目的 探讨针对小儿外科实习学生临床教育的新模式,提高教学效果. 方法 将临床实习学生分为两组,对照组使用传统的教学方法,实验组在传统教学方法基础上加用腹腔镜技术课程.比较两组出科理论考核和四项腹腔镜技能考核成绩,并以调查问卷的形式对两组学生在提高学习积极性、提高腹腔镜操作技术、提高理论知识水平方面的满意度进行调查分析. 结果 出科理论考核成绩、四项腔镜技能考核成绩比较,实验组均优于对照组,差异有统计学意义(P＜0.05);实验组学生在提高学习积极性、提高腔镜操作技术的满意度高于对照组,差异有统计学意义(P＜0.05). 结论 将腹腔镜技术课程引入小儿外科临床实习中可进一步提高教学效果.

目的 探讨硬膜内、外腔联合松解术治疗脊髓栓系综合征的临床疗效.方法 回顾性分析1998年1月至2016年6月手术治疗的286例脊髓栓系综合征患儿的临床资料,采用常规手术治疗77例(常规组),采用硬膜内、外腔联合松解术治疗209例(联合松解组).结果 常规组术后并发症发生率(10.4％,8/77)与联合松解组(6.2％,13/209)无统计学差异(P＞0.05).常规组术后6个月Hoffman分级较术前无明显差异(P＞0.05).联合松解组术后6个月Hoffman分级较术前明显改善(P＜0.05),而且明显优于常规组(P＜0.05).术后6个月,常规组显效7例,改善6例,稳定43例,加重21例;联合松解组显效30例,改善32例,稳定132例,加重15例;联合松解组疗效明显优于常规组(P＜0.05).结论 对于脊髓栓系综合征,在硬膜内腔脊髓栓系松解的基础上,探查硬膜外腔,松解硬膜外腔粘连栓系、离断外终丝,可进一步提高手术效果.

该研究目的:评估手术视频在小儿外科临床实习教学中的应用的价值.方法:通过前瞻性对比研究,将该文作者所在院校五年制医学实习生随机分为对照组(传统教学)和试验组(传统教学联合手术视频教学),对比分析两组学生的一般资料、主观评价、理论考核、技能考核结果.结果:试验组主观评价和理论考试成绩明显优于对照组(P<0.05);而在操作技能考核无明显差异(P>0.05).结论:手术视频教学可提高医学生基础理论知识和临床思维,同时可提高对外科手术操作的认识.

Objective:To explore the operation management mode and socioeconomic benefits of pediatric day surgery at a general hospital.Methods:A retrospective analysis was conducted for 939 cases of day surgery from January 2017 to December 2018. According to different treatment methods, they were divided into experimental and control groups. Five specific diseases included hernia, hydrocele, cryptorchidism, varicocele and concealed penis. The experimental group underwent day surgery mode of going through fast, reasonable and optimized service procedures, incorporating the concept of enhanced postoperative recovery during perioperative period and applying single-hole laparoscopy. For control group, general hospitalization mode and conventional laparoscopy were employed.Results:As for postoperative fever, hernia, hydrocele and cryptorchidism, there were inter-group statistical differences ( P<0.05). And experimental group was better than control group. Regarding postoperative nausea/vomiting, hernia, hydrocele, cryptorchidism and concealed penis, there were inter-group statistical differences ( P<0.05). And experimental group was better than control group; length of hospital stay and total expenditure of hospitalization were statistically different between two groups ( P<0.05). And experimental group was better than control group. The inter-group expenditure of surgery was statistically different ( P<0.05) and experimental group was higher than control group. As for cryptorchidism and varicocele, the expenditure of medical consumables was significantly different between two groups ( P<0.05). And experimental group was more expensive than control group. Conclusions:Reasonable management of pediatric day surgery may shorten the length of hospitalization, lower the expenditure of hospitalization and boost parental satisfaction.

Objective To explore the safety and feasibility of transumbilical single channel laparoscopic cryp-torchidopexy with conventional instruments in treatment of cryptorchidism in children. Methods Thirty-five children with cryptorchidism were treated by transumbilical single channel laparoscopic cryptorchidopexy with conventional instru-ments from November 2017 to March 2018 at Department of Pediatric Surgery,the First Affiliated Hospital of Guangxi Medical University. Clinical data were recorded including the general information,operation time,intraoperative blood loss,postoperative testicular position and postoperative complications,etc. Results All 35 patients completed the cryptorchidopexy in one operation. Among those 35 patients,28 patients had unilateral lesions and 7 patients had bilateral lesions,with a total of 42 sides. Twenty - six patients were of groin type( 33 sides),9 patients abdominal type( 9 sides). The average operation time was(40. 4 ± 8. 2)min for unilateral lesion,and(62. 5 ± 15. 3)min for bilateral le-sions;the average intraoperative blood loss was(3. 0 ± 1. 8)mL;and the average postoperative hospital stay was(6. 4 ± 2. 1)h. Testis of 32 patients(40 sides)were fixed in the middle and bottoms of the scrotum,and testis of 2 patients (2 sides)were fixed on the top of the scrotum. One case had poor healing of naval incision,which was recovered in 1 week after dressing change. There were no postoperative complications such as scrotum hematoma,infection of incision, testicular epididymitis,testicular necrosis,testicular retraction or testicular atrophy,etc. No obvious visible scar was found in the abdomen review 2 weeks postoperatively,with the incidence of complications was 2. 9%(1/35 cases). Conclusions Transumbilical single channel laparoscopic cryptorchidopexy with conventional instruments in treatment of cryptorchidism is characterized by small trauma,quick recovery,low complication rate and visible scar free result, which is worthy of clinical promotion,but the operation is relatively complex and the correct procedures are required.

Wilms＇tumor is a common malignant tumor in children. most patients have a good prognosis,but its pathogenesis is not yet clear. In recent years,some non_coding RNAs have been found to have a close relationship with the development of this tumor. Some non_coding RNAs may serve as biomarkers for the diagnosis,predictors indica_tors,or targets for gene therapy. This paper studied the relationship between some non_coding RNAs associated with nephroblastoma is now available.

Objective To explore the experience of the diagnosis and treatment of surgical procedures for hypospadias.Methods Different surgical methods of 220 patients with hypospadias were followed up and analyzed from July 2012 to July 2015.Results Twenty-three patients received MAGPI,78 patients received TIP,85 patients received Duckett,34 patients received Duckett +onla.Postoperative complications included urethral fistula in 18 cases(8.2％),urethral diverticula in 7 cases(3.2％),urethral stricture in 8 cases(3.6％),the head of penis cracked in 9 cases(4.1％).Conclusions Surgery methods should be determined according to the type of hypospadia,reasonable surgical procedure could induce the incidence of surgical complications.

Objective To summarize the causes and treatment experiences of reoperation for Hirschsprung disease.Methods Form January 2005 to December 2015,60 patients who underwent reoperations after the radical operation of Hirschsprung disease were referred to our institute.The reasons,procedures and outcomes of redo surgery were retrospectively analyzed.Results Among 60 cases,the causes of reoperation included postoperative constipation (46.7％,28 cases),anastomotic fistula (33.3％,20 cases),postoperative adhesion ileus (11.7％,7 cases),and other causes (5 cases).There was no statistically significant difference in the postoperative constipation-related recurrent rate between age ＜1 group and age ≥ 1 group (x2 =2.188,P＞0.05).No significant difference was found in the reoperation rate among different initial radical surgical procedures (x2 =4.390,P =0.222).There was 1 death after reoperation.Forty-eight cases were followed-up from 1 to 11 years.The defecation frequency was 1-3 times per day in 44 cases and 5-11 times per day in 4 cases.No patients had incontinence,but perianal fouling was seen in 4 cases.Thirteen patients suffered form enterocolitis,which was managed by conservative treatment.Conclusions The main causes of reoperation of Hirschsprung disease were postoperative constipation and anastomotic fistula.Reoperation can get better results.Soave surgery is safe and effective,and is used most commonly in constipation-related recurrence.Age has nothing to do with constipation-related recurrence.The initial surgical procedures had no significant correlation with reoperation.

目的:通过观察后尿道瓣膜症(PUV)术后临床指标的变化,分析影响手术疗效的相关因素.方法:回顾性分析2003年1月至2017年3月广西医科大学第一附属医院小儿外科收治的31例PUV患儿的临床资料,随访观察术后临床指标,包括排尿情况、尿流率、残余尿、尿路感染、膀胱形态、肾及输尿管积水、膀胱输尿管反流、肾功能等,对各指标予以评分,制定标准化量表,从而评价手术疗效,并对影响疗效的相关因素进行Fisher确切概率法统计分析.结果:全组获得随访25例,其中术后膀胱功能评估良好17例,中等5例,差3例.影响PUV手术疗效的各个因素中,瓣膜类型、发病早晚、术前肾及输尿管积水、术前膀胱输尿管反流对疗效无明显影响(均P>0.05),而术前肾功能、产前诊断、术前膀胱形态对疗效的影响显著(均P<0.05).结论:术前肾功能损害、术前膀胱形态改变及产前诊断是影响PUV手术疗效的重要因素.

Objective:To establish and compare three different methods of partial obstruction hydronephrosis.Methods:Twenty-one New Zeal rabbits(10-week-old) were randomly assigned to three groups:rats in group 1 were embedded ureter under the psoas major muscle,rats in group 2 were emboliaed the ureter into a plastic cannula,and those in group 3 were inserted a catheter into the ureter,to establish hydronephrosis models.The anteroposterior diameter (APD),renal cortical thickness(RCT),pH,lactate dehydrogenase (LDH),β2-microglobulin(β2-MG) were detected and compared.Results:The APD was increased gradually,while the RCT was decreased after modeling.The APD of group 3 was obviously higher than that of other groups,but the RCT was lower at 21 and 28 days post-operation(P＜0.05).The level of β2-MG in group 3 was notably lower than that in group 1 and 2 at 28 days after modeling(P＜0.05).No Significant difference was found in pH and LDH level among the three groups (P ＞ 0.05).Conclusion:The models of hydronephrosis were successfully established by the three methods.The method of plastic cannula was the best useful for its simple operation.The method of catheterization was relatively complex but more convenient for urine collection.

Objective To explore the clinical efficacy, feasibility and safety of a linear cutting closer for pediatric gastrointestinal surgery . Methods From May 2012 to July 2016, 332 hospitalized patients underwent surgery by a linear cutting closer, including 251 cases of triangle anastomosis ( biliary atresia,n=217;common bile duct cyst, n=34 ) . Among 52 cases of intestinal colostomy, there were splenectomy for hematonosis with splenomegaly (n=21), spleen and pancreatic tail resection for splenic abscess (n=1), Meckel's diverticulum resection of ileum (n=4), gastrojejunostomy for pylorus cicatricial stenosis (n=2) and esophagogastrostomy for lower esophageal stricture (n=1). And laparoscopy (n=114) and traditional open surgery (n=218) were performed. Results During a follow-up period of 1 month to 4 years, closer-related complications included anastomotic leakage (n=2), anastomotic stricture (n=1) and early adhesive intestinal obstruction for biliary atresia (n=1). Conclusion Using cutting closer is simple, safe and effective for pediatric gastrointestinal surgery so that it is worthy of clinical popularization.

Objective To evaluate the clinical diagnosis and operative modality of superior mesenteric artery syndrome (SMAS)in children. Methods The clinical data were collected for 12 SMAS children un-dergoing surgery from August 2000 to January 2015.And their pathogenesis,diagnosis and treatment were ana-lyzed.Results The results of upper gastrointestinal contrast revealed barium obstruction with a classic vertical impression of penholder sign in horizontal duodenum.Three cases showed that barium flowed repeatedly be-tween stomach and duodenum as a pendulum sign.All of them were operated after failed conservative treat-ment.The surgical procedures included side -to -side duodenojejunostomy (n =4),side-to-side duodenojeju-nostomy plus lysis of Treitz ligament (n =2),Ladd's surgery (n =4)and anterior duodenojejunostomy (n =2).All of them were cured and discharged without complications.After a follow -up period of 6 months to 10 years,3 cases of early relapse were cured conservatively. Conclusions The diagnosis of SMAS is dependent upon upper gastrointestinal contrast examination.Surgery is indicated if conservative treatment is ineffective. The choice of surgical approaches is determined by pathological types.Any method of completely eliminating mechanical obstruction factors without side effects may be utilized.Side-to-side duodenojejunostomy and Ladd's surgery are worthy of popularization.

Objective:To explore the diagnosis and treatment of primary testicular tumors in children.Methods:The clinical data of 47 children with primary testicular tumors treated by surgery from January 2000 to December 2010 were analyzed retrospectively,including B-ultrasonography,serum AFP,pathological type,treatment condition,tumor staging and survival condition.Results:Serum AFP was significantly higher in children with testicular malignancy than with benign tumor (P ＜ 0.05).The results of B-ultrasonography showed that malignant testicular tumors perform space occupying lesions,while benign testicular tumors perform cystic-solid mixed.There was significant difference between benign and malignant testicular tumors in their nature (P ＜ 0.05).Among 31 yolk sac tumor patients,2-year survival rate was 75 ％,and 5-year survival rate close to 50％ in Ⅱ and Ⅲ stage.Conclusion:Most of testicular tumor are yolk sac tumor.Serum AFP and B-ultrasonography examination have an important reference value in the preoperative evaluation of benign and malignant tumors,prognosis and follow-up.

Objective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias.Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study,and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery,and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length,diameter of glans penis,bone age,serum testosterone level,and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas,urethral strictures,diverticula,meatal stenosis,and glanular dehiscence in both groups.Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196,P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080,P<0.05).(2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547,P<0.05).There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients,χ2=4.000,P<0.05).The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply.Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover,pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe.

Objetive To investigate the relationship between cytomegalovirus infection and prognosis of biliary atresia.Methods A retrospective analysis was made on 87 cases of biliary atresia from Aug.2014 to Jan.2013.According to the test results of cytomegalovirus-IgMantibody,all the cases were divided into negative group (55 cases)and positive group (32 cases).Results Comparing the two groups,there was no significant difference in age (99.75 ±31.71 d ,101.34 ±33.70 d,P =0.830);or in TBILs (180.42 ±89.94 μmol/L, 191.81 ±91.48 μmol/L,P =0.58).According to Ohkuma Y the pathological results of liver biopsies were gra-ded from Ⅰ to Ⅳ.In negative group :22cases were classified into Grade Ⅰ,18 cases into GradeⅡ,11 cases into Grade Ⅲ,4 cases into Grade Ⅳ;in positive group :4 cases were classified into GradeⅠ,11 cases into GradeⅡ,10 cases into GradeⅢ,7 cases into GradeⅣ.The degree of liver fibrosis in the negative group was lower than that in the positive group,P =0.002 .In the negative group,the serum TBIL after operation was 28.3 (1 1 .2 ,55 .7 )μmol /L,vs.positive group 17 .3 (12 .2 ,46 .7 )μmol /L.There was no significant difference between the two groups,P =0.785 .The cumulative survival rate of the two groups was compared with the log-rank test,and the negative group was higher than that of the positive group,P =0.034. Conclusions The infection of CMV may aggravate the degree of liver fibrosis,and be a prognostic factor of bili-ary atresia.

目的探讨肾上腺无症状嗜铬细胞瘤的CT和MRI表现特征,结合其手术病理结果作对照分析,提高对其诊断的准确性;探讨肾上腺无症状嗜铬细胞瘤与肾上腺其他无功能肿瘤的鉴别诊断问题。方法收集山西医科大学第一医院2009年10月至2013年2月期间经病理证实并有完整临床资料的无症状嗜铬细胞瘤14例(病理证实),肾上腺节细胞神经瘤15例(手术标本12例,腹腔镜标本3例),肾上腺无功能腺瘤28例,转移瘤10例,其中4例为双侧病灶,共67例,71个病灶,其中男性患者30例,女性患者37例,年龄8～82岁,中位年龄44岁。结果肾上腺无功能嗜铬细胞瘤与其他无功能性肾上腺肿瘤在平扫及增强扫描各期CT值比较均有统计学意义(P<0.05),肾上腺无功能嗜铬细胞瘤平扫密度高于节细胞神经瘤和无功能腺瘤,而在增强扫描3期均高于肾上腺节细胞神经瘤。无功能嗜铬细胞瘤的T-D曲线类型分布存在统计学差异(P<0.05)。结论大部分肾上腺无功能嗜铬细胞瘤无特异性儿茶酚胺增高的临床表现。其MSCT表现具有一定的特点,对其诊断及鉴别具有重要价值,能够为临床手术方式选择和术前及术中准备提供必要的影像学支持。

Objective To evaluate the expression of aquaporin 1(AQP1) in congenital hydronephrosis children′s urine,and to study its clinical significance. Methods Twenty-six children with different degree hydronephrosis were selected as experimental group(7 cases mild,10 cases moderate,9 cases severe hydronephrosis).All the patients were diagnosed by ultrasound,X-ray computer tomography(CT),or magnetic resonance imaging(MRI).No one had other urinary system diseases.Ten children without urinary system disease were selected as control group.Under the strict conditions,the preoperative urinasanguinis,intraoperative renal pelvis urine,and urinasanguinis of obstruction which was relieved after 3 days and 7 days were respectively collected in the experimental group.At the same time,the preoperative urinasangu in control group was collected.AQP1 levels was measured by indirect enzyme-linked immunosorbent assay. Results To compared with the control group,AQP1 levels of preoperation in moderate and severe hydronephrosis group significantly decreased(Pa0.05).And AQP1 levels in severe hydronephrosis group were lower than that in the moderate group(P0.05).There was no significant difference between mild hydronephrosis group and control group(P0.05).It made no difference between 3 days after surgery and intraoperation(P0.05).Yet,the expression of urine AQP1 in 7 days after surgery was definitely increased compared with that in intraoperation(P0.05),but still lower than that in control group(P0.05).Urine AQP1 levels in control group,preoperation and 7 days after surgery had positive correlation with urine osmolality;but urine AQP1 levels in intraoperative and 3 days after surgery had no correlation with urine osmolality. Conclusion Urine AQP1 levels of children with congenital hydronephrosis might be a new indicator to evaluating the concentration function of kidney.

Aquaporins(AQP) is a kind of special transmembrane protein that transport water,which widely exist in cell membrane of mammals and plants.Water is very important to the human body,and it plays a very important role in the absorption and excretion of urinary system and maintains the water balance of the body,many diseases can cause kidney damage so as to reduce the ability to water treatment of kidney,and the function of body changes can affect AQP expression of urinary system.The structure and function of AQP1 has been the most hotspot in recent years.This paper as follows reviewed for the research of the expression of AQP1 in urinary system.