目的 比较腹腔镜先天性胆总管囊肿根治术中2种胆肠吻合方式的优劣,为临床选择不同术式提供理论依据.方法 回顾性分析兰州大学第二医院2016年7月-2022年4月收治的117例先天性胆总管囊肿患者,按手术方式分为Roux-en-Y吻合组(63例)与改良Warren吻合组(54例).2组患者均行腹腔镜下胆总管囊肿根治性切除术,肠-肠吻合方式有Roux-en-Y式肠-肠吻合及改良Warren式肠-肠吻合.比较2组患者手术效果、术后效果及术后并发症等指标.结果 2组患者手术时间、吻合时间、术后恢复排气排便时间、术后并发肠梗阻及反流性胆管炎方面差异均有统计学意义(P<0.05),而其余指标没有显示明显差异(P>0.05).结论 改良Warren吻合术较Roux-en-Y吻合术,具有手术时间短、吻合快、术后肠功能恢复快、防反流效果好等优点,且操作简便,不切断肠管,保证肠管电生理活动的连续性,适合在基层医院推广.

Objective: To investigate the clinical value of Clostridium butyricum powders combined with zinc gluconate in the treatment of infectious diarrhea in children, clinical data of 86 children with infectious diarrhea were retrospectively analyzed. Methods: Both groups received routine treatments to reduce symptoms, among which the control group ( n = 40) was given Clostridium butyricum powders, and the experiment group ( n = 46) was given Clostridium butyricum powders and zinc gluconate. Patients in both groups were treated for 5 days. The clinical efficacy, recovery time, safety, serum levels of inflammatory markers (interleukin-6, interleukin-17, C-reactive protein), indicators of the intestinal mucosal function (diamine oxidase, D-lactate) and indicators to intestinal microecology (bifidobacteria, lactobacillus) before and after treatment were compared between the two groups. Results: The clinical efficacy in the experiment group (95.65%) was higher than that in the control group (77.50%, p < 0.05). The time of recovery from symptoms including diarrhea, abdominal pain and vomiting, and to normal body temperature in the experiment group were shorter than those in the control group (all p < .001). After treatment, the serum IL-6, IL-17, CRP levels and DAO, D-lactate levels in both groups were lower than those before treatment, and were lower in the experiment group than in the control group (all p < .001). After treatment, the intestinal bifidobacteria and lactobacillus levels in both groups were higher than those before treatment, and were higher in the experiment group than in the control group (all p < .01). There was no significant difference in the incidence of adverse reactions between the experiment group (8.70%) and the control group (2.50%). Conclusion: In this open-label study, Clostridium butyricum powders combined with zinc gluconate are significantly effective in treating children with infectious diarrhea, which is conducive to relieving early symptoms, downregulating serum inflammatory factor levels, improving intestinal mucosal function, regulating intestinal microecology, and ensuring the safety of patients.

蓝色橡皮疱痣综合征为一种罕见综合征,是发生在皮肤和胃肠道,以及肝脏、肺、肾、骨骼肌、关节等器官的多发性血管畸形,常伴有消化道出血、隐性失血、贫血等,多见于婴幼儿和青壮年,血管瘤的数目和大小随着年龄的增长而增大、增多.蓝色橡皮疱痣综合征发病率较低,容易被误诊、漏诊.本研究通过1例小儿蓝色橡皮疱痣综合征的诊治并复习相关文献,以提高临床医师对蓝色橡皮疱痣综合征的进一步认识.

Objective:To compare the prognosis of children of perianal abscess treated by one-stage radical resection versus staged surgery.Methods:From February 2017 to February 2018, 100 hospitalized children with perianal abscesses and anal fistula at Department of Pediatric Surgery of Seventh Affiliated Hospital, Sun Yat-sen University were selected as research subjects. They were divided randomly into one-stage radical surgery group (A, n=50) and staged surgery group (B, n=50). In group A, there were 41 boys and 9 girls with an average age of (5.2±0.3)(2-48) months and an average duration of disease (15.4±1.6)(1-64) days; in group B, there were 39 boys and 11 girls with an average age of (5.4±0.2)(2-36) months and an average duration of disease (15.6±1.8)(1-52) days. Curative rate, anal function, perianal pain, healing time, anal fistula recurrence rate and parental satisfaction were compared.Results:The clinical curative rate of two groups was (90%, 45/50 vs 68%, 34/50) and the inter-group difference was statistically significant ( P<0.05). The normal rate of anus function was higher in one-stage radical surgery group than that in staged surgery group (88%, 44/50 vs 70%, 35/50) and the difference was statistically significant ( P<0.05). The percentage of grade 0 perianal pain was higher in one-stage radical surgery group than that in staged surgery group (56%, 28/50 vs 42%, 21/50) and there was statistically significant difference ( P<0.05). The postoperative wound healing time of one-stage radical surgery group was longer than that of staged surgery group [(13.5±2.3) vs (13.1±2.4) days] and no statistically significant difference between two groups ( P>0.05). The anal fistula recurrence rate was lower in one-stage radical surgery group than that in staged surgery group (2%, 1/50 vs 16%, 8/50) and the difference was statistically significant ( P<0.05). Conclusions:As compared with staged surgery, one-stage radical resection may significantly improve curative rate, improve anal function, relieve pain and prevent the recurrence of anal fistula in children with perianal abscesses. It has a high value of clinical implementation.

Background: Low-birth-weight is the main factor affecting the survival rate of esophageal atresia (EA)/ tracheoesophageal fistula (TEF). The study aims to summarize the factors influencing the prognosis of EA/TEF, which is expected to be helpful for clinical diagnosis and treatment. Methods: A retrospective data analysis was performed in our hospital underwent TEF/EA repair between January 2012 and January 2015. The incidence of preoperative, intraoperative critical events and postoperative complications and overall survival (OS) were compared between two groups of infants: 81 patients with EA/TEF, 24 low-birth-weight patients (<2500 g) with EA/TEF and 57 patients (>2500 g). The morbidity was compared between patients with stress hyperglycemia and euglycemia postoperatively. Results: The overall incidence of preoperative, intraoperative critical events and postoperative complications in low-birth-weight patients was significantly higher (P=0.002, P=0.001, P=0.001), but OS was lower (75.9% vs 92.3%, p=0.027). OS of patients with stress hyperglycemia postoperatively was lower than that of euglycemia (81.0% vs 93.6%, p=0.03). Conclusions: Low-birth-weight still was the main factor that impacted on the prognosis of EA/TEF. The lower the birth weight was, the higher the mortality was. Postoperative stress hyperglycemia was one of the important factors that influenced survival rate.

Objective:To investigate and compare the therapeutic effect of Foley catheter balloon dilation and the traditional open reduction in the treatment of intussusception in children.Methods:A total of 68 children with intussusception treated by Foley catheter balloon dilatation by laparoscopic surgery or traditional open reduction in Department of Pediatric Surgery, the Second Hospital of Lanzhou University from August 2015 to July 2019 were retrospectively analyzed.Among them, there were 32 cases in the Foley catheter group and 36 cases in the traditional laparotomy group.Foley catheter group were treated with laparoscopic Foley catheter balloon dilatation, while the traditional open group were treated with traditional open surgery which was performed with finger dilatation.The results of surgical treatment, postoperative recovery, short-term complications, patient satisfaction and long-term complications were compared between the two groups.Results:Among the indexes of surgical treatment effect, the operation time[(0.4±1.1) h], intraoperative bleeding volume[(10.2±3.4) mL], incision size[(0.5±0.4) cm] and incidence of the rupture of intestine[6.3%(2/32 cases)] in the Foley catheter group were significantly lower than those in the traditional open group[(1.3±2.9) h, (40.5±2.1) mL, (5.1±0.7) cm, 30.6%(11/36 cases)], and the differences were statistically significant (all P< 0.05). Among the indexes of postoperative recovery and short-term complications, recovery time of gastrointestinal function[(1.2±3.1) d], length of hospital stay[(6.7±1.8) d], incidence of incision infection[9.4%(3/32 cases)]and incidence of incisional hernia(0) in the Foley catheter group were significantly lower than those in the traditional open group[(3.3±6.4) d, (7.3±0.9) d, 36.1%(13/36 cases), 16.7%(6/36 cases)], and the differences were statistically significant (all P<0.05). Among the indexes of family satisfaction and long-term complications, the score of family satisfaction in the Foley catheter group [(8.7±1.2) scores]was significantly higher than that in the traditional open group[(6.6±3.1) scores], and the incidence of adhesive intestinal obst-ructionin the Foley catheter group (0)was significantly lower than that in the traditional open group[0 vs.19.4%(7/36例)], and the differences were statistically significant(all P<0.05). Conclusions:Compared with traditional open reduction in the treatment of intussusception in children, Foley catheter balloon dilation has the advantages of short operation time, safe operation, low incidence of intestinal injury, less bleeding, and so on, and also has the advantages of small incision, fast recovery, short hospitalization time, high satisfaction of parents.In addition, the Foley catheter balloon dilation has a lower incidence of incisional infection, incisional hernia, postoperative intestinal adhesion and other complications.

目的:探究miR-122-5p在婴儿胆道闭锁(BA)中的作用及其机制.方法:RT-qPCR检测miR-122-5p在BA患儿及胆总管囊肿(CC)患儿血清中的表达,及miR-122-5p和PPP2R2A mRNA在LX-2细胞中的表达.CCK-8检测不同组别中LX-2细胞的增殖活性.Western blot检测p-AKT、AKT、PPP2R2A及Ki67蛋白在LX-2细胞内的表达.通过生物信息学网站预测miR-122-5p的下游靶基因,并通过双荧光素酶报告基因实验验证其靶向关系.结果:miR-122-5p在BA患儿血清中的表达水平显著升高.抑制miR-122-5p的表达显著抑制LX-2细胞的增殖、细胞内AKT的激活并促进LX-2细胞的凋亡,过表达PPP2R2A对LX-2细胞生物学行为的影响与前述一致.双荧光素酶报告基因实验证实PPP2R2A是miR-122-5p的下游靶基因.同时过表达LX-2细胞内miR-122-5p及PPP2R2A的表达水平对LX-2细胞的生物学行为无显著影响.结论:miR-122-5p在BA患儿血清中过表达,并通过体外实验证实miR-122-5p靶向PPP2R2A影响AKT信号通路的激活调控肝纤维化的进程.

目的 探讨Foley导尿管在小儿腹腔镜下肠套叠复位术中的临床应用价值.方法 对兰州大学第二医院小儿外科2016年1月—2017年12月收治的15例空气灌肠复位失败的急性肠套叠患儿行腹腔镜探查、Foley导尿管辅助肠套叠复位术.结果 15例患儿均复位成功,其中2例复位后发现末端回肠局部坏死;1例末端回肠局部穿孔,行肠修补术;1例发现Meckel憩室,行腹腔镜下Meckel憩室切除术.结论 对空气灌肠复位失败、腹腔镜下使用无损伤钳复位困难的急性肠套叠患儿,Foley导尿管辅助小儿腹腔镜下肠套叠复位是一种简便、安全有效的治疗方法.

Objective To compare the advantages and disadvantages of negative pressure line suction method and hernia needle in the treatment of pediatric laparoscopic hernia inguinal surgery.Methods 324 patients were randomly divided into negative pressure line suction group (168) and hernia needle group (156).The authors' own method of negative pressure line suction was used for the former group to conduct laparoscopic high ligation of hernia sac,while the hernia needle group was administered with the hook needle to carry out laparoscopic high ligation of hernia sac.The surgical and postoperative results and postoperative complications were compared between the two groups.Results For the two groups,the operation time,bleeding volume,preoperative needle diameter,incidence of secondary injury,postoperative pain time,hospitalization expenses and scrotum edema,incision infection,hernia recurrence were all statistically different (P ＜ 0.05),while regarding the average length of stay,family satisfaction and testicular atrophy,the differences were not statistically significant (P ＞ 0.05).Conclusion The suction line method uses a shorter operative time,produces less bleeding,less injury in the operation area,and a lower incidence of secondary injury compared to the hernia needle method.At the same time,the suction line method also has the advantage of a shorter postoperative pain time,lower cost of hospitalization and hernia recurrence after surgery.

Objective: To investigate the effcacy and essential technical points of laparoscopic treatment for severe acute cholangitis (SAC). Methods: The clinical data of 117 patients with SAC secondary to common bile duct stones, who underwent laparoscopic treatment during January 2010 to November 2014, were retrospectively analyzed. Results: In the entire group, 110 patients (94.0%) underwent totally laparoscopic common bile duct exploration, and 7 patients required open conversion. hTe mean operative time was 144 min and intraoperative blood loss was 53 mL. hTe septic shock was exacerbated in 4 patients atfer operation, which improved by antishock measures, while postoperative duodenal fistula, bile leakage and intra-abdominal collection occurred in 1, 3 and 4 cases respectively, which were resolved by drainage and anti-infective treatment. The mean length of postoperative hospital stay was 7.2 d. Conclusion: Based on rigorous medical indications and proifcient laparoscopic skill, laparoscopic therapy of SAC is safe and feasible.

Objetive To discuss the application of anastomat in pediatric gastrointestinal reconstruction surgery. Methods From May 2007 to August 201 2,78 cases suffering from partial bowel resectomy for chil-dren over 1 year old were enrolled in our study.According to the type of anastomotic,the patients were divided into two groups,including technique anastomosis of 45 cases,stapling anastomosis of 33 cases.There was no significant difference in the location of the anastomosis between the two groups. Results The time of anasto-mosis was 35 ±6 min and 25 ±8 min in technique group and appliance group,respectively (P<0.05 ).Post-operative recovery of gastrointestinal function was 60 ±1 2 h in technique group.In appliance group was(50 ± 1 5)h,respectively (P<0.05 ).There weren’t anastomotic leakage and anastomotic stenosis in appliance group.However,As far as handiwork group was concerned,one case appeared anastomotic leakage and one patient appeared anastomotic stenosis.Two groups all included one bleeding case.There wasn’t dead case in two groups. Conclusion The application of anastomat on operation could reduce the occurrence of anastomotic complications,shorten operating time and the time of postoperative recovery of gastrointestinal function.

Objective To investigate the changes of serum procalcitonin (PCT), interleukin-6 (IL-6) and C reactive protein (CRP) in children with Henoch-Sch?nlein purpura (HSP) combined with surgical complications. Methods From January 2010 to June 2013, 48 children with HSP combined surgical complications were enrolled, the fasting venous blood were obtained in day 1, 3, 5 of admission and before discharge. Meanwhile, 30 healthy children were selected as control. Results Compared with the control group, the levels of serum PCT and IL-6 in day 1, 3, 5 of admission, and the levels of serum CRP in day 1, 3 of admission were higher in children with HSP combined with surgical complications (all P<0.01). The differences of levels of serum PCT, CRP and IL-6 in day 1, 3, 5 of admission and before discharge were statistically signiifcant between surgical group and non-surgical group. All these indicators showed a gradual downward trend. Compared with surgical group, the levels of serum PCT and IL-6 in day 3, 5 of admission and serum CRP in day 5 of admission were signiifcantly lower in non-surgical group (P<0.05). There were positive linear correlations between the level of serum PCT and IL-6, and between the level of PCT and CRP (r=0.48, 0.62, P<0.01). Conclusions The changes of serum PCT, IL-6 and CRP may be associated with the occurrence of surgical complications in children with HSP, monitor these indicators may help to assess the condition and to guide the treatment.

目的 探讨黑斑息肉综合征及其常见并发症的诊断及治疗. 方法 回顾性分析本院收治的两例P-J综合征患儿的临床资料.结果 病例1术后病理检查结果提示结肠息肉部分腺上皮细胞增生,符合P-J息肉改变,诊断为P-J综合征、肠套叠.病例2术后病理检查结果提示幼年性息肉并绒毛管状腺瘤,部分区域腺上皮伴轻度不典型增生.两例均好转出院. 结论 P-J综合征常并发肠梗阻,应予尽早以手术治疗.

过敏性紫癜(anaphylactoid purpura)又称亨-舒综合征(Henoch-Sch(o)nlein purpura,HSP)是儿科常见病之一,以全身小血管炎为主要病变的免疫性疾病.HSP患儿常伴有多种外科并发症,尤以急腹症多见[1].本文收集了自2007年1月至2011年8月收治的34例伴腹部外科并发症的HSP患儿临床资料,重点总结该类并发症的诊治体会.

血管内皮生长因子(vascular endothelial growth factor,VEGF),又称血管通透因子(vascular permeability factor,VPF)或血管调理素(vascutotropin),最初在1983年由Senger等[1]在猪肝癌模型中发现,当时认为它可诱发肿瘤,直到1989年才由Ferrara等在牛垂体滤泡星形胶质细胞体外液中分离纯化出来.近年国内外研究发现,VEGF在多种中枢神经系统(central nervous system,CNS)疾病中表达异常,提示它与CNS疾病关系密切.

Objective To study the effects of epidermal growth factor(EGF) and transforming growth factor β1(TGF-β1) on acute gastric mucosa lesion(AGML) following craniocerebral injury in rats,and evaluate the correlation between EGF and TGF-β1.Methods The animal models were established by the Feeney's free-falling weight method.The serum levels of EGF and TGF-β1 were examined by ELISA,and the expression of TGF-β1 on gastric mucosa were evaluated at different time phases after craniocerebral brain injury by immunohistochemistry,the cinnamomeous granules in cytoplasm represented positive signal.Results The serum levels of EGF and TGF-β1 declined after craniocerebral injury,reduced to its minimum points 24h after injury(P0.001),then started increasing 3d after injury,reached the normal levels 5d after injury,and there was positive relation between the 2 variables.The expression of TGF-1 on gastric mucosa was reduced significantly 24h after craniocerebral injury(P0.01),which was markedly elevated 3d after craniocerebral injury(P0.01).Conclusion The acute gastric mucosa lesion caused by craniocerebral injury may be correlated with the lost synergetic protection to gastric mucosa of endogenetic EGF and TGF-β1.The detection of EGF and TGF-β1 will contribute a lot to a successful judgment of pathogenetic condition,treatment and assessment of prognosis.