Abstract Aims This study aimed to investigate the feasibility and effectiveness of utilizing three-dimensional (3D) printing technology in the simulation teaching of congenital malformations. Methods We conducted a comparative analysis between an experimental group that received traditional teaching supplemented with 3D printing model demonstrations and hands-on model operation, and a control group that received traditional teaching methods. Various parameters, including classroom interest, classroom interaction, learning enthusiasm, disease awareness, teaching satisfaction, and independent operation confidence, were assessed, along with theoretical and practical tests. Results The results showed no significant difference in theoretical test scores between the two groups (91.92 ± 15.04 vs. 89.44 ± 14.89), but the practical test revealed a significantly higher number of qualified trainees in the experimental group compared to the control group (23 vs. 8). In terms of classroom engagement, both groups exhibited similar levels of interest (8.08 ± 1.52 vs. 8.74 ± 0.984), classroom interaction (7.88 ± 1.97 vs. 8.7 ± 1.33), learning enthusiasm (8.81 ± 1.021 vs. 8.52 ± 1.189), and disease awareness (8.58 ± 0.99 vs. 8.58 ± 0.99). However, the experimental group demonstrated significantly higher teaching satisfaction (8.81 ± 1.06 vs. 9.19 ± 0.96) and greater operation confidence (7.67 ± 2.56 vs. 5.5 ± 2.79) than the control group. Conclusion 3D printing technology can be effectively utilized to create surgical teaching models, enhancing the confidence of standardized training doctors and improving teaching outcomes.

To evaluate whether infants with prenatal diagnosis of meconium peritonitis (MP) have a poorer prognosis. A retrospective analysis of data from infants treated with surgery from January 2008 to December 2020 was conducted. The patients were divided into prenatal diagnosis group and postnatal diagnosis group based on the timing of diagnosis. The intraoperative and postoperative parameters of the two groups of patients were compared. A total of 71 cases of MP were included in the study, with 48 cases in the prenatal diagnosis group and 23 cases in the postnatal diagnosis group. The comparison of preoperative indicators between the two groups of patients showed no statistically significant differences in baseline (p > 0.05). Intraoperative indicators, including blood loss, anastomosis, retained intestinal tube length and excised intestinal tube length, showed no statistically significant differences between the two groups (p > 0.05). However, the postnatal diagnosis group had a significantly shorter operation time than the prenatal diagnosis group (p < 0.05). Postoperative indicators, including fasting time, albumin usage, complications, and abandonment or mortality rates, show no difference (p > 0.05). Nevertheless, the postnatal diagnosis group exhibited significantly shorter hospital stay and time to first bowel movement compared to the prenatal diagnosis group (p < 0.05). Prenatal diagnosis of meconium peritonitis is associated with increased surgical complexity, prolonged hospital stay, and delayed recovery of intestinal function. However, there is no evidence of higher mortality or more complications compared to infants diagnosed postnatally, and there is no significant difference in long-term prognosis.

BackgroundCHPS dramatically affects infant growth and development and can even cause aspiration resulting from esophageal reflux. There is potential danger. CHPS is common, while CHPS with gas in the stomach wall and portal vein is rare. Gas in the stomach wall and portal vein are often the key features of more serious disease. It can be easily mistaken as a serious disease when patients with CHPS have gas in the stomach wall and portal vein.Case presentationA 56-day-old baby was hospitalized for aspiration pneumonia after vomiting without bile for 20 days. Compared with vomiting, which is the most common symptom, pneumonia tends to attract more attention. Because of pneumonia, a chest CT scan was performed and revealed massive gas accumulation in the walls of the esophagus, stomach, and portal vein. Therefore, NEC was considered first and was treated conservatively for one week. However, the vomiting continued, and CHPS was confirmed by ultrasound. The delay in CHPS diagnosis was due to insufficient recognition of the signs of gas accumulation. Because of inexperience and lack of knowledge about CHPS with gastrointestinal pneumatosis, physicians failed to make an early accurate diagnosis. Case 2 was a 29-day-old male who was admitted to the hospital with vomiting without bile. He was examined by ultrasound, which revealed gas in the stomach wall and portal vein after admission to the hospital. No peritonitis was found after a detailed and comprehensive physical examination. Emergency life-threatening diseases such as NEC were quickly ruled out. He received surgery as soon as possible and had an uneventful recovery with no complications.ConclusionCHPS may present with gas in the gastric or esophageal wall and portal vein, which is not a contraindication to surgery.

Objective:To explore the effect of antireflux valve on the prognosis of infants with biliary atresia (BA) during Kasai procedure to guide later surgical procedure.Methods:Randomized and non-randomized controlled studies were retrieved from the databases of PubMed, EMBASE, Cochrane Library, Web of Science, VIP, WanFang and CNKI until July 2021.Revman5.3 software was utilized for comparing the incidence of postoperative cholangitis, jaundice clearance rate and 2-year survival rate of autologous liver in BA infants during Kasai procedure with and without antireflux valve.Stata12.0 Begg's test was employed for examining the publication bias.Results:A total of 6 literatures were retrieved, including 1 rectangular valve (n=60) and 5 intussusception valves (n=2924). Among 2984 BA infants, antireflux valve was applied (n=670) and non-applied (n=2314). Meta-analysis indicated that inter-group statistical difference existed in the incidence of postoperative cholangitis ( OR=0.71, 95% CI: 0.59-0.86, P<0.01); no inter-group statistical difference existed in postoperative jaundice clearance rate ( OR=1.02, 95% CI: 0.85-1.22, P=0.85) or 2-year autogenous liver survival rate ( OR=1.12, 95% CI: 0.50-2.51, P=0.77). And Begg's test revealed no significant publication bias ( P=0.028-0.310). Conclusions:During Kasai procedure for BA, antireflux valve has no effect on postoperative jaundice clearance rate or 2-year survival rate of autologous liver.However, it may effectively lower the incidence of postoperative cholangitis.Thus antireflux valve is recommended during Kasai procedure.

目的 探讨胆道闭锁(biliary atresia,BA)Kasai手术后发生胆管炎的危险因素.方法 回顾性分析西安交通大学附属儿童医院2018年1月至2020年9月收治的109例因BA行Kasai手术患儿的临床资料.收集并记录性别、手术时日龄[＜60 d、60～90 d(含60 d)、≥90 d]、术前体重、心血管畸形、EB病毒(Epstein-Barr virus,EBV)感染、巨细胞病毒(cytomegalovirus,CMV)感染、术前肝脏弹性模量值、术前肝功能指标[总胆红素(total bilirubin,TBIL)、直接胆红素(direct bilirubin,DBIL)、谷草转氨酶(aspartate aminotransferase,AST)、谷丙转氨酶(alanine aminotransferase,ALT)、碱性磷酸酶(alkaline phos-phatase,ALP)、谷氨酰转肽酶(glutamyl transpeptidase,GGT)、总胆汁酸(total bile acid,TBA)、白蛋白(al-bumin,ALB)、总胆固醇(total cholesterol,TC)]、手术时长、术后禁食时长、术后住院时长、术后激素使用情况、术后6个月内黄疸消退情况以及术后胆管炎发生情况;根据术后是否出现胆管炎分为胆管炎组(n=71)和非胆管炎组(a=38);采用卡方检验或非参数检验进行单因素分析,采用Logistic回归进行多因素分析.结果 109例患儿中,7例(7/109,6.4％)术后1个月黄疸完全消退,41例(41/109,37.6％)术后3个月黄疸完全消退,53例(53/109,48.6％)术后6个月黄疸完全消退;随访期内共发生胆管炎71例(71/109,65.1％),术后3个月内发生胆管炎51例(51/109,46.8％),术后6个月内发生胆管炎60例(60/109,55.0％);早期胆管炎34例(34/71,47.9％),复发性胆管炎40例(34/71,56.3％).两组术前肝功能(TBIL、DBIL、ALT、AST、ALP、GGT、TBA、TC、ALB)比较,差异均无统计学意义(P＞0.05);两组男性占比[64.7％(33/51)比35.3％(18/51)]、术前体重[4.54(4.03,5.00)kg 比4.50(3.90,4.54)kg]、合并心血管畸形比例[63.6％(42/66)比36.4％(24/66)]、术前彩超检查肝右叶弹性模量值[12.80(10.50,15.60)kPa比 10.70(8.70,14.70)kPa]、术前 EB 病毒感染率[62.7％(47/75)比 37.3％(28/75)]、手术时长[(3.42(2.92,3.70)h比3.24(2.90,3.75)h]、术后禁食时长[3.00(3.00,3.29)d 比3.00(3.00,4.00)d]、术后激素使用率[54.8％(17/31)比 45.2％(14/31)]、住院时长[23.00(18.00,27.00)d 比 24.00(20.00,28.00)d]比较,差异均无统计学意义(P＞0.05);术前CMV感染患儿胆管炎的发生率明显低于术前无CMV感染的患儿[50％(13/26)比74.1％(40/54),x2=4.549,P=0.033],差异有统计学意义;术后6个月内黄疸消退患儿胆管炎的发生率明显低于黄疸未消退患儿[50.9％(27/53)比78.6％(44/56),x2=9.153,P=0.002],差异有统计学意义;多因素Logistic回归分析结果显示,手术时日龄(OR=2.764,95％CI:1.017～7.515,P＜0.05)及术后6 个月内黄疸是否消退(0R=0.283,95％CI:0.123～0.653,P＜0.05)是影响 BA术后胆管炎发生的危险因素.结论 手术时日龄60～90d及术后6个月内黄疸未消退是BA患儿Kasai手术后发生胆管炎的危险因素;选择合适的手术时机以及早期退黄能降低胆管炎的发生率.

Objective:To explore the diagnostic value and standard of serum gammaglutamyl transferase (GGT) and to improve the diagnostic accuracy in biliary atresia (BA) patients at different ages.Methods:Preoperative general data and liver function were reviewed for 350 children (180 boys and 170 girls) operated for cholestasis from April 2012 to July 2019. According to the findings of intraoperative cholangiography, they were divided into two groups of BA (n=244) and non-BA (n= 106). In BA group, there were 106 boys and 138 girls. The race was Han (n=239) and other ethnic groups (n=5). They were full-term (n=238) and premature (n=6). Body weight was (4.6±0.8) kg; The last preoperative detection value of gamma-glutamyl transferase (GGT) was (622.6±505.8) U/L. In non-BA group, there were 74 boys and 32 girls. The nationality was Han (n=105) and other ethnic group (n=1) . They were full-term (n=63) and premature (n=43) . Body weight was (3.7±1.1) kg. The last GGT detection value preoperatively was (181.5±136.5) U/L. According to the last preoperative GGT detection value and age, two groups were divided into 4 ages: ≤30 d, 31-60 d, 61-90 d and >90 d. In BA group, there were 6 children ≤30 d, 130 31-60 d, 86 61-90 d and 22 >90 d. In non-BA group, there were 3 children ≤30 d, 58 31-60 d, 34 61-90 d and 11 >90 d. GGT values of children of the same age in two groups were compared. According to the Jorden index, cut-off value of GGT was utilized for diagnosing BA in all ages. Sensitivity (Se) , specificity (Sp) and accuracy were compared.Results:In terms of general status, compared with non-BA group, statistically significant inter-group differences existed in gender, full-term birth and body weight at the ages of 31-60 d and 61-90 d ( P< 0.05) . In children aged >90 d, inter-group difference was statistically significant ( P<0.05 ) . GGT values were higher in BA group than those in non-BA group at different ages and regardless of age. And the differences were statistically significant ( P<0.05) . In terms of receiver operator characteristic curve (ROC) of GGT values at ≤30 d , 31-60 d, 61-90 d and >90 d, area under the curve (AUC) was 1.000, 0.874, 0.839 and 0.872. The best truncation values of GGT for diagnosing BA were 305, 236, 319 and 331 U/L respectively. AUC of all ages was 0.851 with an optimal cut-off value of 305 U/L. In terms of discriminance of using GGT value in diagnosing BA at different ages, Se, Sp and accuracy of using GGT in diagnosing BA at ≤30 d were 100% ; Se , Sp and accuracy 71.5%, 87.9% and 76.6% from 31 to 60 days ; Se , Sp and accuracy 70.0% , 85.3% and 74.2% from 61 to 90 days. Se , Sp and accuracy of >90 d 77.3%, 100% and 81.8%; Se, Sp and accuracy 68.3%, 87.7% and 74.2% respectively. Conclusions:GGT value has a certain value in the diagnosis of BA. However, great differences exist in BA children at different ages. The value of GGT value in the diagnosis of BA at 31 to 60 days is relatively high.

There are fewer reports of thoracoscopic surgical resection of mediastinal cysts in neonates. The aim of this article is to report on the feasibility of thoracoscopic resection of a large mediastinal cyst and the management of chylothorax after surgery in neonates.

BACKGROUND:Laparoscopic Ladd's procedure for malrotation in children is still a controversial approach. Although some retrospective studies have compared the outcomes of the two types of procedure with inconsistency outcomes. Currently, there are few large-scale studies on laparoscopic treatment in malrotation with neonates and infants. We did a study based on propensity score matching to compare the effects of the two kinds of approach in neonates and infants. To investigate the therapeutic effect of laparoscopy and open Ladd's procedure by the propensity score-matching (PSM) to enhance the validity of the comparison. METHODS:A total series of 143 cases of intestinal malrotation without intestinal necrosis was included in the study during the 8 years from January 2012 to January 2020, including 68 cases of open Ladd's procedure and 75 cases of laparoscopic Ladd's procedure including five cases of transfer laparotomy. By a propensity score 1:1 matching, 62 patients were stratified for each group. RESULTS AND CONCLUSION:There was no significant difference in volvulus degree, weight and gender between the two groups (p > 0.05). Laparoscopic surgery took more time than open surgery (105.9 min vs 70.6 min, p < 0.05), but it had less hospital stay (12.4 days vs 14.6 days, p < 0.05) or less incision infection (0 vs 6, p < 0.05). There was no significant difference between the two groups at the time of first defecation, blood loss, time of full feeding and reoperation (p > 0.05). The cosmetic effect of laparoscopic surgery is better than that of open surgery. Laparoscopic Ladd's procedure is a safe approach. It can reduce the length of hospital stay and incision infection, but the operation time was extended, the other complications are similar compared with open procedure for intestinal malrotation in neonates and infants.

Abstract Background Carbon nanoparticle suspension (CNS) was applied to locate the lymphatic leakage in chylous ascites (CA). However, the flow speed and distance of the CNS were particularly decreased in the following two cases (patient 5 and 6). This study aimed to investigate and improve the flow speed and distance of the CNS via a rat model. Methods Seven patients with CA were accepted for surgery in the past two years. Clinical data were recorded. Rats were divided into two groups to confirm the hypothesis regarding whether accepting milk or orally administered food before surgery was the key factor in CA surgery with CNS. The animals were divided into 2 groups: experimental group of 5 rats receiving fat emulsion injection (2 g/kg) 30 min before the operation and control group of 5 rats receiving saline. We analyzed flow speed and distance of the CNS in two groups of rats. The hypothesis established was that CNS movements pattern differ depending on the degree of capillary lymph duct filling. Finally, the late case reconfirmed the hypothesis again. Results In animal experiments, the CNS in the preoperative high-fat feeding group moved faster and over a longer distance than that in the control group (0.51 ± 0.09 cm vs. 0.19 ± 0.10 cm, respectively; p < 0.05). Based on this, the CNS was applied to the seventh patient, who had been given a diet with a slightly higher fat content 3 days before the operation, and marked improvement with a complete cure was recorded. Conclusions The capillary lymph duct was beginning to swell after dietary intake. The dilation of the lymph vessel could make it easier for the CNS to move and reach the leakage.

Objective:To explore the surgical application of nanocarbon for chylous ascites (CA).Methods:From January 1st, 2013 to November 1st, 2019, 42 children were definitely diagnosed as CA.Clinical characteristics, treatments and short-term outcomes were assessed retrospectively.There were 34 males and 8 females aged (26.54±10.25)d.CA was detected during pregnancy examination (n=6) while the remainder gradually appeared after birth (n=36). Among 18 surgical cases, 4 cases used nanocarbon.Twenty-four cases received conservative measures.Results:In nanocarbon group, all four cases were confirmed while only one case was detected in conventional surgical group.Time of special milk powder post-operation was shorter in nanocarbon group than that in non-operation group [(8±2) vs.(16±4) weeks]. And the differences were statistically significant ( P<0.05). Preoperative fasting time, postoperative fasting time and total hospital stay of nanocarbon group were shorter than those of traditional surgical group [(14.60±3.68) vs.(19.38±3.60) days, (5.40±4.56) vs.(7.86±2.51) days and (31.63±9.36) vs.(39.82±2.59) days] (all P<0.05). Conclusions:Nanocarbon can successfully locate the leakage site based upon structural characteristics of lymphatic vessels.With the exploration of CA, the results will be significantly improved.Therefore reasonable decisions should be made for gradual curing.

Objective: The objective of the study is to explore a less invasive laparoscopic pyloromyotomy for treating infantile hypertrophic pyloric stenosis. Patients and Methods: A series of 154 cases from January 2014 to January 2020 were retrospectively analysed. Seventy patients were treated with the method of transumbilical single-site laparoscopic pyloromyotomy (SSLP), and 84 patients were treated with two-site laparoscopic pyloromyotomy. There was no difference in the body weight, sex ratio or age between the two groups. The operation time, blood loss, post-operative feeding time and complications between the two groups were compared. Results: The novel single-site method had better cosmetic effect than the two-site approach. There was no difference in the operation time, blood loss, post-operative feeding time or complications between the two groups. Conclusion: The novel SSLP method requires only two incisions through the umbilicus to complete the procedure, with barely visible scars and similar surgical complications to that of the two-site approach; thus, the novel method is worth promoting.

Gastric cancer (GC) is the most common gastrointestinal malignancy worldwide. However, the molecular mechanisms of the progression of GC are not fully understood. Ras-responsive element binding protein 1 (RREB1) is an oncogene in many types of cancer that is involved in various biological processes, such as DNA damage repair, cell growth and proliferation, cell differentiation, fat development, and fasting glucose balance. In this study, we demonstrate the role of RREB1 in gastric cancer. First, by immunohistochemistry staining (IHC) and bioinformatics analysis, we demonstrated the expression of RREB1 in gastric cancer and paired normal gastric tissues. Then, we established RREB1 overexpression and knockdown cell lines via lentiviral transfection and detected cell proliferation by using MTT, colony-forming, cell cycle and apoptosis assays in vitro. We demonstrated the effect of RREB1 on cell proliferation in vivo by using a subcutaneous xenograft tumor model in nude mice. Finally, by using Western blotting and IHC, we demonstrated the possible mechanism by which RREB1 affects cell proliferation. The IHC and bioinformatics analyses demonstrated that RREB1 was highly expressed in gastric cancer and showed that RREB1-expressing patients had a larger tumor size and more lymphovascular invasion than RREB1-negative patients. Knockdown of RREB1 inhibited cell proliferation in vivo and in vitro. Knockdown of RREB1 enhanced p16 expression in vivo and in vitro, and p16 expression was negatively related to RREB1 in gastric cancer tissue. RREB1 was highly expressed in gastric cancer, and knockdown of RREB1 inhibited cell proliferation via enhanced p16 expression.

Objective:To establish a personalized prediction model for biliary atresia (BA) risk in cholestatic children.Methods:Retrospective analysis was conducted for clinical data of 329 cholestatic children diagnosed intraoperatively by cholangiography. There were BA (n=227) and non-BA (n=102). The parameters of gender, age, weight, ethnicity, term, white stool and liver function were collected. There were 173 boys and 156 girls. SPSS software was utilized for randomly splitting 67.2%(221/329) and 32.8%(108/329) into modeling and validating groups. Single-factor analysis was employed for screening out risk factors of two groups. Multi-factor Logistic regression model was used for analyzing the risk factors of BA. R software was utilized for establishing a nomogram model for predicting infantile BA. The effect of the model was tested by area under curve (AUC) value and fitness.Results:Single-factor analysis modeling group indicated that gender, weight, term, white stool, total bilirubin, direct bilirubin, albumin, alanine aminotransferase, aspartate aminotransferase and glutamyl transpeptidase had inter-group statistical differences ( P<0.05). Finally five factors including gender, weight, white stool, direct bilirubin and glutamyl transpeptidase were modeled by stepwise regression. The AUC of nematic diagram modeling group was 0.927 and AUC of validating group 0.951 and the discrimination was excellent. Ultimately the accuracy of the model was 86.4% in modeling group and 88.9% in validating group. Conclusions:This study has successfully established a nomogram prediction model based upon five factors of gender, weight, white stool, direct bilirubin and glutamyl transpeptidase. With a high level of predicating accuracy of BA in cholestatic infants, this model is worth promoting.

Objective: Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. In infants, CA is mostly caused by lymphatic malformation or unknown reasons. The creation of a shunt for the lymphorrhea is the last option for patients unresponsive to all other conservative treatments. Localization of the leakage is a critical problem during surgery. We applied a carbon nanoparticle suspension (CNS) in CA patients to locale the external lymphatic leakage and evaluated its utility during surgery. Patients and methods: Twelve infants with CA were treated in our center recently. Ten patients received laparotomy, one refused therapy, and one was cured after undergoing conservative treatment. Recently, two infants with CA received CNS in the visceral peritoneum during laparotomy. The results of the traditional procedure were compared to our innovative technique for CA to evaluate the use of CNS in treating CA. Results: The features of the baseline data did not differ substantially. Location of the leakage with CNS was employed in 2 of the 10 patients whose lymphatic leakages were identified with the resolution of the refractory CA. Overall, in 5 patients, ascites was resolved successfully. The refractory CA was resolved more effectively in patients in whom the leakage site was identified with CNS than in patients in whom the leakage site could not be identified under conventional surgery. Conclusions: Injecting CNS improved the accuracy of lymphorrhagia leakage site identification and the outcomes of infants who underwent surgical treatment for refractory CA. (C) 2019 Published by Elsevier Inc.

Necrotizing enterocolitis (NEC) is a major cause of mortality and morbidity in newborns, characterized by inflammatory intestinal necrosis. Sirtuin-1 (SIRT1), a NAD-dependent deacetylase, is involved in multiple biological functions. It has been reported that SIRT1 was downregulated in NEC tissues. However, the precise role of SIRT1 in NEC progress remains unknown. In this study, we found that SIRT1 was decreased in serum samples of NEC patients, associated with an inflammation response. an in vitro model was established by using LPS-induced NEC-like cell in this study. The results indicate that overexpression of SIRT1 inhibited the cell apoptosis induced by LPS. Besides, overexpression of SIRT1 suppressed the high expression of proinflammatory factors (IL-6, IL-8, and TNF-α), the decrease of transepithelial electrical resistance (TEER), and the decline expression of tight junction proteins (ZO-1, ZO-2, and Claudin-4) induced by LPS in Caco-2 cells. What is more, serum HIF-1α was increased in NEC patients. SIRT1 overexpression suppressed the expression and activity of HIF-1a, while knockdown of SIRT1 made the opposite effect. In summary, this study indicates that overexpression of SIRT1 alleviates the inflammation response and intestinal epithelial barrier dysfunction through regulating the expression and inactivation of HIF-1a.

目的:通过对6月龄以下恶性骶尾部畸胎瘤的相关危险因素分析,建立个体化预测6月龄以下骶尾部畸胎瘤恶性风险的列线图模型.方法:收集小婴儿骶尾部畸胎瘤80例,其中成熟畸胎瘤69例,未成熟畸胎瘤11例,统计其年龄、性别、Altman分型、肿瘤体积、体重、血液AFP(甲胎蛋白)结果等临床资料,分析不同指标在判定骶尾部畸胎瘤恶性程度的价值.采用多因素Logistic回归模型分析畸胎瘤恶性的危险因素;应用R软件建立预测6月龄以下婴儿骶尾部畸胎瘤良恶性风险的列线图模型,采用Bootstrap法进行模型验证,根据AUC值和拟合度检验验证模型效果.结果:AFP阳性和肿瘤体积是骶尾部畸胎瘤提示肿瘤为恶性畸胎瘤(P＜0.05)的独立危险分析,较大的体重是保护性因素(P＜0.05);列线图模型AUC值为0.918(0.856～0.981),区分度良好,模型的Hosmer Lemeshow检验提示(P=0.902,x2=3.431)模型有较好的校准度.最终该模型预测准确度87.5％.结论:基于肿瘤体积、体重和AFP是否阳性建立的列线图模型,对6月龄前儿童骶尾部畸胎瘤是否恶性有预测作用,应用方便.

Objective:To evaluate the effect and safety of adjustable closed loop(ACL) in the treatment of short bowel syndrome (SBS).Methods:From January 2017 to December 2017, the clinical data of 2 cases with ostomy in continuity after surgery in Children's Hospital Affiliated to Xi'an Jiaotong University were analyzed.The age was 1 and 3 months, both were females, and preservation of intestinal tube length were 65 cm and 60 cm respectively.They were all diagnosed SBS with a lot of stool like water.Self-made ACL was installed to maintain SBS.The blood circulation of stoma, weight, BMI, defecating, abdomen, nutrition status changes, nursing convenience, intestinal infection susceptibility were observed.Results:There was no necrosis in stoma, and the overall condition was improved, and no significant increase in abdominal distension.ACL used in babies with ostomy in continuity could improve the anus stool, weight, nursing convenience.Conclusion:ACL installed in baby with SBS could contribute to intestinal management, and is easy to install.

目的 探讨肿瘤体积体重比与肿瘤标志物在婴幼儿骶尾部畸胎瘤成熟度评估中的应用价值.方法 回顾性分析我院新生儿外科2012年1月至2018年12月收治的78例骶尾部畸胎瘤患儿的临床资料,根据术后病理结果将患儿分为成熟畸胎瘤组(67例)与未成熟畸胎瘤组(11例).分析不同指标在骶尾部畸胎瘤成熟度评估中的应用价值.结果 单独应用肿瘤标志物阳性进行评估的AUC值为0.723(0.570～0.875),灵敏度81.8％,特异度62.7％;应用肿瘤体积体重比评估的AUC值为0.771(0.598～0.944),灵敏度72.7％,特异度83.6％;肿瘤体积体重比联合肿瘤标志物阳性评估的AUC值为0.879(0.796～0.962),灵敏度90.9％,特异度79.1％.结论 肿瘤体积体重比评估肿瘤成熟度的价值优于肿瘤标志物阳性,当肿瘤体积体重比>43 cm3/kg时患儿为未成熟骶尾部畸胎瘤的可能性较大.肿瘤体积体重比联合肿瘤标志物阳性可以提高肿瘤成熟度评估的准确性.

目的 比较3种手术方式治疗先天性肥厚性幽门狭窄的疗效. 方法 回顾性分析2012年9月至2017年6月西安交通大学第二附属医院与西安交通大学附属儿童医院收治的160例先天性肥厚性幽门狭窄患儿临床资料,按照手术方式分为3组:经脐部弧形切口组52例、传统两孔腹腔镜组56例和经脐单操作孔腹腔镜组52例.3组患儿在年龄、体重、术前准备、发病时间、性别比例方面无显著差异(P＞0.05).对比各组患儿在手术时间、出血量、住院时间、足量喂养时间以及切口并发症等资料. 结果 经脐部弧形切口组手术时间和术后足量喂养时间均长于腹腔镜组(P＜0.05).3组间出血量差异无统计学意义(P＞0.05).经脐单操作孔腹腔镜组和传统两孔腹腔镜组手术时间、术后足量喂养时间、住院时间差异无统计学意义(P＞0.05),但经脐单操作孔组术后切口更加美观. 结论 腹腔镜手术与经脐部弧形切口手术相比创伤更小,术后可以更早地进行足量喂养.此外,经脐单操作孔腹腔镜法可以完成腹腔镜下幽门环肌切开术,不增加手术时间及并发症,切口更加美观,值得推广.

目的 探讨经脐两孔法与传统两孔腹腔镜下幽门环肌切开术的临床效果.方法 回顾性分析我院2013年1月至2017年1月的收治的109例先天性肥厚性幽门狭窄患儿的临床资料,根据手术方式不同分为单部位组(52例)和传统组(57例),比较两组患儿的临床效果.结果 所有患儿均顺利完成手术,单部位组1例患儿幽门呈勾形走向无法完全暴露,为避免切开不全,增加一个Trocar完成手术;传统组1例患儿出现切口感染;两组患儿的手术时间、术中出血量、住院时间、并发症等方面无明显差异(P>0.05);术后随访3月,单部位组患儿的瘢痕评分高于传统组(P<0.05).结论 经脐部单部位只需经脐两孔即可完成腹腔镜下幽门环肌切开术,同时比传统两孔法手术瘢痕隐蔽性更好,美容效果更好,值得推广.