142例低位肛门直肠畸形的治疗

肛门直肠畸形在小儿外科中多见,其发生率在消化道畸形中占第一位,低位畸形约占40%。此类畸形位于体表,易于诊断。通过手术治疗建立具有正常排便功能的肛门,手术效果满意,未遗留排便功能障碍。从1990年1月～1997年6月我院收治低位肛门直肠畸形142例,现报告如下:临床资料男74例,女,68例。年龄最小1天,最大11岁。按1984年世界小儿外科医师制订的国际分类法分型,肛门皮肤瘘44例,肛门前     

后矢状切口治疗小儿肛门直肠畸形11例体会

后正中矢状切口用于肛门直肠成形术经临床实践证明具有暴露充分损伤小、能利用所有肌肉组织修复先天性缺陷达到良好控制排便等优点[1～ 3] 。我院自1987年 1月～ 1999年 10月应用后正中矢状切口治疗小儿肛门直肠疾病 11例 ,报告如下。1　临床资料1·1　病例　本组共 11例。男 4例 ,女 7例。年龄最小 7个月 ,最大 4岁。后正中矢状切口用于肛门闭锁直肠舟状窝瘘 8例 ,行后矢状肛门成形术 6例 ,后矢状肛门直肠成形术 2例 ;短段型先天性巨结肠症 2例 ,行直肠肌条切除术 ;肛门闭锁直肠后尿道瘘 1例 ,行肛门直肠成形尿道瘘修补术。术后切口甲级愈…     

MRI对先天性肛门直肠畸形的诊断价值

目的探讨MR I对先天性肛门直肠畸形手术前后的诊断价值。方法对5例正常对照组,14例先天性肛门直肠畸形病例均行盆腔、骶尾部MR检查。观察肛门内、外括约肌、耻骨直肠肌形态,肛门直肠本身发育缺陷以及骶椎、泌尿生殖系统等畸形。结果本组MR显示耻骨直肠肌、括约肌群发育好13例,发育较好3例,发育差3例,T1W I不抑脂序列为显示肛周肌群较好的序列。7例合并骶尾椎畸形,5例合并泌尿系统畸形。结论MR I对先天性肛门直肠畸形具有重要诊断价值,可从形态上了解盆底肌的发育,并能明确骶骨、椎管、泌尿系统等畸形,在确定手术方式及评价手术疗效方面具有重要意义。     

先天性肛门直肠畸形儿童生存质量的研究

目的了解先天性肛门直肠畸形(anorectal malformations,ARM)儿童术后生存质量的状况,为临床制定有效的干预措施提供依据,以提高患儿的生存质量。方法采用PedsQLTM4.0生存质量量表中文版对100例ARM术后2年和术后5年的儿童进行随访调查,比较ARM患儿与健康儿童生存质量的差异。结果 1)2岁~ARM患儿情感功能生存质量得分高于同龄健康儿童相应维度得分(P0.05);5岁~ARM患儿生存质量各维度得分及总分均高于同龄健康儿童得分(P0.05),其中情感功能生存质量得分差异最大。2)5岁~ARM儿童自评生存质量得分高于家长报告得分(P0.05);5~岁健康儿童自评生存质量各维度得分高于家长报告得分(P0.05)。3)2岁~和5岁~两组伴有排便障碍的ARM患儿生存质量相应维度得分低于不伴有排便障碍的患儿(P0.05)。结论 1)生存质量可以通过减少心理压力,给予更多的关爱与照护得到提高,尤其在情感功能方面,家长给予了特别关注。2)排便障碍对2岁~和5岁~ARM患儿的生存质量有着不可忽视的负面影响。     

肛门后切术治疗低位肛门直肠畸型

随着对肛门直肠畸型病理、组织学研究的深入,手术方法在不断改进,我院自1992～1993年应用肛门后切术治疗低位无肛合并瘘15例,随访12例,随访时间4～6年,效果满意。现将治疗体会总结如下。     

肛门直肠及畸形发育胚胎学的研究

[目的]通过采用乙烯硫脲(ETU)诱导孕鼠胎仔肛门直肠畸形,研究胚胎发育过程中肛门内括约肌间神经节细胞及神经丛的数目及形态。[方法]采用Wastar孕鼠16只,随机分为空白对照组及模型组,每组8只,在妊娠的d7、d9、d11.5及d13.5、d14.5、d15、d16由胃管注入125mg/kg的乙烯硫脲(ETU),空白对照组8只Wastar大鼠于d11.5、d13.5、d14、d16,模型组4只Wastar大鼠于11.5d、13.5d、14d、15d、16d进行取材,取胎仔行正中矢状面进行连续切片,取材标本进行HE及PAS染色,观察直肠肛管发育情况及肛门内括约肌肌间神经节细胞及神经丛数的数目。[结果]11d、13d模型组产生的肛门直肠畸形的发生率为75.00%(6/8),模型组肛门直肠畸形胎仔每个视野下肛门内括约肌肌间神经节的细胞数为(1.341±0.024),神经丛数为(0.406±0.029),空白对照组胎仔为(3.156±0.074)、(1.375±0.053),两者比较差异有统计学意义(P﹤0.05);其中模型组中正常胎仔的数值分别为(3.087±0.059)、(1.324±0.031),与空白对照组比较差异无统计学意义(P﹥0.05)。[结论]乙烯硫脲是良好的诱导肛门直肠畸形的致畸剂,肛门内括约肌肌间神经节细胞数及神经丛数的减少是肛门直肠畸形的病理学改变的重要影响因素。     

抚触配合光疗对肛门直肠畸形患儿高胆红素血症的效果研究

目的探讨抚触配合光疗对肛门直肠畸形患儿高胆红素血症的临床效果。方法将我院2012年7月至2014年7月收治的肛门直肠畸形患儿高胆红素血症120例分成对照组和观察组各60例。对照组患儿采用光疗方法进行治疗,观察组患儿在对照组患儿治疗的基础上配合应用抚触护理,比较两组患儿在治疗后第2、4、6天的黄疸指数、每天摄入奶量、大便次数、睡眠时间、体重与患儿哭闹次数。结果在治疗后第2、4、6天,观察组患儿的黄疸指数、哭闹时间均显著少于对照组(P<0.05),而每天摄入奶量、体重、大便次数、睡眠时间均显著多于对照组(P<0.05)。结论针对肛门直肠畸形新生儿的血清胆红素水平,在给予患儿光疗的同时进行抚触护理,可以促使患儿摄入奶量逐渐增多、体重增长加快,促进患儿神经系统的发育。     

先天性肛门直肠畸形肛门内括约肌肌间神经节细胞及神经丛的研究

目的 通过对肛门直肠畸形动物模型肛门内括约肌肌间神经节细胞及神经丛数目的 观察,来研究其神经病理改变.方法 用乙烯硫脲诱导健康妊娠Wistar-Imammichi大白鼠产生67例有内括约肌的肛门直肠畸形动物模型,取这些胎仔,正中矢状面连续切片,经染色后观察直肠肛管发育情况及肛门内括约肌肌间神经节细胞和神经丛数的数目.结果 在实验组肛门直肠畸形鼠仔中每个视野的肛门内括约肌肌间神经节细胞数平均为1.206,每个视野的神经丛数平均仅为0.308个,而正常鼠仔平均值分别为3.710个和1.227个,经u检验(Z-test),两者比较差异均有统计学意义(P＜0.05、P＜0.01),而实验组正常鼠仔两项数值分别为3.012和1.187,与对照组相比差异无统计学意义.结论 肛门直肠畸形的病理改变涉及很多方面,包括肌肉、粘膜及神经系统.其中肛门内括约肌肌间神经节细胞数和神经丛数的减少是肛门直肠畸形的重要病理改变.     

湛江市900名学龄前儿童心理行为问题调查研究

目的探讨湛江市900名学龄前儿童心理行为问题状况。方法分层随机抽取湛江市900名3～6岁学龄前儿童并采用Conners父母症状问卷（PSQ）对其心理行为问题进行调查研究。结果本组儿童心理行为问题总检出率为15.78%;其中男童8.00%,女童7.78%,两者比较差异无统计学意义（P〉0.05）。男童在品行问题、冲动-多动及多动指数方面得分方面高于女童组,两者比较差异具有统计学意义（P〈0.05）。5～6岁组儿童焦虑因子得分明显高于3～5岁组,两者比较差异具有统计学意义（P〈0.05）。结论我市学龄前儿童心理行为问题严重,应采取积极有效的防治措施进行干预。     

湛江市900名学龄前儿童心理行为问题调查研究

目的探讨湛江市900名学龄前儿童心理行为问题状况。方法分层随机抽取湛江市900名3～6岁学龄前儿童并采用Conners父母症状问卷(PSQ)对其心理行为问题进行调查研究。结果本组儿童心理行为问题总检出率为15.78%;其中男童8.00%,女童7.78%,两者比较差异无统计学意义(P>0.05)。男童在品行问题、冲动-多动及多动指数方面得分方面高于女童组,两者比较差异具有统计学意义(P<0.05)。5～6岁组儿童焦虑因子得分明显高于3～5岁组,两者比较差异具有统计学意义(P<0.05)。结论我市学龄前儿童心理行为问题严重,应采取积极有效的防治措施进行干预。     

先天性巨结肠术后患儿远期行为问题探讨

目的：探讨先天性巨结肠术后患儿远期心理行为问题及发生原因。方法：利用自制的一般情况调查表和Achenbach儿童行为量表（CBCL）对46例先天性巨结肠根治术后的患儿和138例对照进行调查，研究其行为问题。结果：（1）病例组行为问题的发生率（23．91％）较对照组（10．14％）高（P＜0．05），6－11岁男性儿童病例组违纪问题较对照组高（P＜0．05）；（2）长段型和全结肠型行为问题的发生率较短段型和普通型的高（P＜0．05）。结论：先天性巨结肠患者术后较对照组儿童有着较多的心理行为问题，主要原因是病变本身及病变类型影响了患儿的排便功能，采取针对性措施改善先天性巨结肠术后患儿远期心理行为发育状况是必要的。     

学习困难儿童的智力与心理行为问题的探讨

[目的]探讨学习困难儿童的智力和心理行为特点,为心理矫治提供科学依据。[方法]应用韦氏智力量表（WISC-R）、Rutter行为问卷、Conners父母用量表及汉密顿焦虑表（HAMA）、抑郁量表（HAMD）对46俐学习困难儿童进行智力和心理行为分析评估。[结果]学习困难儿童的总智商和言语智商低于对照组（P〈0．05）;Rutter问卷显示有82．6％学习困难儿童存在行为问题,以N行为（神经症状）为主。A行为（违纪行为）次之;Conners父母用量表中的各因子得分数均高于对照组（P〈0．05）,且存在焦虑、抑郁情绪。[结论]学习困难儿童受言语智商的影响。同时还晋遍存在着心理行为问题,综合治疗应是解决儿童学习困难的重要方法。     

Impact of County Disadvantage on Behavior Problems Among US Children With Cognitive Delay

Objectives. We investigated relationships among cognitive delay, community factors, and behavior problems over 2 years in early childhood with a national sample of US families.Methods. Data were from 3 waves of the Early Childhood Longitudinal Study, Birth Cohort (2001–2005; n = 7650). We defined cognitive delay as the lowest 10% of mental scores from the Bayley Short Form–Research Edition, administered at 9 and 24 months. At 24 months, we classified children as typically developing or as having resolved, newly developed, or persistent cognitive delays. Behavior was measured at age 4 years with the Preschool and Kindergarten Behavior Scales (range = 0–36). Community factors included perceived neighborhood safety and an index of county disadvantage.Results. Behavior scores at age 4 years (mean = 12.4; SD = 4.9) were higher among children with resolved (Β = 0.70; SE = 0.20), newly developed (Β = 1.92; SE = 0.25), and persistent (Β = 2.96; SE = 0.41) cognitive delays than for typically developing children. The interaction between county disadvantage and cognitive delay status was statistically significant (P < .01), suggesting that county disadvantage was particularly detrimental for children with persistent delays.Conclusions. The community context may provide an opportunity for public health interventions to improve the behavioral health of children with cognitive delays.Children with cognitive delays develop behavior problems at much higher rates than do their typically developing peers.1–5 Such problems have been shown to emerge at very young ages6 and to persist through school age into adulthood,7,8 contributing to a wide range of negative consequences for children’s health and well-being.9,10 Despite these marked disparities, there has been very little research to date to inform the mechanisms underlying the development of behavior problems among children with cognitive delays, especially in early childhood.1,11 In a recent review, Einfeld et al.1 noted that few studies reporting on the prevalence of mental health or behavior problems among children with cognitive delays have examined associated risk factors beyond age, gender, and severity of the child’s limitation. Further inquiry into factors associated with behavior problems among children with cognitive delays is needed to illuminate the etiology of such problems and inform future intervention studies.From a social–ecological perspective,12,13 the contextual environment in which children with cognitive delays grow and develop may contribute to their risk for behavior problems. A number of studies have shown significant associations between community and neighborhood socioeconomic factors and young and early school-aged children’s mental health, internalizing and externalizing behavior problems,14 and criminal, delinquent, and violent behaviors.15–17 It is possible that young children with cognitive delays who are prone to health and developmental difficulties are especially sensitive to their community’s social and economic characteristics. However, to our knowledge, the relationship between community factors and behavior problems has not yet been examined among children with cognitive delays.Therefore, the purpose of this study was to investigate the relationships among cognitive delay, community factors, and behavior problems in early childhood by using a national sample of US children. We focused on very early childhood as it is a critical period for the development of behavior problems among children with cognitive delays.6 We expected to observe significant disparities in behavior problems between 4-year-old children with and without cognitive delays. Furthermore, we hypothesized that children with cognitive delays living in adverse community environments would be particularly vulnerable to developing behavior problems. To our knowledge, this is the first study to investigate the role of community factors on behavior problems among young children with cognitive delays.     

儿童行为问题调查分析

目的　了解儿童行为问题状况。方法　采用Achenbach儿童行为调查表父母问卷和康纳父母评定量表 ,随机抽取广州市越秀区 1 42例儿童进行调查。结果　 5 9 86%的儿童社会能力低下 ;3 9 49%的儿童存在行为问题 ;可疑为注意力障碍的儿童占 7 70 % ;有注意力障碍的儿童行为问题主要表现在注意问题、违纪问题、社交问题和攻击行为方面。结论　儿童注意力障碍和儿童行为问题是不容忽视的社会问题     

肥胖儿童行为问题浅析

目的 了解肥胖儿童与肥胖发生有关的行为问题,为制定防治方案提供依据。方法 采用自行设计的行为问题问卷对112名肥胖儿童和105名正常体重儿童进行问卷调查。结果 与正常体重儿童比较,肥胖儿童的行为问题有：进食速度快,睡前进食,看电视时进食,喜喝甜饮料等;运动方面的问题有：户外活动少,静坐时间长,不喜欢体育运动等。结论 肥胖儿童存在着与肥胖发生,发展密切相关的饮食和运动行为问题,防治肥胖,应从改变不良的饮食和运动行为着手。     

Pediatric-Based Assessment Children With School Problems

Twenty-one children with school problems underwent pediatric assessment within a university hospital primary care clinic. Assessment included history-taking facilitated by parent and teacher questionnaires, physical examinations, vision and hearing screening and neurodevelopmental examination. For 11 of the children, psychoeducational assessment was also obtained. Parent and school personnel were interviewed 2 to 6 months following assessment to determine implementation rates for recommendations. Overall, 66% of parent recommendations were implemented, including 72% of medical, 58% of mental health and 64% of educational recommendations. Seventy-two percent of school recommendations were implemented. Interdisciplinary evaluation as compared to pediatric-based assessment alone resulted in a greater number of recommendations generated (p less than .05) and a higher percentage of school recommendations implemented (p less than .01). Implementation rates for school recommendations were greater for young children (p less than .01). This study supports the usefulness of pediatric-based assessments for school problems and documents the advantages of an interdisciplinary approach to such children.     

滨州市注意缺陷多动障碍儿童行为问题分析

目的探讨注意缺陷多动障碍儿童的行为问题,为ADHD儿童的综合治疗提供依据。方法抽取滨州市4263名6～16岁儿童,通过家长填写注意力及多动问题问卷和CBCL量表来完成儿童ADHD和行为问题的评估,比较ADHD儿童和正常儿童的行为问题。结果筛查出ADHD儿童273名,6～16岁儿童ADHD的总患病率为6.4%,其中男童(8.9%)高于女童(4.1%)(χ2=32.06,P0.01),6～11岁组(7.7%)高于12～16岁组(5.3%)(χ2=9.900,P=0.002)。ADHD儿童行为问题发生率(55.29%)明显高于对照组(9.78%)(χ2=214.749,P0.01),不同性别和年龄段ADHD儿童行为问题发生率均高于非ADHD儿童(P值均0.01)。除6～11岁女童的性问题2组差异无统计学意义外,其余各年龄组儿童行为问题总分及各因子分均表现为ADHD组高于对照组。结论ADHD儿童易伴发多种行为问题。诊治ADHD时应重视伴发的行为问题对儿童造成的损害。