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

目的 探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在小儿先天性巨结肠(hirschsprung's disease,HD)围手术期中应用的安全性和有效性.方法 回顾性分析2017年9月至2021年10月于郑州大学第一附属医院小儿外科接受手术治疗的58例HD患儿的临床资料,将接受传统康复干预措施的27例HD患儿纳入对照组,接受基于ERAS理念干预的31例HD患儿纳入ERAS组,比较两组患者的术后住院时间、术后首次进食时间、完全肠内营养时间,及术后并发症的发生情况.结果 ERAS组术后住院时间、术后首次进食时间、完全肠内营养时间均短于对照组,差异有统计学意义(P<0.05).ERAS组患儿并发症的发生率(3.2％)明显低于对照组(11.1％),差异有统计学意义(P<0.05).结论 围手术期采用ERAS理念可以促进HD患儿术后康复且降低术后相关并发症的发生率.

本文报道1例先天性幽门闭锁术后合并大疱性表皮松解症的病例。患儿表现为非胆汁性呕吐、上腹部膨隆，上消化道造影示胃充盈，十二指肠未见显影。术中见幽门实质性闭锁，行胃十二指肠吻合术。患儿术后5 d出现大疱性表皮松解症，术后25 d痊愈出院。

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

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

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

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