Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study北大核心CSCD

目的 探讨生长抑素对急腹症患儿术后胃肠功能及应激水平的影响。 方法 选取2019年8月至2021年6月徐州市儿童医院收治的行手术治疗的102例急腹症患儿为研究对象。将患儿随机分为观察组和对照组,每组各51例。对照组患儿术后给予止血、抗感染等常规治疗,观察组在常规治疗的基础上加用生长抑素。术前、术后第1天及术后第5天采集两组患儿外周血,比较两组患儿血清血管内皮素-1（endothelin-1,ET-1）、促肾上腺皮质激素（adrenocorticotropic hormone,ACTH）、皮质醇（cortisol,Cor）及胃泌素、胃动素水平,以及两组患儿术后恢复情况及并发症发生率。 结果 术前两组患儿血清ET-1、ACTH、Cor、胃动素及胃泌素水平差异无统计学意义（P>0.05）。术后第1天、第5天,观察组患儿血清ET-1、ACTH、Cor水平均显著低于对照组（P<0.05）;术后第5天,观察组患儿胃动素与胃泌素水平均高于对照组（P<0.05）。术后观察组患儿首次肛门排气时间、肠鸣音恢复时间、首次排便时间、住院时间均较对照组缩短（P<0.05）。观察组并发症发生率（6%）显著低于对照组（24%,P<0.05）。 结论 生长抑素可显著降低急腹症患儿术后应激反应,改善胃肠功能,降低并发症发生率,有益于疾病预后。     

两种手术方法下化脓性腹膜炎患儿血清t-PA、PAI的变化研究

目的通过比较开腹手术及腹腔镜手术下化脓性腹膜炎患儿血清t-PA、PAI的动态变化,探讨其与腹膜粘连的关系以及腹腔镜手术对化脓性腹膜炎术后腹膜粘连的保护作用。方法采用开腹手术及腹腔镜手术治疗化脓性腹膜炎,取血检测血浆中t-PA、PAI两种粘连因子的变化及粘连发生情况,并比较两组病人临床恢复情况。结果经腹腔镜治疗的患儿术后24-48ht-PA、PAI值即开始发生变化,而开腹手术治疗的患儿术后96h才出现变化,腹腔镜治疗的患儿术后肠鸣音恢复时间、肛门排气、排便时间、术后白细胞恢复正常时间均短于开腹手术组。结论腹腔镜手术可以有效清除腹腔内炎症渗出,使术后粘连形成过程中,体内t-PA、PAI值出现变化,起到减轻粘连的作用。     

非气腹腹腔镜辅助儿童阑尾切除术的探讨

目的 探讨非气腹腹腔镜辅助儿童阑尾切除术(laparoscopic appendectomy,LA)的应用价值.方法 回顾性分析我院近3年来60例儿童阑尾切除术的临床资料.将行非气腹腹腔镜辅助手术的30例患儿与行常规开腹手术(open appendectomy,OA)的30例患儿分成两组,比较两组手术时间、术后肛门排气时间、住院时间以及术后并发症方面的区别.结果 非气腹LA组手术时间、术后肛门排气时间、术后住院时间较OA组明显缩短(P＜0.01).LA组无并发症,OA组出现切口感染3例.结论 非气腹LA较OA创伤小,恢复快,住院时间短,并发症少.     

嚼口香糖对腹部手术后肠动力恢复的影响及作用机制研究

目的探讨儿童腹部手术后咀嚼口香糖是否能促进肠动力的恢复，并从神经和体液两方面因素来研究其作用机制。方法将34例肠吻合手术患儿，随机分为试验组和对照组，每组各17例。试验组于术后第1天晨开始咀嚼无糖口香糖，直至开始进食，每日3次，每次1h，对照组禁食。记录两组术后第1次肛门排气时间，并于第3次咀嚼口香糖后1h抽取血液检测胃泌素和儿茶酚胺（包括去甲肾上腺素和肾上腺素），对两组术后第1次排气时间、血胃泌素及儿茶酚胺水平进行统计学分析。结果试验组术后第1次肛门排气时间为术后63h，对照组为78h，差异有统计学意义（t=5．665，P〈0．05）。试验组去甲肾上腺素水平低于对照组，差异有统计学意义（t=3．335，P〈0．05），而两组肾上腺素（t=1．201，P〉0．05）及胃泌素（t=0．418，P〉0．05）比较，差异无统计学意义。结论根据假饲原理，腹部手术患儿术后嚼口香糖有助于肠功能的早日恢复，其作用机制与血去甲肾上腺素水平降低有关。     

腹腔镜阑尾切除术与开腹阑尾切除术治疗急性阑尾炎比较

目的 对比分析腹腔镜阑尾切除术(LA)与开腹阑尾切除术 (OA)治疗急性阑尾炎的疗效.方法 分析185例急性阑尾炎患儿的病例资料.其中85例患儿实施LA(LA组),术后病理证实单纯性阑尾炎30例,化脓性阑尾炎36例,坏疽穿孔阑尾炎19例;另外100例同期行OA患儿作为对照组(OA组),术后病理证实单纯性阑尾炎28例,化脓性阑尾炎38例,坏疽穿孔阑尾炎34例.比较不同类型急性阑尾炎患儿行LA及OA的手术时间、术后肛门排气时间、住院时间,发生腹腔脓肿、切口感染、肠梗阻例数.结果 单纯性阑尾炎、化脓性阑尾炎患儿行LA的术后肛门排气时间、住院时间短于OA组,手术时间长于OA组,差异均有统计学意义(Pa<0.05).坏疽穿孔阑尾炎患儿行LA的术后肛门排气时间短于OA组,差异有统计学意义(P<0.05);手术时间与OA组比较,差异有统计学意义(P<0.05);发生腹腔脓肿、切口感染例数均低于OA组,差异均有统计学意义(Pa<0.05).结论 对于单纯性和化脓性阑尾炎,LA在缩短住院时间、肛门排气时间,降低发生腹腔脓肿、术后切口感染、发生肠梗阻方面存在优势,但对于坏疽穿孔阑尾炎,LA在缩短肛门排气时间,降低发生腹腔脓肿及切口感染方面存在优势.     

加速康复外科在腹腔镜手术治疗儿童复杂性阑尾炎中的应用

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念应用于腹腔镜治疗儿童复杂性阑尾炎中的有效性及安全性。方法回顾性分析江苏省盐城市妇幼保健院和淮安市妇幼保健院2017年3月至2018年4月收治的58例儿童复杂性阑尾炎患儿临床资料,根据患儿病情和家长意愿分为ERAS组(n=29)和对照组(n=29)。两组均在腹腔镜下行阑尾切除术,ERAS组围术期采用加速康复外科处理方案,对照组则采用传统处理方案,比较两组术后首次进食时间、肛门排气时间、术后下床活动时间、住院时间、手术并发症发生率、住院费用、疼痛评估及满意度等指标。结果 58例复杂性阑尾炎均痊愈出院。ERAS组术后首次进食时间(12. 11±2. 23) h,肛门排气时间(26. 61±12. 30) h,术后下床活动时间(9. 17±1. 35) h,住院时间(4. 23±1. 18) d,住院费用(9 948. 12±105. 36)元,疼痛评分(2. 35±0. 26)分,满意度为96. 55%。对照组术后首次进食时间(24. 62±3. 28) h,肛门排气时间(44. 63±17. 28) h,术后下床活动时间(24. 75±2. 85) h,住院时间(6. 15±1. 49) d,平均住院费用(12 131. 65±132. 29)元,疼痛评分(5. 48±0. 79)分,满意度为75. 86%。两组患儿术后首次进食时间、肛门排气时间、下床活动时间、住院时间、住院费用、疼痛评分及满意度等指标比较,差异均有统计学意义(P 0. 05)。ERAS组术后1例并发腹壁切口感染(3. 44%),对照组2例并发腹壁切口感染(6. 88%),差异无统计学意义(P 0. 05)。所有患儿术后随访3个月,均恢复良好,无切口感染、阑尾残株炎及粘连性肠梗阻等并发症发生。结论在腹腔镜治疗儿童复杂性阑尾炎围手术期,应用ERAS能够加速术后康复,缩短住院时间,提升就诊满意度,且不增加额外经济负担,因此安全有效,值得临床推广。     

小儿腹腔镜下阑尾切除术与开腹阑尾切除手术的对比研究

目的 比较小儿腹腔镜下阑尾切除术与开腹阑尾切除术的优缺点.方法 2009年1月至10月作者采用腹腔镜下阑尾切除术治疗小儿阑尾炎136例,并与传统开腹阑尾切除手术145例作比较,对比两种手术方式在手术时间、术后肛门排气时间、住院时间以及并发症的发生率等方面有无差异.结果 腹腔镜下阑尾切除术手术时间长于传统开腹阑尾切除术,患儿手术切口较短,术后肛门排气早,住院时间缩短,并发症明显减少.结论 腹腔镜下阑尾切除术可作为小儿急性阑尾炎的首选术式.     

小儿急性阑尾炎手术中腹腔冲洗的必要性探讨

目的通过对比各型小儿阑尾炎术中行腹腔冲洗与未行腹腔冲洗的疗效,探讨术中行腹腔冲洗的必要性。方法收集本院近3年内收治的急性阑尾炎病例共350例,其中A组为单纯性阑尾炎,行腹腔镜阑尾切除术;B、C组为化脓性阑尾炎未穿孔,B组行腹腔镜阑尾切除+腹腔引流术,C组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术;D、E组为坏疽穿孔性阑尾炎,D组行腹腔镜阑尾切除+腹腔引流术,E组行腹腔镜阑尾切除+腹腔冲洗+腹腔引流术。术后对患者资料进行详细统计和相应分析。结果急性单纯性阑尾炎行腹腔镜阑尾切除术后患儿预后良好。急性化脓性阑尾炎组术中行腹腔冲洗后,术后患儿肛门排气排便时间、直肠刺激症状、间断腹痛情况明显增加,且术后腹腔脓肿的发生率明显增多,术后5 d血常规白细胞稍高,1例并发右侧膈下脓肿,平均住院时间较未冲洗组明显延长;相反,急性坏疽穿孔性阑尾炎组,术中行腹腔冲洗后,患儿术后舡门排气排便时间缩短,术后腹腔残余感染、直肠刺激症状、间断腹痛情况降低,术后腹腔脓肿等并发症的发生率降低,术后5 d血白细胞较未冲洗组稍低。术后患儿恢复相对较快,住院时间短。结论小儿急性阑尾炎术中冲洗治疗应根据具体情况选择合适的方法,术中调节体位,充分显露脓腔,引流彻底,引流管位置适宜;急性化脓性阑尾炎未穿孔者不需行腹腔冲洗,而急性坏疽穿孔性阑尾炎则需术中行腹腔冲洗。     

小儿肠套叠术后小肠套叠八例

小儿肠套叠术后小肠套叠非常少见 ,目前未见专门报道。其临床表现不典型 ,诊断困难 ,如延误诊治 ,死亡率非常高。本文报道近 10年来收治的小儿肠套叠术后小肠套叠 8例 ,并对其诊断方法进行探讨。临床资料本组 8例 ,男 3例 ,女 5例 ;年龄 3～11个月 ,平均 5 .5个月。原肠套叠类型 :回 结型 5例 ,回 回 结型 3例 ,发病时间 12～ 5 0ｈ ,均经空气灌肠复位不成功后再行手术探查复位 ,无肠坏死或肠占位。本组患儿有 6例第一次术后 1～ 3ｄ有肛门排气、排便、肠鸣音恢复正常 ,已恢复进食 ;另 2例无排气、排便 ,腹胀 ,肠鸣音弱。再次出现症状距…     

儿童结肠冗长症的微创治疗

目的探讨腹腔镜技术在儿童结肠冗长症中的应用价值。方法选择2004年6月～2006年1月结肠冗长症患儿8例作为腹腔镜组,于腹腔镜下行根治术;选择2002年6月～2004年12月经开腹手术治疗的结肠冗长症患儿7例作为开腹手术组。比较两组疗效、手术时间、术后进食时间及住院时间等。结果腹腔镜组8例,均治愈,无并发症,无中转开腹病例,平均手术时间1.8±0.4h(1.4～2.1h);开腹手术组平均手术时间3.1±1.1h(2.5～4.1h);两组比较,P<0.05,差异有统计学意义。腹腔镜组肠鸣音恢复时间平均为术后1.1±0.3d(0.9～1.4d),有自主排便,恢复饮食;开腹手术组肠鸣音恢复时间平均为术后2.2±0.8d(1.8～3.1d),有自主排便,5～7d恢复饮食;两组比较,P<0.05,差异有统计学意义。腹腔镜组平均住院时间为5.4±1.2d(4～6d);开腹手术组平均住院时间为9.1±2.1d(8～11d);两组比较,P<0.05,差异有统计学意义。腹腔镜组随访3～6个月,患儿生长发育良好,无术前类似症状发生,无再住院及二次手术病例;开腹手术组有2例因不全性机械性肠梗阻再次住院,经保守治疗缓解。结论腹腔镜技术应用于儿童结肠冗长症根治术,疗效好,手术时间及住院时间缩短,术后肠道功能恢复优于开腹手术。     

Update on Cochrane data on paediatric respiratory diseases

INTRODUCTION: Systematic reviews seek to describe and summarise the best evidence for a given intervention by pooling data from relevant quality clinical trials. The Cochrane Collaboration has fostered the development and dissemination of systematic reviews throughout the world. We have identified and summarised The Cochrane systematic reviews of relevance to the paediatric pulmonologist. METHODS: We performed an expert search of the Cochrane Database of Systematic Reviews using a combination of medical subject headings and free text terms relating to paediatric respiratory disease. RESULTS: The search identified 120 systematic reviews with interventions specific to children with some relevance to pulmonary disease, and 327 reviews with interventions relating to pulmonary disease in adults and children. After pragmatic exclusions, 81 reviews were sorted by disease and 59 of these are discussed in detail. CONCLUSIONS: There are now many systematic reviews that make a positive contribution to paediatric pulmonology. The majority of reviews (69%) found evidence that either confirmed or refuted an accepted practice. The remaining reviews concluded that the evidence for an accepted practice is poor and sometimes wholly absent. Clinicians must be aware that lack of evidence of effect is not the same as evidence of lack of effect. Caution must be exercised before applying the conclusions of systematic reviews based upon adult data to childhood disease.     

不同气体条件对腹膜形态影响的实验研究

目的 在体实验研究提示,CO2气腹后,腹膜结构出现改变.本实验研究不同气体条件对腹膜形态的影响,探讨CO2气腹对腹腔肿瘤细胞影响的潜在机制.方法 在体实验:乳猪14头,年龄7～14 d,体重2～4 kg.随机分为两组:CO2气腹组(CO2组,n=7),N2O气腹组(N2O组,n=7).分别行100%CO2及100%N2O气腹,气腹时间为4 h,气腹压力为12 mm Hg.实验结束,采集腹膜标本.离体实验:C57BL/6小鼠10只,年龄4周左右,经0.125%胰酶预处理后,通过腹腔灌洗分离培养小鼠腹膜间皮细胞.离体细胞随机分为三组:对照组(5%CO2组).100%CO2组,8 cm H2O压力100%CO2组.细胞培养至连续单层后,将细胞分别暴露于5%CO2、100%CO2及8cmH2O压力100%CO2中4 h.不同气体条件下腹膜及分离培养的间皮细胞行电镜观察.结果 在体实验腹膜电镜结果提示压力12 mm Hg的100%CO2气腹维持4 h,导致腹膜间皮细胞层破坏,基底膜暴露,仅存细胞骨架;相同条件的100%N2O气腹使间皮细胞间隙增大,部分区域基底膜暴露.离体实验观察100%CO2破坏间皮细胞微绒毛,压力下的100%CO2对问皮细胞影响更加明显.结论 100%CO2使在体腹膜及离体间皮细胞超微结构发生明显改变,因此,小鼠模型中发现的CO2气腹后神经母细胞瘤转移增加可能与间皮细胞屏障削弱有关.

Abstract：

Objective Electron microscopic studies have shown significant morphologic changes of peritoneum after CO2 pneumoperitoneum in vivo. This experiment was to assess the effect of different gas on the morphology of peritoneum and the underlying mechanism of CO2 pneumoperitoneum on tumor cells. Methods In vivo, fourteen piglets (2-4 kilogram in weight, 7-14 days of age) were equally divided into the CO2 group(n = 7) and N2O group(n = 7). 100% CO2 or 100% N2O pneumoperitoneum was infused for 4 hours. Pneumoperitoneum pressure was 12 mmHg. At the end of the experiment, the samples of peritoneum were collected. In vitro, primary murine peritoneal mesothelial cells were36 collected by peritoneal lavage from ten C57BL/6 mice (4 weeks of age) after 0. 125% trypsin pretreatment. Isolated cells were divided into three groups: control group (5% CO2),100% CO2 group and 8 cm H2O pressure &. 100% CO2 group. After monolayers of mesothelial cells were established, cells were cultured with 5%CO2, 100% CO2 and 100% CO2 with 8 cm H2O pressure for 4 hours. Peritoneum and isolated mesothelial cells were examined by scanning electron microscopy. Results Scanning electron microscopy investigation suggested in vivo, 12 mmHg 100% CO2 pneumoperitoneum for 4 hours destroyed mesothelial cells layer of peritoneum, exposing the basal lamina. In contrast, 100% N2O pneumoperitoneum leaded to an increase of intercellular gaps and the basal lamina was exposed in part areas under same pressure and duration. In vitro, 100% CO2 exposition was associated with a significant destruction of the microvilli formation of isolated mesothelial cells. 100% CO2 with 8 cm H2O pressure had more significant impact on mesothelial cells. Conclusions The peritoneal mesothelial cells lose their typical cell morphology when exposed to 100% CO2. Thus, the increased neuroblastoma metastasis observed after CO2 pneumoperitoneum in mice might be related to an impaired mesothelial barrier function.     

Passive smoking by asthmatics: its greater effect on boys than on girls and on older than on younger children

In 415 nonsmoking asthmatic children who were seen consecutively, asthma symptoms were more severe if the mother was a smoker than if she was a nonsmoker. This applied to both sexes but was more marked in boys than in girls. There were also other indications that sons were the more severely affected: the forced expiratory volume at 1 second, the forced expiratory flow rate during the middle half of the forced vital capacity, and the provocation concentration of histamine needed to result in a 20% decrease in the forced expiratory volume at 1 second were significantly decreased only in the sons, and lung function test results were significantly less in sons than in daughters of mothers who smoked. When the 415 children were stratified according to age, lung function improved significantly with increasing age in the children of nonsmokers; in children of smokers, by contrast, symptoms and lung function test results became progressively worse. As well, there was a correlation between these indications of asthma severity and the number of years the child had been exposed to the mother's smoke. It appeared that, compared with girls, boys were more sensitive to passive smoking, and that its adverse effect increased with age and with duration of exposure.