumatic ballistic lithotripsy,the observation group was given with holmium laser lithotripsy,the outcomes in the two groups were recorded and analyzed by using the prospective studymethod.Results There was no significant difference in operation time between the two groups (P ＞ 0.05),but the postoperative hospital stay in the observation group was significantly less than that in the control group (P ＜ 0.05).The stone clearance rate of the observation group was 97.5％ (39/40) and 100％ (40/40),respectively,and so that were 82.5％ (33/40) and 85％ (34/40) in the control group that the observation group were significantly higher than those in the control group(P ＜ 0.05).The complications such as urinary tract infection,ureteral fragmentation,ureteral perforation and renal infection was 7.5％ (3/40)in the observation group,the control group was 27.5％ (11/40),the observation group was significantly less than that of the control group (P ＜ 0.05).The satisfaction degree of the observation group and the control group was 97.5％ (39/40) and 85.0％ (34/40),respectively and the satisfaction degree of the observation group was significantly higher than that of the control group three months after operation (P ＜ 0.05).Conclusions Compared with pneumatic ballistic,the holmium laser lithotripsy for the treatment of upper urinary tract calculi in children under the condition of not increase medical cost and time of surgery which improve the stone clearance rate,shorten the hospitalization time,reduce the incidence of postoperative complications.

Objective: To investigate the clinical values of nerve electrical regulation in the treatment of early micturition dysfunction in pediatric urology.Methods: From January 2014 to February 2016, 120 children in Department of Pediatric Urology of our hospital were selected and studied retrospectively.All the children were equally divided into the observation group and control group by a random number table.Two groups were given conventional surgical treatment, the control group was given conventional bladder training during the operation, and the observation group was given the nerve electrical regulation during the operation.The recovery of postoperative micturition dysfunction was recorded.Results: All the surgical operations were successfully completed.The total effective rate in observation group and control group was 98.3% and 88.3% respectively (P<0.05).After treatment, the frequency of micturition and the number of 24-h urinary incontinence in the observation group were (6.53±1.32) times and (0.89±0.42) times, respectively, significantly less than those in the control group of (8.92±1.41) times and (1.87±0.54) times (P<0.05).There was significant difference in the maximum urethral pressure and filling phase detrusor pressure in the observation group and the control group before and after the treatment (P<0.05), and between two groups after treatment (P<0.05).The incidence of infection, intestinal function change, pelvic hematoma and other complications in the observation group and control group was 10.0% and 8.3% respectively (P>0.05).Conclusions: The neural electrical intervention used in pediatric urology can improve early micturition dysfunction, the maximum urethral pressure and filling phase detrusor pressure, and has better security.

目的 探讨新生儿先天性十二指肠闭锁发生的影响因素.方法 现对湖北省十堰市太和医院1995-01/2015-12收治的40例先天性十二指肠闭锁患儿的临床资料进行回顾性分析,将这40例设为病例组,选择与病例组同期住院,无十二指肠闭锁的新生儿40例作为对照组.采用单因素分析和多因素Logistic回归分析探讨先天性十二指肠闭锁发生的影响因素.结果 单因素分析显示,病例组和对照组两组在新生儿性别、新生儿呕吐、新生儿胎粪、母亲怀孕年龄、胆汁分泌量、孕早期是否口服叶酸、孕早期有无感染及羊水是否过多方面比较,差异有统计学意义(P＜0.05).父亲方面的因素对疾病发生风险没有统计学差异.多因素Logistic回归分析显示,新生儿呕吐、新生儿无排便、母亲孕期胆汁不足、母亲孕早期感染、羊水过多的OR值均＞1,结果具有统计学意义,属于先天性十二指肠闭锁的危险因素.结论 加强对胆汁不足、羊水过多的孕妇的检查和护理,避免孕早期的感染.新生儿呕吐和无排便与先天性十二指肠闭锁有极高的风险,对临床诊断具有参考价值.

舌咽神经痛（ GPN）是一种较少见的疾病。临床医生往往缺乏对本病系统的认识，易误诊误治。现回顾分析我院2例GPN临床误治的资料，探讨GPN的误诊误治原因及其治疗方法。

MicroRNA-431 (miR-431) has been recognized as an oncogenic miRNA, being implicated in the initiation and development of human cancers. Recently, deregulation of miR-431 has been reported in several tumors. However, the clinical significance of miR-431 and its underlying role in human hepatocellular carcinoma (HCC) are poorly explored. Herein, we found that miR-431 expression was reduced in HCC tissues compared to noncancerous tissues. Otherwise, down-regulation of miR-431 was observed in aggressive tumor tissues. The levels of miR-431 expression in HCC cell lines were significantly lower than that in a nontransformed hepatic cell line. Clinical association analyses disclosed that a low level of miR-431 was prominently associated with poor prognostic features of HCC including venous infiltration, high Edmondson-Steiner grading and advanced tumor-node-metastasis (TNM) tumor stage. Our in vitro studies showed that up-regulation of miR-431 expression reduced cell invasion and migration in HCCLM3 cells. In contrast, down-regulation of miR-431 expression promoted SMMC-7721 cell invasion and migration. We found that up-regulation of miR-431 expression decreased zinc finger E-box binding homeobox 1 (ZEB1) expression and inhibited the epithelial-mesenchymal transition (EMT) with increased E-cadherin expression and decreased vimentin expression in HCCLM3 cells. Otherwise, down-regulation of miR-431 expression increased ZEB1 expression and promoted EMT in SMMC-7721 cells. Significantly, ZEB1 was identified as a target of miR-431 in HCC. ZEB1 knockdown abrogated the effect of miR-431 silencing on EMT and cell mobility in SMMC-7721 cells. In conclusion, miR-431 inhibits migration and invasion of HCC cells by suppressing ZEB1-mediated EMT.

Objective To explore whether or not the function of atragalus membranaceus combined fosinopril on decreasing NF- κB activity and OPN expression in overload albumin stimulating proximal tubuler cells. Methods Cultured cells without stimulation were used as placebo. Cultured cells were incubated with bovine serum albumin fat acid free (BSA) 20mg/ml as the control. Cultured cells were incubated with fosinopril for different hours as the treatment. Cultured cells were incubated with atragalus membranaceus combined fosinopril for different hours as the atragalus membranaceus group. ELISA and RT-PCR were used to observe NF -κB activity and OPN expression after cultured for 12h, 24h. Result Atragalus membranaceus combined fosinopril rapidly decreased NFκB activity and OPN expression. Compared with the other groups, the difference was significant. Conclusion Astragalus membranaceus combined fosinopril can obviously decrease NFκB activity and OPN expression in overload albumine stimulating proximal tubular cells.

复发性尿路感染(RUTI)尤其是不伴有常见易患因素者其发病机制常不明,临床诊治十分困难.我们对15例复发性尿路感染患者的尿培养、情感障碍状况、淋巴细胞Fas表达与凋亡以及T淋巴细胞亚群的变化进行观察,以探讨复发性尿路感染可能的发病机制.

目的探讨头孢吡肟对老年尿毒症患者的不良反应。方法回顾性分析4例患者在使用头孢吡肟过程中出现的神经精神症状。结果4例老年尿毒症患者在使用头孢吡肟过程中出现神经精神症状,停药及对症处理后症状体征完全缓解,未遗留神经精神后遗症。结论头孢吡肟对老年尿毒症患者有导致神经精神异常的风险,使用过程中应加强监护。

目的评价经会阴入路补片植入加改良Block术治疗直肠前突的效果,探讨直肠前突的手术方式。方法对32例确诊为直肠前突的病人采用经会阴入路补片植入加改良Block术的手术方法治疗,并对疗效进行随访。结果随访6~24个月,痊愈26例(81.25%),显效4例(12.5%),有效2例(6.25%),无效0例。结论经会阴入路补片植入加改良Block术式治疗直肠前突能有效的加强直肠阴道隔并能同时处理松弛的直肠黏膜及肌层,疗效显著。

Objective To observe the effect of ω-3 polyunsaturated fatty acids(PUFAs) on the serum C-reactive protein(CRP) in severe acute pancreatitis(SAP) patients.Methods Thirty SAP patients were divided into two group randomly: 15 patients were given PUFAs by peripheral veins(PUFAs group),and the other 15 patients(control group) were not given PUFAs.The serum CRP was measured by the immunoscattering assay at 1,3,7,and 14 day after the patients were admitted.Results The increasing level of CRP in PUFAs group was lower than that in the control group within the first 3 days,and its decreasing level was higher in PUFAs group than in control group after the third day(P<0.05).Conclusion PUFAs could decrease significantly the serum CRP in SAP patients,and avoid the extensive tissue damage induced by the excessive inflammatory reaction,which had the important significance on the clinical healing rate,decreasing the period of treatment,and improving the effect of treatment for SAP patients.

目的:评价经阴道折叠缝合术治疗直肠前突的疗效。方法:回顾性分析92例采用经阴道折叠缝合术治疗直肠前突手术患者的效果。结果:术前、术后直肠排粪造影显示直肠前突深度有显著变化。随访2年,痊愈70例(76.09%),显效10例(10.87%),有效10例(10.87%),复发2例(2.17%)。结论:经阴道折叠缝合术治疗直肠前突疗效显著。