囊胃吻合治疗假性胰腺囊肿

作者手术治疗假性胰腺囊肿（PP）24例，其中囊胃吻合16例，其它术式8例，现报告如下。临床资料一、一般资料本组男16例，女8例。年龄2～14a。腹部包块21例；腹胀、腹痛3例。不规则发热9例，发作性腹痛、胀痛、除痛13例。B超检查均显示胰腺囊性肿物；7例上消化道造影有孤型压迹，横结肠向下移位，十二指肠通过受阻，或十二指肠窗泡满；9例行CT检查见胰腺囊性占位；16例囊内液淀粉酶检查，240～819IU6例，1000～2000IU5例，20OOIULZ上5例。二、手术方式：囊胃吻合术16例，囊肿空肠RollX－Y－en吻合术4例，囊肿切除2例，单纯外引流2例…     

小儿不同级别闭合性胰腺损伤的疗效分析

目的初步探讨儿童闭合性胰腺损伤的诊疗思路。方法回顾性分析本院2008年1月至2016年12月收治的42例闭合性胰腺损伤患儿的临床资料,总结其临床特点、治疗经验及预后。结果 42例中,男33例,女9例,年龄1.6~14岁,低级别胰腺损伤(Ⅰ级、Ⅱ级)25例,高级别胰腺损伤(Ⅲ级、Ⅳ级、Ⅴ级)17例。低级别胰腺损伤患儿中,1例死于多发伤导致的多脏器功能衰竭,24例经保守治疗痊愈;高级别胰腺损伤患儿中,1例死于合并肝挫裂伤和下腔静脉撕裂所致的失血性休克后DIC;1例急诊行胰头端胰腺结扎+胰体尾部空肠Roux-Y吻合术,术后出现假性胰腺囊肿,经保守治疗后痊愈;其余15例早期给予保守治疗,对并发顽固假性胰腺囊肿的患儿选取合适的引流手术,效果良好。结论 (1)儿童闭合性胰腺损伤发病率低,症状隐匿,不合并其它组织脏器损伤的单纯性胰腺损伤往往损伤级别较高,更容易延误诊治,腹部超声是良好的筛查手段;(2)单纯的胰腺损伤通常不会危及生命,早期保守治疗,后期针对并发顽固假性胰腺囊肿的患儿,个性化选择合适的引流手术是安全和有效的。     

小儿肠系膜乳糜囊肿

目的探讨小儿肠系膜乳糜囊肿的临床特点及诊治方法。方法回顾性分析我院1987～2003年经手术治疗及病理检查证实的6例小儿肠系膜乳糜囊肿的临床表现及治疗经过。结果本组男4例，女2例，年龄7个月～10岁（平均3岁10个月）。病程30h～2年，病程在7d以内4例。5例表现为急腹症，1例表现为慢性复发性腹痛。术中证实空肠系膜囊肿4例，回肠系膜囊肿2例，囊肿压迫肠管并发肠梗阻2例，并发肠扭转1例，并发乳糜腹2例。3例行囊肿及部分肠管切除吻合术，3例行单纯囊肿切除术，囊内液均呈乳糜状，苏丹Ⅲ染色及乳糜试验阳性。结论小儿肠系膜乳糜囊肿主要表现为腹痛伴腹腔囊性包块，常以急腹症为首发表现，手术切除囊肿及受累肠管预后良好。     

小儿胰腺假性囊肿17例诊疗分析

目的探讨小儿胰腺假性囊肿的治疗体会。方法回顾性分析本院1999年1月至2012年12月收治的17例胰腺假性囊肿患儿临床资料,男8例,女9例,年龄2-16岁,平均年龄8．4岁,其中13例行保守治疗;1例行超声引导下经皮穿刺引流;3例手术治疗（1例行囊肿外引流术,1例行囊肿胃吻合术,1例行胰腺囊肿切除术）。结果13例保守治疗病例中,10例治疗有效;3例失败其中1例经皮穿刺引流病例好转出院。3例手术病例均治愈出院。17例中,1例复发,其余治愈及好转病例随访半年至1年均无复发及相关并发症出现。结论胰腺假性囊肿无论大小,大多数经早期保守治疗,可获好转或痊愈;出现手术适应证时应及时手术,手术治愈率高,囊肿吸收快,并发症少。     

儿童假性胰腺囊肿外科治疗探讨

目的探讨儿童假性胰腺囊肿的治疗方法,以提高疗效,改善预后。方法回顾性分析本院15年来收治的18例假性胰腺囊肿患儿临床资料,男10例,女8例,年龄4～14岁,平均年龄9岁,10例有急性胰腺炎病史,8例有外伤史,15例有上腹痛,8例扪及上腹部包块。11例行保守治疗,6例作内引流,1例作囊肿切除术。结果18例均治愈,无一例死亡,均无严重并发症发生。随访8个月至2年无复发。结论儿童假性胰腺囊肿应根据具体情况采用不同的治疗方法,手术治疗以囊肿Roux—Y吻合术为最佳。     

小儿大网膜囊肿和肠系膜囊肿引发急腹症的诊治体会

目的 探讨小儿大网膜囊肿和肠系膜囊肿引发急腹症的诊治特点。方法 回顾性分析大网膜囊肿和肠系膜囊肿引发急腹症患儿共12例。结果 12例中，10例囊肿破裂造成腹膜炎，2例大网膜囊肿导致肠梗阻。全部经手术治疗，预后良好。结论 大网膜囊肿和肠系膜囊肿引发急腹症多因外伤造成囊肿破裂，引发腹膜炎或肠系膜囊肿突然增大压迫肠腔、囊液外渗导致肠梗阻和腹膜炎。此类患儿应早期诊断，及时手术治疗。     

儿童假性胰腺囊肿26例诊治分析

目的总结儿童假性胰腺囊肿的诊断与治疗经验。方法回顾性分析华中科技大学同济医院小儿外科1990—2010年收治的26例假性胰腺囊肿患儿临床资料,对其诊断及治疗方法、预后进行分析。结果26例中,男21例,女5例;继发于外伤18例,原因不明7例,胰腺炎1例;临床症状以腹痛（19例）、呕吐（20例）、腹部肿块（13例）及发热（7例）为主。24例经B超明确囊肿的位置和大小;11例血尿淀粉酶不同程度升高;保守治疗7例,囊肿胃吻合术7例,囊肿空肠Roux—Y吻合术7例,外引流术4例,囊肿及胆囊切除1例,术后病理检查均符合假性胰腺囊肿;治愈18例,好转7例,自行出院1例,无一例死亡。结论儿童假性胰腺囊肿多继发于上腹部外伤,B超是重要的诊断方法,血尿淀粉酶监测对于判断假性胰腺囊肿的进展有重要意义,在囊肿未完全形成时可采用保守治疗,囊肿形成后则宜采用内引流术。     

新生儿胎粪性腹膜炎30例临床分析

目的 探讨新生儿胎粪性腹膜炎的临床特点和治疗经验.方法 回顾性分析1999年至2007年收治的30例胎粪性腹膜炎新生儿的临床表现、影像学特点、手术所见及治疗方法.结果 30例胎粪性腹膜炎患儿产前超声检查最常见的表现为胎儿腹水及肠管扩张.7例保守治疗,17例行肠切除肠吻合术,3例只行腹腔引流术,3例行回肠造瘘术.胎粪性腹膜炎常见型13例,纤维黏连型8例,囊肿型2例.病死率6.7%,并发症发生率36.7%.结论 新生儿胎粪性腹膜炎病死率高,超声检查有助于早期诊断.一期肠切除肠吻合术或肠造瘘术可取得较好的治疗效果.     

新生儿胎粪性腹膜炎30例临床分析

目的 探讨新生儿胎粪性腹膜炎的临床特点和治疗经验.方法 回顾性分析1999年至2007年收治的30例胎粪性腹膜炎新生儿的临床表现、影像学特点、手术所见及治疗方法.结果 30例胎粪性腹膜炎患儿产前超声检查最常见的表现为胎儿腹水及肠管扩张.7例保守治疗,17例行肠切除肠吻合术,3例只行腹腔引流术,3例行回肠造瘘术.胎粪性腹膜炎常见型13例,纤维黏连型8例,囊肿型2例.病死率6.7%,并发症发生率36.7%.结论 新生儿胎粪性腹膜炎病死率高,超声检查有助于早期诊断.一期肠切除肠吻合术或肠造瘘术可取得较好的治疗效果.     

新生儿胎粪性腹膜炎30例临床分析

目的 探讨新生儿胎粪性腹膜炎的临床特点和治疗经验.方法 回顾性分析1999年至2007年收治的30例胎粪性腹膜炎新生儿的临床表现、影像学特点、手术所见及治疗方法.结果 30例胎粪性腹膜炎患儿产前超声检查最常见的表现为胎儿腹水及肠管扩张.7例保守治疗,17例行肠切除肠吻合术,3例只行腹腔引流术,3例行回肠造瘘术.胎粪性腹膜炎常见型13例,纤维黏连型8例,囊肿型2例.病死率6.7%,并发症发生率36.7%.结论 新生儿胎粪性腹膜炎病死率高,超声检查有助于早期诊断.一期肠切除肠吻合术或肠造瘘术可取得较好的治疗效果.     

A case of perforated cystic duplication of the transverse colon

A 7-year-old girl presented with an abdominal cystic mass close to the pancreas. US and CT could not identify its origin. The diagnosis of duplication of the transverse colon was made at surgery. This location is rare. The differential diagnosis in this case included a pancreatic cystadenoma, a pseudocyst or a mesenteric cyst. Received: 20 March 1997 Accepted: 23 June 1997     

Perforated tubular duplication of the transverse colon: a rare cause of meconium peritonitis with prenatal diagnosis

The transverse colon is an exceptional location of intestinal duplication. Perforated duplications are rarely described in neonates. Meconium peritonitis (MP) can originate from prenatal perforated intestinal duplication. The authors report a case of a baby girl with prenatal diagnosis of MP. Rapid worsening of clinical aspects at birth and the presence of a pneumoperitoneum on systematic abdominal plain radiographs led to urgent surgery on the 1st day of life. Laparotomy showed a perforated necrotizing tubular duplication of the transverse colon. Removal of the duplication followed by limited segmental colonic resection and double colostomy were carried out. Follow-up was uneventful.     

Rare association of severe hypoplasia of the abdominal aorta with imperforate anus, colonic atresia, and choledochal cyst

Hypoplasia of the abdominal aorta (HAA) is a rare condition that causes marked hypertension. Although multiple etiologies have been postulated for HAA, congenital structural anomalies are rarely observed except in cases associated with some hereditary syndromes. The authors describe a neonatal case with HAA complicated by multiple anomalies including colonic atresia (CA), imperforate anus, choledochal cyst, facial cleft, and brain defects. This patient showed CA in the descending colon and caliber change in the transverse colon mimicking Hirschsprung disease, both of which were thought to be caused by vascular insult to the mesentery due to HAA. Although multiple surgical corrections were successfully performed, the hypertension was uncontrollable.     

Coincidence of a ductal pancreatic cyst and a gastric duplication cyst: a case report.

We report a case of two abdominal cystic formations in an 18-month-old girl. Laparotomy was performed with surgical removal of both cysts. The cysts were connected by a fibrous bridge. Histology revealed a gastric duplication cyst and a ductal pancreatic cyst originating from an aberrant pancreatic lobe. No fistula was found either to the alimentary tract or in either of the cysts. The clinical picture and treatment are described and compared to findings in the literature.     

Cystic meconium peritonitis: ultrasonographic features

Meconium peritonitis occasionally occurs as a localized, encysted collection of meconium ranging from a few centimeters in size to huge cysts occupying most of the abdominal cavity. The cyst wall consists of fibrous granulation tissue and the cyst may contain only meconium or may also encase loops of bowel. Gas within the cyst indicates persistent communication between the perforated bowel and the cyst cavity; if the perforation seals over in utero the cyst remains gasless. Calcification is a variable finding. Sonography in two neonates with cystic meconium peritonitis showed well-defined, echogenic masses, one of which contained calcifications and was detected in utero.     

Ovarian torsion and amputation resulting in partially calcified,pedunculated cystic mass

Three children with torsion and amputation of the right overy are presented. The detached ovary resulted in a cystic mass containing necrotic material and a solid, partially calcified mural node. The cysts were attached to the omentum, to the mesentery of the transverse colon, or to the lower edge of the liver by a long twisted pedicle containing thin-walled vascular spaces. The radiographic and sonographic findings were quite similar and clearly reflected the operative and pathologic changes.     

An unusual presentation of an infected urachal cyst. Review of urachal anomalies

An infected urachal cyst classically presents with a tender lower midline abdominal mass and systemic signs of infection, including fever, malaise, and leukocytosis. At times, the findings may be clinically confused with those of acute appendicitis, Meckel's diverticulitis, or peritonitis. Sonography aids in differentiating these entities by identifying the localized cystic mass containing debris, located anteriorly in the low mid-abdomen, extending from the region of the bladder to the umbilicus. We present an unusual case of an infected urachal cyst in a 6-year-old boy who presented with lower abdominal pain, fever, intermittent diarrhea, polyuria and dysuria, a firm, fixed left lower quadrant tender mass, and an elevated white blood cell count.     

Transumbilical approach for neonatal surgical diseases: woundless operation

Purpose  The transumbilical approach by means of a circumumbilical incision has up until recently been the main method for performing a pyloromyotomy. This study aims to assess the clinical usefulness of the transumbilical approach for neonates with a variety of surgical intraabdominal diseases in order to achieve minimally invasive surgery with excellent cosmetic results. Methods   In 14 neonates with surgical diseases (3 hypertrophic pyloric stenoses, 3 ileal atresias, 2 jejunal atresias, 1 duodenal stenosis, 1 duodenal atresia, 2 ovarian cysts, 1 malrotation, and 1 segmental dilatation of ileum), treatment using a transumbilical approach by means of a half circumumbilical incision was performed at our institution. The clinical features of 14 cases were evaluated. Results  Eight cases except for three patients with hypertrophic pyloric stenosis, two with ovarian cysts and one with intestinal malrotation underwent the operation within 4 days of birth. In 10 of 14 cases, the umbilicus was incised on its upper half circumference, while the umbilicus of 4 cases was incised on its lower half circumference. In one ileal atresia patient with a remarkable degree of oral intestinal dilatation, a slight additional transverse incision was added. In four cases (1 case with ileal atresia, 2 cases of an ovarian cyst, and 1 case with a segmental dilatation of the ileum), laparoscopy-assisted transumbilical surgery was performed. In all cases, no operative complications were encountered. Postoperatively, there was no wound in appearance and the umbilicus appeared to be normal. Conclusion  The transumbilical approach with or without laparoscopic assistance is considered to be a feasible, safe, and cosmetically excellent surgical procedure in neonates with a wide variety of surgical intraabdominal diseases.     

胆总管囊肿切除术中胰管损伤的防治

目的探讨胆总管囊肿切除术中胰管损伤的处理及预防。方法 分析手术处理５例胰管损伤的临床资料。结果 ５例胰管损伤中行胰管修补３例、胰管十二指肠吻合１例及副胰管结扎１例;术后４例效果满意,１例胰漏经保守引流治愈。结论 术中造影可清楚显示胆胰管连接系统,指导胆总管囊肿根治切除术离断 胆胰管连接部水平,避免损伤胰管。对胰管损伤者应行胰管修复或重建术。