小儿椎管内肿瘤显微切除术中的椎管重建

目的 探讨小儿椎管内肿瘤显微切除术中保留椎板棘突重建椎管后部结构的手术方法，以求避免椎板切除术后并发症发生。方法 自1997年1月～2002年3月笔者采用保留和重建椎板后部结构进行椎管内肿瘤切除9例，男6例，女3例，年龄2．5～10岁，平均年龄8．5岁，病程1～5年。采用保留带蒂椎板棘突(6例)或游离椎板棘突复合体(3例)，经棘突椎板截骨取下椎管后部，形成椎板骨窗，显微切除椎管内肿瘤后，再将后部结构原位回植固定重建椎管。结果 9例经MRI诊断证明的椎管内肿瘤，颈段2例，胸段3例，腰骶段4例。6例采用保留带蒂椎板棘突重建椎管后部，3例采用游离椎板棘突重建椎管后部。椎板切开数1～4个，平均2．5个，随访3个月～5年，全部患儿在3个月复查X线见到良好的骨性愈合，脊椎序列正常，未见骨不愈合和椎板棘突复合体移入椎管倾向，无一例脊柱畸形和椎体滑脱者。6例复查MRI，见肿瘤切除完全，未见椎管狭窄及神经根粘连。结论 小儿椎管内肿瘤显微切除后重建椎管后部，可达到保持脊柱正常结构完整，避免椎板切除后脊柱变形，防止瘢痕粘连压迫硬膜及神经根的效果。     

带蒂椎板成形术治疗椎管内肿瘤9例

目的 探讨带蒂椎板成形术重建椎管后部结构治疗椎管内肿瘤的临床效果。方法 对9例经MR1诊断椎管内肿瘤，行显微切除椎管内肿瘤后，采用带蒂椎板棘突复合体，实行椎板成形术重建椎管。结果 9例患儿采用保留带蒂椎板棘突重建椎管后部，术中椎板切开1～4个，平均2．5个。随访3个月～5年，均在3个月复查X线见良好骨性愈合，脊椎序列正常，未见骨不愈合椎板棘突复合体移入椎管倾向，无1例发生脊柱畸形和椎体滑脱、6例复查MR1示肿瘤切除完全，未见椎管狭窄及神经根黏连。结论 带蒂椎板成形术符合脊柱的解剖生物特性，可替代现行的椎板切除术，可避免椎板切除术后并发症发生。     

儿童椎管内硬脊膜外蛛网膜囊肿的外科治疗

目的 探讨儿童椎管内硬脊膜外蛛网膜囊肿的临床特点及其诊治.方法 回顾性分析2001年1月至2009年8月我科收治的4例儿童椎管内硬脊膜外蛛网膜囊肿.其中颈胸段1例,胸腰段3例.临床表现3例患儿出现运动障碍,1例有感觉障碍,1例有小便失禁,1例有根痛表现.4例患儿均采用外科手术治疗,其中2例囊肿节段小于3个椎体的采用椎板切除+囊肿切除术,2例囊肿节段大于3个椎体的采用椎板成形+囊肿切除术.结果 4例患儿术后均恢复良好,除1例患儿术后随访1年下肢仍有轻度乏力外,其余临床症状均消失,恢复学习.随访1～9年均未见囊肿复发,复查脊柱三维CT未见脊柱畸形的发生.结论 儿童椎管内硬脊膜外蛛网膜囊肿是一种少见疾病,外科手术治疗能获得满意的结果,椎板成形术能够减少囊肿节段过长的患儿术后脊柱畸形的发生.

Abstract：

Objective To review the clinical features and surgical treatment of spinal extradural arachnoid cysts (SEACs) in children. Methods Four children with SEAC from were admitted to our department between January,2001 to August,2009. One SEAC was located at the cervicothoracic spine whereas the other three were found in the thoracolumbar spines. All cases were treated by surgery.Two children underwent the laminectomy for resection of the SEAC, which occupied less than 3 segments. SEAC, spreading more than 3 segments in the remaining cases, were treated by laminoplasty and en bloc resection. Results Postoperatively, the children had good recovery and resumed school. Followup of 1 to 9 years revealed no recurrences. The three-dimensional CT spine did not demonstrate any spine deformity in follow-up study. Conclusions SEACs in children are rarely reported in the literature. Excision of the SEAC result in a favorable outcome. The larninoplasty can reduce spinal deformity in patients with the long segment SEAC.     

儿童寰枢椎脱位的临床特征及手术疗效分析

目的观察并分析后路复位内固定治疗儿童寰枢椎脱位的临床特征及手术疗效。方法以2010年9月至2017年12月陆军军医大学第一附属医院神经外科收治的18例明确诊断为寰枢椎脱位(2例齿状突骨折)儿童患者作为研究对象,其中男9例、女9例,年龄6～17岁,平均(13. 17±3. 48)岁;采取经后路复位螺钉-钛棒(板)系统内固定技术,于手术前后应用颅颈交界区CT薄层扫描及上颈椎CT三维重建测量寰齿间距(Atlantodens interval,ADI)、硬腭枕骨大孔线(Chamberlain’s line,CL)和斜坡枕骨大孔线(McRae’s line,ML)上距离,通过延髓脊髓角(Cervicomedullary angle,CMA)评价高位脊髓受压程度,采用日本骨科协会(Japanese Orthopedic Association Scores,JOA)评分标准评估颈脊髓神经功能改善程度;采用神经电生理学方法监测神经传导功能,系统分析经后路复位内固定术治疗儿童寰枢椎脱位术前、术后神经功能的改善情况及脱位复位、植骨融合的可行性。结果 15例患儿随访18～100个月,平均(45. 8±14. 49)个月,失访3例。患儿寰椎侧块及枢椎椎弓根均能容纳3. 5 mm钛钉,术中无椎动脉损伤、骨质裂开等情况,术后恢复较为理想,除个别出现颈椎活动受限外,无其他并发症。术前ADI(3. 86±2. 71) mm,CL(10. 05±6. 55) mm,ML(2. 17±4. 48) mm,CMA(122. 84±18. 02)°,JOA(11. 5±3. 26);术后ADI(1. 96±2. 041) mm,CL(6. 42±4. 85) mm,ML(0. 56±3. 78) mm,CMA (128. 29±17. 8)°,JOA(15. 44±1. 46);上述指标差异均有统计学意义(P 0. 05)。寰枢关节脱位13例完全复位,5例有不同程度复位;神经电生理检查结果均有明显改善,末次随访影像学检查示植骨区获得骨性融合,无内固定松动、断裂等情况出现。结论后路复位内固定治疗儿童寰枢椎脱位的疗效明确,远期预后较好。     

儿童椎管内肠源性囊肿的诊治体会

目的 总结儿童椎管内肠源性囊肿的临床特点和治疗经验。方法 回顾性分析我院6例儿童椎管内肠源性囊肿的临床、影像学资料。结果 本组6例均有肢体活动障碍，4例伴有神经根性疼痛，5例感觉障碍。囊肿位于颈段4例，胸段2例。MRI检查表现为稍长T1、长T2均匀信号。5例作全切或大部切除术，1例行部分切除术。5例术后神经功能恢复良好。结论 儿童椎管内肠源性囊肿是少见的先天性疾患，多发生于颈段椎管硬膜下脊髓腹侧。MRI是有效的检查工具。早期诊断和显微手术是治疗的最佳方案。     

小儿颈4椎板、棘突骨母细胞瘤一例

患儿 :女 ,11岁。颈部疼痛 1年 3个月入院。疼痛为间歇性 ,多在夜间发作。检查 :一般状态好 ,颈 4棘突压痛阳性 ,局部无肿胀 ,颈部活动轻度受限 ,无肢体运动及感觉异常。ＣＴ检查 :颈 4椎板、棘突膨胀性、溶骨性破坏 ,边界清楚 ,骨膜菲薄 ,但连续性完好 ,无骨膜反应 ,考虑为骨的良性病变。手术中所见 :颈4棘突大部分破坏、消失 ,仅上位端残存部分棘突 ,后部椎板骨膜菲薄、变软 ,切开见瘤体呈紫褐色 ,其中混有肉芽样组织 ;前部椎板骨膜及部分骨质完好 ,未侵及硬脊膜 ;棘间韧带及黄韧带部分呈肉芽样改变。切除残存棘突及后部椎板 ,彻底刮除两…     

脊髓纵裂1例尸检报告

患儿：男，１岁６个月。出生后发现脊柱侧凸。体检：胸腰段脊柱左侧凸，背部有２ｃｍ×３ｃｍ血管荡，右足短１．５ｃｍ，右下肢较对侧细１．０ｃｍ，肌力稍差。脊髓造影胸１２～腰３呈岛屿征。ＣＴ检查：腰１水平见一骨峙前后横穿椎管。脊髓探查术后患儿持续昏迷，抢救无效死亡。尸体解剖：脑、心、肺和肝脏等无异常，右肺下叶发育不良。胸腰段脊柱旋转侧凸，肋骨椎板多处畸形，胸１２～腰４椎管呈梭形，增宽２倍。腰１有由前上向后下之骨嵴，背侧以软骨与畸形椎板连接，分隔椎管、硬脊膜、脊髓为左右两半（图１）。脊髓长约２８ｃｍ，胸１…     

罕见椎管内海绵状血管瘤一例

椎管内海绵状血管瘤是椎管内少见的一种血管瘤 ,儿童就更少见。近来我院收治 1例 ,现报告如下。患儿 :女 ,10岁。因双下肢感觉减退半年 ,胸背部痛 2ｄ入院。检查 :双侧Ｔ6水平以下针刺感觉减退 ,肌力正常 ,双下肢腱反射活跃 ,双侧病理征阳性。Ｘ线片示 :以Ｔ5为中心向右侧弯。ＭＲＩ示 :Ｔ4～ 5椎体水平段椎管内见椭圆形肿物 ,呈等Ｔ1等信号和长Ｔ2 高信号 ,肿瘤边界清 ,位于椎管内右侧硬膜外 ,约 2 .98ｃｍ× 1.0ｃｍ大小 ,增强扫描仅轻微异常对比增强信号 ,脊髓受压并向左移。手术探查见脊髓受压、右侧椎体椎板受压凹陷达 0 .4ｃｍ ,肿瘤…     

儿童胸腰椎骨折脱位的外科治疗

目的 探讨儿童胸腰椎骨折脱位的伤情特点及椎弓根钉固定手术方法与疗效.方法 自2000年1月至2007年12月,对15例胸腰椎骨折脱位并伴有不同程度脊髓神经损伤的患儿,男11例,女4例.年龄5～12岁,平均7岁8个月,采用胸腰椎后路复位、减压,同时行椎弓根钉系统内固定术.结果 15例患儿术后随访10～48个月,平均32个月,术后X线检查显示伤椎高度恢复50%～80%,脊椎脱位都得到纠正,椎弓根钉位置好,未见松动、断裂.无一例发生血管损伤及感染.术前不同程度的脊髓神经损伤症状除了2例全瘫患儿无恢复外,其他病例在术后均得到不同程度的恢复.结论 儿童胸腰椎骨折脱位属于高能量损伤,创伤严重,常伴有不同程度脊髓神经损伤及合并伤;椎弓根钉固定治疗儿童胸腰椎骨折脱位是一种安全、可行方法,达到重建脊柱稳定性,解除脊髓神经受压,便于术后护理及提高患儿生活质量.     

胸椎管原始神经外胚叶瘤一例

患儿:女,15岁。因背部疼痛不适4个月,双下肢活动不能10d入院,患儿入院时背部疼痛不能行走,大小便功能障碍。检查:神清,T6、7棘突左侧可触及6cm×8cm大小的肿块,质硬、压痛、固定,剑突平面以下感觉、反射消失,双下肢肌力0级。CT示:T6、7椎管及其左侧椎板后外方可见软组织肿块影,病灶紧贴椎板及棘突生长,肿块向内通达椎间孔与椎管连接,呈亚铃状,椎管后部受累。肺部CT未见异常。MRI示:T6、7左侧可见一占位性病变,T1W1以等信号为主并伴有不规则低信号,T2W1是不均匀高信号。全身骨骼ECT扫描未见骨骼转移。诊断:胸椎管和左背部软组织肿瘤,…     

Unusual neuroenteric cysts: diagnosis and management

Six cases of unusual neuroenteric (NE) cysts, occurring in children aged 15 months to 18 years, are reported here. Three of the cysts were extramedullary, while the other three were intramedullary. Two of the extramedullary cysts were located at the lumbosacral region, an unusual site. Only one patient had the cyst located in a ventral relation to the cord in the cervicothoracic region. None of the patients had communication with the mediastinum or intraabdominal viscera. Stigmata of spinal dysraphism were seen in three patients. All the children had variable neurological involvement and it was difficult to differentiate NE cyst from other causes of spinal cord or cauda equina lesion, particularly in the absence of some dysraphic marker. One patient presented with minimal neurological deficits and painful torticollis; this patient was suspected to have an atlantoaxial dislocation. All patients were investigated with MRI, and the only diagnostic feature of an NE cyst was an intradural cyst with an anterior vertebral body anomaly in a single case. It was not possible to radiologically differentiate NE cyst from other intraspinal cysts in the rest of the patients. All patients were operated on by the posterior route; an attempt to excise the cyst nearly in toto was made. Evidence of neural tethering most probably due to cyst contents was seen in three patients. All patients improved after surgery. None showed recurrence of the cyst at follow-up of 3 months to 2 years.     

后路半椎体切除短节段固定治疗儿童不平衡型多发半椎体的效果分析

目的 评价后路半椎体切除术短节段固定治疗儿童不平衡型多发半椎体的临床效果.方法 回顾性分析2003年6月至2013年6月行后路半椎体切除短节段固定术,治疗不平衡型多发半椎体(≥2个)22例的临床资料.其中,男12例,女10例;初次手术年龄3.0～7.5岁,平均4.2岁.手术前、后及末次随访时所有患儿均行站立位全脊柱正侧位X线检查.对比手术前、后冠状面Cobb角、顶椎偏距、冠状面平衡及矢状面局部后凸角、矢状面平衡变化;测量并比较胸椎(T1 ～T12)及脊柱高度(T1～S1)变化.结果 随访时间36～156个月,平均86.1个月.22例共51个半椎体,手术切除41个;平均每例有2.3个半椎体,平均切除1.9个;平均每例固定3个节段.术后侧凸Cobb角12.6°±7.2°明显小于术前45.8°±12.7°,侧凸矫形率为72.5％;术后局部后凸角11.2°±7.5°明显小于术前23.6°±18.0°,后凸矫形率为52.5％,差异均有统计学意义(P均＜0.05),末次随访时无明显丢失.冠状面平衡由术前(14.0±6.7)mm降至术后(8.5±4.0)mm,差异有统计学意义(P＜0.05).胸椎高度术前为(18.5±1.9)cm,末次随访时增至(24.4±3.0)cm;脊柱高度术前为(29.3±3.7)cm,末次随访时增至(38.7±4.4)cm,差异均有统计学意义(P均＜0.05).结论 对于3.0～7.5岁儿童双侧不平衡型多发半椎体畸形,后路选择性半椎体切除短节段固定矫形效果较好,同时可维持躯干整体平衡,保留脊柱生长潜能.     

儿童先天性脊柱后凸畸形截骨方式的选择及效果分析

目的探讨儿童先天性脊柱后凸畸形截骨矫形及不同类型后凸截骨方式的选择与治疗效果。方法回顾性分析2010年1月至2017年12月因先天性脊柱后凸畸形于首都医科大学附属北京儿童医院行一期后路截骨矫形内固定术患者的临床资料,共48例,其中男26例,女22例;年龄2~16岁,平均(7.6±3.8)岁。记录患者的后凸类型、截骨方式及固定节段;测量并比较术前、术后及末次随访时节段性后凸角(segmental kyphosis,SK)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)和矢状面平衡(sagittal vertical axis,SVA)情况,记录患者术中及随访期间的并发症发生情况。结果随访时间为24~108个月,平均(37.9±10.2)个月。Ⅰ型后凸19例,Ⅱ型后凸16例,Ⅲ型后凸13例。采用Ponte截骨9例,经椎间隙截骨5例,经椎弓根截骨(pedicle subtraction osteotomy,PSO)13例,SRS-Schwab 4级截骨8例,全脊椎切除(vertebra column resection,VCR)13例。术前SK为(52.3±14.3)°,TK为(11.2±13.7)°,LL为(33.2±14.3)°,SVA为(21.9±13.6)mm;术后1个月时SK为(20.0±12.1)°,TK为(26.8±10.0)°,LL为(43.5±10.4)°,SVA为(-24.0±19.1)mm;与术前相比,术后SK、TK、LL及SVA均有明显改善。末次随访时SK为(19.4±13.4)°,TK为(23.9±6.0)°,LL为(41.9±9.4)°,SVA为(-17.6±15.3)mm,与术后相比均未见明显矫正丢失。1例出现后凸矫形部分丢失,1例出现冠状面近端Adding-on,均未行翻修手术。患者随访期间未出现神经系统并发症。结论截骨手术治疗儿童先天性脊柱后凸畸形可取得较好的矫形效果,并发症较少。具体截骨方式需要根据后凸类型及程度决定,对于Ⅰ型后凸可选择Ponte截骨、SRS-Schwab 4级截骨或VCR截骨;Ⅱ型后凸可选择经椎间隙截骨、PSO截骨或SRS-Schwab 4级截骨;Ⅲ型后凸可选择PSO截骨或SRS-Schwab 4级截骨。     

Col-Ⅳ、LN、FN和MMP-9在不同时期婴幼儿型血管瘤中的表达和意义

目的 观察不同时期婴幼儿型血管瘤(infantile hemangioma,IH)中细胞外基质结构蛋白和基质金属蛋白酶-9 (matrix metalloproteinase-9,MMP-9)的表达和分布,探讨基质结构蛋白和MMP-9在IH中潜在的作用和意义.方法 收集手术切除的血管瘤标本,经HE染色和Glut-1免疫组织化学染色后确诊为IH;应用免疫组织化学染色MaxVision法检测各标本中Ⅳ型胶原(Col-Ⅳ)、层黏连蛋白(LN)、纤维连接蛋白(FN)和MMP-9的表达情况,通过ImagePro Plus 6.0图像分析软件测量各组织中阳性染色区域的平均光密度(IOD).按患儿年龄将标本分为年龄＜3个月龄组,≥3～6个月组,≥6～9个月组,≥9～12个月组和≥12个月龄组5组.比较不同年龄组IH中基质结构蛋白和MMP-9表达的差异.结果 按标准纳入的IH共34例,其中月龄＜3个月8例,≥3～6个月7例,≥6～9个月6例,≥9～12个月8例,≥12个月5例.观察免疫组织化学染色结果显示Col-Ⅳ、LN、FN和MMP-9在各年龄组中表达强度不同,比较IOD值显示IH组织中Col-Ⅳ在≥12个月龄组(84.90±12.48)的表达较其他各年龄组高,且与＜3个月龄组(55.10±16.06)、≥3～6个月组(56.96±22.66)、≥6～9个月组(51.60±20.38)比较差异有统计学意义(P＜0.05).LN在≥9～12个月组(80.04±29.36)IH中表达最高,分别与＜3个月龄组(38.02±9.88)、≥3～6个月组(68.62±16.19)、≥6～9个月组(60.67±10.72)、月龄≥12个月组(45.96±5.02)比较差异均有统计学意义(P＜0.05).FN在≥6～9个月组(62.86±15.41) IH中表达最高,分别与＜3个月龄组(32.36±19.79)、≥3～6个月组(43.04±19.78)、≥9～12个月组(36.25±11.19)、月龄≥12个月组(27.57±13.90)比较差异有统计学意义(P＜0.05).MMP-9在＜3个月龄组(73.23±18.19)IH组织中表达最高,并随年龄增长≥3～～6个月组(59.31±12.85)、≥6～9个月组(35.80±7.50)、≥9～12个月组(26.89±10.21)、月龄≥12个月组(24.04±10.00)逐渐下降,其中＜3个月龄组、≥3～6个月组IH与其他各组比较差异有统计学意义(P＜0.05).结论 不同时期IH组织中Col-Ⅳ、LN、FN和MMP-9的表达有差异,这种差异可能是影响IH增生和消退的重要因素.     

Pediatric low-grade and ependymal spinal cord tumors

Our institutional experience with pediatric spinal cord tumors includes 25 patients with the diagnosis of ependymoma (EP; n = 4), myxopapillary ependymoma (MPEP; n = 4), juvenile pilocytic astrocytoma (JPA; n = 5), nonpilocytic astrocytoma (WHO grade I or II, n = 6), and other nonastrocytic spinal cord tumors (n = 6) treated during the period 1974-1999. Nineteen patients required radiation therapy (RT). The median progression-free survival following RT was 65 months (range 1-206 months). Seven patients recurred at an average of 22 months. The EP patients recurred at an average of 8.5 months, while the patients with low-grade astrocytoma recurred at an average of 42 months. Including the 6 nonsurviving patients, the median overall survival was 96 months. Two EP patients died with a progression-free survival of 9 months. One patient with MPEP died of other causes at 7 months. The treatment of pediatric spinal cord tumors should be individualized based on the histologic type. Radical surgery is indicated for nonmyxopapillary EP and low-grade astrocytic tumors. The need for adjuvant therapy most often depends on the extent of resection as well as the tumor type. Patients with disseminated EP, MPEP, JPA and nonpilocytic astrocytoma may achieve long-term progression-free survival with craniospinal irradiation.     

Spinal sagittal malalignment following surgery for primary intramedullary tumours in children.

BACKGROUND/OBJECTIVE: As prior studies analysed predictive factors for various post-laminectomy spinal deformities in mixed spinal regions, age groups or pathologies, their validity and conclusions were unclear. The objective of this study was to determine predictive factors for worsened cervical or thoracic spinal sagittal alignment following laminectomy or laminotomy for primary intramedullary spinal cord tumours in children. METHODS: In this retrospective study, patients treated between 1980 and 1998 were reviewed. Changes in spinal alignment at the last follow-up compared to the pre-operative state were studied. Factors analysed were age, pre-operative spinal alignment, procedure types (laminectomy or laminoplasty), number of laminae operated, surgery of C2 or T1 laminae, histological grade, presence of post-operative neurological deficit and post-operative radiotherapy. RESULTS: There were 27 patients. The mean age was 5.6 years (range 1.3-14.0 years), and the mean duration of follow-up was 3.7 years (range 0.075-9.9 years). In the cervical-cervicothoracic surgical group (n = 12), alignment worsened post-operatively in 3 patients. The number of laminae operated upon had a statistically significant impact on the development of post-operative kyphosis (p = 0.07). In the thoracic-thoracolumbar surgical group (n = 15), alignment worsened in 9 patients. Procedure types were statistically significantly different, with laminectomy associated with an increased risk of post-operative kyphosis (p = 0.01). All 5 patients who had spinal fusion for worsened post-operative alignment were in the thoracic-thoracolumbar group; no patients in the cervical-cervicothoracic group required spinal fusion (p = 0.047). Other predictive factors did not reach statistical significance (p > 0.05). CONCLUSIONS: Worsened spinal sagittal alignment following laminectomy or laminoplasty and the need for spinal fusion is more common in the thoracic-thoracolumbar region than in the cervical-cervicothoracic region. In the cervical-cervicothoracic region, operation on a greater number of laminae tends to increase the risk of worsened alignment. In the thoracic-thoracolumbar region, laminectomy is associated with worsened alignment, while laminoplasty reduces this risk; also, pre-operative kyphotic deformity tends to increase the risk of worsened alignment post-operatively.     

输尿管镜气压弹道碎石术治疗小儿下尿路结石疗效观察

目的 探讨经输尿管镜气压弹道碎石术在治疗小儿下尿路结石中的应用效果.方法 收集我科2012年1月至2015年1月33例小儿下尿路结石患儿,其中男32例,女1例,年龄6个月至12岁,平均年龄29个月,年龄小于3岁的患儿有27例.膀胱结石17例,尿道结石16例,其中前尿道结石6例,后尿道结石10例,结石大小8 mm～25 mm,平均13 mm.所有患儿经B型超声、泌尿系CT等检查,均无尿道狭窄、神经源性膀胱、先天性畸形.全身麻醉、电视监视系统下应用Wolf输尿管镜(Wolf 6～7.5F,工作通道F4.0)气压弹道碎石术(碎石杆直径1.0 mm)治疗,观察碎石成功率、术后有无尿道损伤、膀胱穿孔、有无发热等并发症发生情况及结石复发情况.结果 33例患儿均1次碎石成功,碎石时间15～60 min,平均(26±9)min,术后2d～7d内结石清除率100％,4例患儿术后第一天体温超过38.0℃、无“石街”、无尿道狭窄、无尿道损伤、无膀胱穿孔和排尿异常等并发症发生,术后住院时间2～3 d,平均2.4d.随访2～24个月,无结石复发.结论 经输尿管镜气压弹道碎石术治疗小儿尿路结石安全简便、效果确切、结石清除率高,且损伤小,术后恢复快,可作为小儿下尿路结石治疗的首选方法之一.     

开放小切口Anderson-Hynes术治疗小儿肾积水83例疗效分析

目的探讨开放小切口Anderson-Hynes术治疗小儿肾盂输尿管连接部狭窄(ureteropelvic junction obstruction,UPJO)所致肾积水的有效性及临床应用价值。方法回顾性分析2016年7月至2017年6月昆明市儿童医院泌尿外科因肾积水行开放性Anderson-Hynes术患儿的临床资料,结合国内外最新Anderson-Hynes术相关文献报道,从手术时间、术中出血量、住院天数、术后并发症发生情况等方面评价其疗效。结果本研究共纳入83例患儿,年龄31日龄至8岁,平均(2.1±1.9)岁;左侧47例,右侧28例,双侧8例;因积水加重行二次手术3例,取管后反复尿路感染3例,取管后积水未减轻1例;手术时间45~165 min,平均(95.2±26.5)min;术中出血量2~15 m L,平均(6.9±3.5)m L;住院天数5~28 d,平均(12.2±4.2)d。5例因尿外渗及输尿管长段狭窄而延迟至术后3个月取出双J管,其余患儿均于术后1个月取管,无一例发生管位回缩及结石形成;随访6个月至3年。术前肾盂前后径(anterior and posterior diameter of renal pelvis,APD)较术后缩短[(44.2±18.4)mm vs.(16.1±9.6)mm,P<0.001];术后最小肾皮质厚度较术前增厚[(9.3±1.4)mm vs.(4.2±2.0)mm,P<0.001],患儿均成功解除梗阻,临床症状消失。结论开放小切口Anderson-Hynes术疗效确切,学习曲线短,硬件设施要求低,在不具备腹腔镜设备的二级和三级医院值得推广。     

亚甲蓝在单孔腹腔镜保留淋巴管治疗小儿精索静脉曲张中的应用

目的探讨向睾丸鞘膜腔注射亚甲蓝后,经脐单孔腹腔镜淋巴管显影治疗精索静脉曲张的可行性。方法回顾性收集2016年7月至2019年10月由青岛大学附属医院收治的15例精索静脉曲张患者作为研究对象,患侧均为左侧;3例以阴囊坠涨感就诊,12例以阴囊肿物就诊;Ⅱ级4例,Ⅲ级11例。所有患者术前行B超检查确诊,B超结果提示患侧精索静脉有不同程度的增粗,内径直径为2.40~4.80 mm,平均(3.37±0.67)mm。患者年龄11~14岁,平均(12.67±1.03)岁,所有患者行单孔腹腔镜下保留淋巴管的精索静脉高位结扎术,术中向睾丸鞘膜腔注入亚甲蓝3 mL,待淋巴管充分显影后,用带线疝针经皮穿刺避开精索内淋巴管的同时行高位结扎精索血管术,所有患者未保留睾丸动脉,观察患者术后治疗效果以及恢复情况。结果所有患者手术获得成功,术后随访6~18个月,阴囊肿物,阴囊不适感均获得改善,无精索静脉曲张的复发,无鞘膜积液、阴囊水肿、阴囊色素沉积发生。淋巴管均成功显影,至少保留1根淋巴管,从注射到显影时间为30~90 s,平均(60.40±20.03)s。手术时间33~60 min,平均(40.13±11.25)min。患者住院时间1~6 d,平均(3.40±1.40)d,阴囊蓝染消失时间3~7 d,平均(4.40±1.45)d。与术前相比术后双侧睾丸体积明显增大,左侧睾丸体积平均增大(1.68±0.52)mm³,右侧睾丸体积平均增大(1.58±0.44)mm³。结论通过单孔腹腔镜下睾丸鞘膜腔内注射亚甲蓝保留淋巴管治疗小儿精索静脉曲张,可使精索内淋巴管清晰显影,便于保留淋巴管,避免术后鞘膜积液、阴囊水肿等并发症的发生,且该方法疝针操作方便,手术时间短,手术切口小,更加美观。     

Intramedullary spinal neurenteric cyst with fluid-fluid level

Spinal neurenteric cysts are rare intradural extramedullary lesions of the spine, commonly located in the cervical and thoracic regions. The majority localize ventral to the spinal cord and are associated with other vertebral anomalies. Here, the authors report a rare case of a 3-year-old boy presenting with a 1-week history of meningismus followed by rapid-onset (over a few hours) paraplegia. Magnetic resonance imaging revealed an intramedullary cystic lesion with a fluid-fluid level in the cervicothoracic region of the spinal cord without associated bony or soft tissue abnormalities. To the best of the authors' knowledge, such clinical and radiological presentation of a spinal neurenteric cyst has never been reported. A brief review of the pertinent literature is presented, and the possible pathophysiology of such a presentation is also discussed.