共查询到20条相似文献，搜索用时 31 毫秒
1.
Lisa M. Soler Steven L. Raymond Shawn D. Larson Janice A. Taylor Saleem Islam 《Journal of pediatric surgery》2018,53(10):1960-1963
Purpose
The management of primary spontaneous pneumothorax (PSP) in the pediatric population is not standardized. The purpose of this study was to understand the management options for a first episode of PSP in children and adolescents, and their associated outcomes.Methods
A retrospective study was conducted for patients 5–20 years old with a diagnosis of PSP at a large academic children’s hospital between 2002 and 2014. Patient data were reviewed for each case. Management and outcomes were analyzed and compared between groups.Results
Eighty patients met all inclusion criteria. Overall recurrence rate was 40% with 86% occurring within 12 months of the initial PSP. Patients with recurrent PSP were significantly taller. Size of pneumothorax based on initial chest x-ray was comparable between recurrent and nonrecurrent groups. A negative CT scan for subpleural blebs did not predict recurrence. Patients undergoing thoracoscopic blebectomy and mechanical pleurodesis at initial presentation had significantly lower recurrence rate compared to patients who underwent nonoperative management (operative group 14%, nonoperative group 45%; p = 0.0373).Conclusions
Recurrence following nonoperative management was high with the majority occurring within a year and requiring readmission. These findings support offering surgery to families as a potential initial management option.Level of Evidence
3b/4 — retrospective series or case control study, single institution, very limited population 相似文献2.
Aim
To assess the evolution in management of children with parapneumonic effusion and empyema in a tertiary referral centre.Method
We conducted a retrospective case note review of paediatric patients with parapneumonic effusion, pleural effusion and pleural empyema between December 2006 and December 2015. Digital database searches were performed to identify demographic data, referring hospital, radiological and microbiological investigations. Length of stay and morbidity were analysed.Results
One hundred fifteen patients had 159 interventions over the study period. Fifty-four children were successfully treated with intercostal drainage (ICD) and urokinase fibrinolysis alone. There were 19 primary video assisted thoracoscopic surgeries (VATS) and 12 VATS after initial intercostal drains. Thirty-three children required a thoracotomy, a reduction of 26% from the previous era (p = 0.009). The median length of stay was 9 days (range 2–54).Conclusion
Parapneumonic effusion can be successfully treated with intercostal drainage and intrapleural fibrinolytics, but a proportion requires further surgical intervention. In our hospital, increased utilisation of fibrinolysis and VATS occurred with a corresponding decrease in the need for thoracotomy. Patients needing thoracotomy all had severe disease on ultrasound, but ultrasound did not reliably predict failure of fibrinolytic therapy.Level of Evidence
III 相似文献3.
Mark O. Wielpütz Oyunbileg von Stackelberg Mirjam Stahl Bertram J. Jobst Monika Eichinger Michael U. Puderbach Lutz Nährlich Sandra Barth Christian Schneider Matthias V. Kopp Isabell Ricklefs Michael Buchholz Burkhard Tümmler Christian Dopfer Jens Vogel-Claussen Hans-Ulrich Kauczor Marcus A. Mall 《Journal of cystic fibrosis》2018,17(4):518-527
Background
A recent single-centre study demonstrated that MRI is sensitive to detect early abnormalities in the lung and response to therapy in infants and preschool children with cystic fibrosis (CF) supporting MRI as an outcome measure of early CF lung disease. However, the feasibility of multicentre standardisation remains unknown.Objective
To determine the feasibility of multicentre standardisation of chest MRI in infants and preschool children with CF.Methods
A standardised chest 1.5 T MRI protocol was implemented across four specialised CF centres. Following training and initiation visits, 42 infants and preschool children (mean age 3.2 ± 1.5 years, range 0–6 years) with clinically stable CF underwent MRI and chest X-ray (CXR). Image quality and lung abnormalities were assessed using a standardised questionnaire and an established CF MRI and CXR score.Results
MRI was successfully performed with diagnostic quality in all patients (100%). Incomplete lung coverage was observed in 6% and artefacts also in 6% of sequence acquisitions, but these were compensated by remaining sequences in all patients. The range of the MRI score in CF patients was similar across centres with a mean global MRI score of 13.3 ± 5.8. Cross-validation of the MRI against the CXR score revealed a moderate correlation (r = 0.43–0.50, p < 0.01).Conclusion
Our results demonstrate that multicentre standardisation of chest MRI is feasible and support its use as radiation-free outcome measure of lung disease in infants and preschool children with CF. 相似文献4.
Steven S. Rothenberg 《Journal of pediatric surgery》2018,53(1):121-125
Purpose
This study evaluates the results of thoracoscopic management of complex, non-type C, EA and TEF in infants.Methods
From March 2000 to February 2017, 23 patients were treated for Type A N = 13, Type B N = 4, and Type E N = 6. Patients diagnosed with EA had G-tube feeds for a period of 4–9 weeks. All procedures were performed thoracoscopically. EA gaps were between 4 and 7 1/2 vertebral bodies.Results
All surgeries were completed thoracoscopically. Average operative time was 95 min for Type A, 115 min for Type B, and 50 min for Type E. Two patients with long gaps had small leaks which resolved with conservative management. One patient with an H-type was re-intubated causing a partial disruption of the tracheal repair. This required thoracoscopic re-exploration with repair and placement of an intercostal muscle flap. No patient has any clinical evidence of fused ribs, chest wall asymmetry, shoulder girdle weakness, or winged scapula.Conclusion
Thoracoscopic repair of complex EA and TEF is safe and effective. The excellent visualization of the thoracic inlet allows for extensive mobilization creating sufficient length for long gaps and safely managing high fistulas. This may limit injury to adjacent structures and avoid a neck incision and chest wall deformity.Level of evidence
IV. 相似文献5.
Chenghao Chen Qi Zeng Zhongzhi Li Na Zhang Jie Yu 《Journal of pediatric surgery》2018,53(9):1855-1857
Objective
To measure the force required for correcting pectus carinatum to the desired position and investigate the correlations of the required force with patients’ gender, age, deformity type, severity and body mass index (BMI).Methods
A total of 125 patients with pectus carinatum were enrolled in the study from August 2013 to August 2016. Their gender, age, deformity type, severity and BMI were recorded. A chest wall compressor was used to measure the force required for correcting the chest wall deformity. Multivariate linear regression was used for data analysis.Results
Among the 125 patients, 112 were males and 13 were females. Their mean age was 13.7 ± 1.5 years old, mean Haller index was 2.1 ± 0.2, and mean BMI was 17.4 ± 1.8 kg/m2. Multivariate linear regression analysis showed that the desirable force for correcting chest wall deformity was not correlated with gender and deformity type, but positively correlated with age and BMI and negatively correlated with Haller index.Conclusions
The desirable force measured for correcting chest wall deformities of patients with pectus carinatum positively correlates with age and BMI and negatively correlates with Haller index. The study provides valuable information for future improvement of implanted bar, bar fixation technique, and personalized surgery.Type of study
Retrospective study.Level of evidence
Level 3–4. 相似文献6.
Marcus D. Jarboe Samir K. Gadepalli Joseph T. Church Meghan A. Arnold Ronald B. Hirschl George B. Mychaliska 《Journal of pediatric surgery》2018,53(1):159-162
Purpose
The Avalon dual-lumen venovenous catheter has several advantages, but placement techniques and management have not been adequately addressed in the pediatric population. We assessed our institutional outcomes and complications using the Avalon catheter in children.Methods
We reviewed all pediatric patients who had Avalon catheters placed for respiratory failure at our institution, excluding congenital heart disease patients, from April 2009 to March 2016. All patients were managed using our standard ECMO protocol, and cannula position was followed by daily chest x-ray and intermittent echocardiography (ECHO). Data included demographics, diagnosis, PRISM3 predicted mortality, ECMO duration, complications, and survival. The primary outcome was the need for catheter repositioning.Results
Twenty-five patients were included, with mean age 8.3 ± 6.9 years and 15 ± 22 days of ECMO support. Overall survival was 68% (17/25). Fourteen patients (56%) underwent placement with fluoroscopy in addition to ultrasound and ECHO, primarily after 2013. Overall, thirteen patients (52%) had problems with cannula malposition. 9 of these (69%) required cannula repositioning. Three of 14 (21%) cannulas placed with fluoroscopy required repositioning, compared to 7/11 (64%) placed without fluoroscopy (p = 0.05).Conclusions
Complications are common with the Avalon catheter in children. Safe percutaneous access requires ultrasound guidance, and use of intraoperative fluoroscopy in addition to echocardiography decreases malposition rates.Level of evidence
IV (Prognosis study). 相似文献7.
Robert J. Obermeyer Nina S. Cohen Robert E. Kelly M. Ann Kuhn Frazier W. Frantz Margaret M. McGuire James F. Paulson 《Journal of pediatric surgery》2018,53(6):1221-1225
Purpose
The purpose of this study was to determine variables predictive of an excellent correction using vacuum bell therapy for nonoperative treatment of pectus excavatum.Methods
A single institution, retrospective evaluation (IRB 15-01-WC-0024) of variables associated with an excellent outcome in pectus excavatum patients treated with vacuum bell therapy was performed. An excellent correction was defined as a chest wall depth equal to the mean depth of a reference group of 30 male children without pectus excavatum.Results
Over 4 years (11/2012–11/2016) there were 180 patients enrolled with 115 available for analysis in the treatment group. The reference group had a mean chest wall depth of 0.51 cm. An excellent correction (depth ≤ 0.51 cm) was achieved in 23 (20%) patients. Patient characteristics predictive of an excellent outcome included initial age ≤ 11 years (OR = 3.3,p = .013), initial chest wall depth ≤ 1.5 cm (OR = 4.6,p = .003), and chest wall flexibility (OR = 14.8,p < .001). Patients that used the vacuum bell over 12 consecutive months were more likely to achieve an excellent correction (OR = 3.1,p = .030). Follow-up was 4 months to 4 years (median 12 months).Conclusion
Nonoperative management of pectus excavatum with vacuum bell therapy results in an excellent correction in a small percentage of patients. Variables predictive of an excellent outcome include age ≤ 11 years, chest wall depth ≤ 1.5 cm, chest wall flexibility, and vacuum bell use over 12 consecutive months.Type of study
Retrospective chart review.Level of evidence
Level III treatment study. 相似文献8.
Punam P. Parikh Eduardo A. Perez Holly L. Neville Anthony R. Hogan Juan E. Sola 《Journal of pediatric surgery》2018,53(6):1175-1180
Introduction
There remains a paucity of literature on survival related to pediatric appendiceal tumors. The purpose of this study was to determine the incidence, surgical management, and survival outcomes of appendiceal tumors in pediatric patients.Methods
The Surveillance, Epidemiology, and End Results (SEER) Registry was analyzed for pediatric appendiceal tumors from 1973 to 2011. Parameters analyzed were: tumor type, surgical management (appendectomy vs. extensive resection), tumor size, and lymph node sampling. Chi-square analysis for categorical and Student's t test for continuous data were used.Results
Overall, 209 patients had an appendiceal tumor, including carcinoid (72%), appendiceal adenocarcinoma (16%), and lymphoma (12%). Patients undergoing appendectomy vs. extensive resection had similar 15-year survival rates (98% vs. 97%; p = 0.875). Appendectomy vs. extensive resection conferred no 15-year survival advantage when patients were stratified by tumor type, including adenocarcinoma (87% vs. 89%; p = 0.791), carcinoid (100% vs. 100%; p = 0.863), and lymphoma (94% vs. 100%; p = 0.639). There was no significant difference in 15-year survival between tumor size groups ≥ 2 and < 2 cm (both 100%) and presence or absence of lymph node sampling (96% and 97%; p = 0.833) for all patients with a carcinoid tumor.Conclusion
Appendectomy may be adequate for pediatric appendiceal tumors. Extensive resection may be of limited utility for optimizing patient survival, placing patient at greater operative risk.Type of Study
Retrospective Prognostic Study.Level of Evidence
III 相似文献9.
Toshiharu Matsuura Yusuke Yanagi Makoto Hayashida Yoshiaki Takahashi Koichiro Yoshimaru Tomoaki Taguchi 《Journal of pediatric surgery》2018,53(4):671-675
Background
No protocol has been established for the diagnosis and management of chylous ascites after liver transplantation (LT). In this study, we retrospectively reviewed our cases of posttransplant chylous ascites (PTCA) and aimed to propose a diagnostic and management protocol.Patients and methods
We retrospectively reviewed the clinical records of 96 LT recipients who underwent LT at our department. The incidence of PTCA and the associated risk factors were analyzed and our protocol for chylous ascites was evaluated.Results
PTCA occurred in 6 (6.3%) patients (mean age: 10.7 ± 11.0 years) at a mean of 10.8 ± 3.6 days after LT. The primary disease in all of PTCA cases was biliary atresia (BA). The periportal lymphadnopathy was an independent risk factor for PTCA. In all cases PTCA successfully resolved according to our protocol. Octreotide was administered in 4 of our 6 PTCA cases. The mean postoperative hospital stay was 40.2 ± 8.4 days, which was similar to that of cases without PTCA.Conclusions
The incidence of PTCA in LT patients, especially in those with BA, is relatively high. Our diagnostic criteria and our management protocol were helpful for patients with refractory ascites after LT.Type of study
Diagnostic test: Level II. Treatment study: Level III. 相似文献10.
Silvia Yukari Togoro Miguel Lia Tedde Robert S Eisinger Erica Mie Okumura Jose Ribas Milanez de Campos Paulo Manuel Pêgo-Fernandes 《Journal of pediatric surgery》2018,53(3):406-410
Background
To minimize cardiac perforation during the minimally invasive repair of pectus excavatum (MIRPE), several surgeons have suggested using a suction device to intraoperatively lift the sternum. Whether or not this technique is effective for all PE patients is not yet known. As such, our aim was to quantify the extent to which a suction device is capable of lifting the sternum with a short duration of use.Methods
30 PE patients received a low-dose CT scan as part of standard PE evaluation. A Vacuum Bell suction was then applied for only two minutes, and a repeat CT scan was obtained only at the deepest point of the chest wall deformity. We compared chest dimensions before and after Vacuum Bell suction.Results
The Vacuum Bell lifted the sternum in all 29 patients included in the analysis. The absolute change in depth ranged from 0.29 to 23.67 mm (M = 11.02, SD = 6.05). The average improvement in Haller index was 0.76. The suction was most effective for individuals with low BMI and smaller chest depths. Efficacy was not associated with gender, age, or chest morphology.Conclusions
The Vacuum Bell device effectively lifted the sternum in PE patients with different demographics and chest morphologies. Future research is needed to address whether or not the device reduces risk of cardiac perforation during MIRPE.Levels of evidence
Prognosis Study Level IV. 相似文献11.
Kristine S. Corkum Catherine J. Hunter Julia E. Grabowski Timothy B. Lautz 《Journal of pediatric surgery》2018,53(7):1295-1300
Background
Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children.Methods
Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained.Results
We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°.Conclusion
Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively.Level of evidence
Level IV. 相似文献12.
Cristen N. Litz David J. Ciesla Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(3):446-448
Background
Teenagers receive appendicitis care at both adult and pediatric facilities. The purpose of this study was to evaluate outcomes following treatment of acute appendicitis in teenagers based on the type of hospital facility.Methods
Patients aged 13–17 years with acute appendicitis who were discharged from acute care hospitals from 2009 to 2014 were identified using a statewide discharge dataset. Hospitals were classified as pediatric or adult and outcomes were compared.Results
There were 5585 patients treated in adult hospitals and 1625 in pediatric hospitals. Fewer patients at adult hospitals had complicated appendicitis (20.4% vs. 33.0%, p < 0.01). Open appendectomy occurred more often in adult hospitals compared to pediatric hospitals (12.6% vs. 6.0%, p < 0.01). Pediatric hospitals had higher rates of non-operative management (10% vs. 3.4%, p < 0.01) and percutaneous drain placement (1.2% vs. 0.4%, p < 0.01). Postoperative complication rates did not significantly differ between hospital types.Conclusion
Most teenagers undergo appendectomy at adult facilities; however, a greater proportion of younger patients and patients with complicated appendicitis is treated at pediatric hospitals. Treatment at a freestanding children's hospital results in lower rates of open procedures and no difference in complications. Opportunities may exist to standardize care across treating facilities to optimize outcomes and resource use.Type of study
Prognosis study.Level of evidence
II. 相似文献13.
Punam P. Parikh Jun Tashiro Gustavo A. Rubio Juan E. Sola Holly L. Neville Anthony R. Hogan Eduardo A. Perez 《Journal of pediatric surgery》2018,53(9):1753-1760
Background
There is a paucity of literature on treatment of melanoma in children with surgical management extrapolated from adult experience. The incidence and clinical outcomes of pediatric extremity melanoma were studied.Methods
SEER registry was analyzed between 1973 and 2010 for patients < 20 years old with extremity melanoma. Multivariate and propensity-score matched analyses were performed to identify independent predictors of survival.Results
Overall, 917 patients were identified with an age-adjusted incidence of 0.2/100,000 persons, annual percent change 0.96. Most had localized disease (77%), histology revealing melanoma-not otherwise specified (52%). Surgical procedures performed included wide local excision (50%), excisional biopsy (32%), lymphadenectomy (LA) (28%), and sentinel lymph node biopsy (SLNB) (15%). Overall, 30-year disease specific mortality was 7% with lower survival for extremity melanoma (90%), males (89%), nodular histology (69%), and distant disease (36%) (all P < 0.05). Post-treatment multivariate analysis revealed localized disease (HR 9.76; P = 0.006) as an independent prognosticator of survival; earlier diagnostic years 1988–1999 (HR 2.606; P = 0.017) were a negative prognosticator of survival. Propensity-score matched analysis found no difference in survival between SLNB/LA vs no sampling for regional/distant disease.Conclusions
Pediatric extremity melanoma in SEER demonstrate no survival advantage between children undergoing sampling procedures vs no sampling for regional/distant disease.Type of study
Retrospective, prognostic study.Level of evidence
III. 相似文献14.
15.
Muhammad Saleem Bilal Mirza Nabila Talat Muhammad Sharif 《Journal of pediatric surgery》2018,53(2):234-236
Background
Teratomas originating from the stomach are extremely rare and account for less than 1% of all cases of teratomas. This site of occurrence has unique diagnostic and management issues.Methods
A single centre case-record review of gastric teratomas presenting between January 2000 and April 2017 was performed.Results
Thirteen children were found to have gastric teratomas. Presenting features were abdominal distension in 12 (92%) and palpable abdominal mass in 9 (69%). At operation, 8 (61%) were exogastric tumors. The tumor was excised with partial gastrectomy (n = 7, 54%), total gastrectomy (n = 1, 8%), partial gastrectomy and limited transverse colectomy (n = 2, 15%), and excision of small part of serosa (mucosal sparing) (n = 3, 23%). Histopathologically, these were identified as mature gastric teratomas in 8 (61%). Three (23%) children died postoperatively.Conclusion
Gastric teratomas are rare, with the majority described as exogastric. Partial gastrectomy is always needed, but occasionally complete gastrectomy is necessary. Overall survival is > 75% in our experience.Level of evidence
IV 相似文献16.
Cristen N. Litz Laurie Stone Roberta Alessi Nebbie E. Walford Paul D. Danielson Nicole M. Chandler 《Journal of pediatric surgery》2018,53(4):625-628
Background
In 2012, a same-day discharge protocol following appendectomy for acute appendicitis was initiated. Our objective was to determine the success of the protocol by reviewing the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) outcomes following protocol development.Methods
The 2015 NSQIP-P Participant Use Data File was queried to identify patients with acute appendicitis who underwent appendectomy. Outcomes were compared to institutional outcomes.Results
There were 154 institutional patients and 4973 from NSQIP-P centers. Institutional rate of outpatient management was higher compared to NSQIP-P (84% vs 48%, p < 0.0001). Surgical length of stay was shorter compared to national rates (0.3 ± 0.7 vs 1.1 ± 1.9 days, p < 0.0001). There was no significant difference in the incidence of superficial (1.9% vs 1.0%, p = 0.2), deep (0.6% vs 0.1%, p = 0.17) or organ/space surgical site infections (1.3% vs 0.7%, p = 0.31). The incidences of other complications (1.3% vs 0.6%, p = 0.26) and 30-day readmissions (3.2% vs 2.6%, p = 0.61) were similar.Conclusion
Outpatient management following appendectomy in children is possible with low morbidity and readmission rates. Comparison with other NSQIP-Pediatric centers suggests an opportunity to generalize this practice with considerable savings to the health care system.Level of evidence
Prognosis study, level II. 相似文献17.
Scott C. Dolejs Justin Sheplock Robert J. Vandewalle Mathew P. Landman Frederick J. Rescorla 《Journal of pediatric surgery》2018,53(1):73-76
Purpose
Rectal prolapse is a commonly occurring and usually self-limited process in children. Surgical management is indicated for failures of conservative management. However, the optimal approach is unknown. The purpose of this study is to determine the efficacy of sclerotherapy for the management of rectal prolapse.Methods
This was a retrospective review of children < 18 years with rectal prolapse who underwent sclerotherapy, predominantly with peanut oil (91%), between 1998 and 2015. Patients with imperforate anus or cloaca abnormalities, Hirschprung disease, or prior pull-through procedures were excluded.Results
Fifty-seven patients were included with a median age of 4.9 years (interquartile range (IQR) 3.2–9.2) and median follow-up of 52 months (IQR 8–91). Twenty patients (n = 20/57; 35%) recurred at a median of 1.6 months (IQR 0.8–3.6). Only 3 patients experienced recurrence after 4 months. Nine of the patients who recurred (n = 9/20; 45%) were re-treated with sclerotherapy. This was successful in 5 patients (n = 5/9; 56%). Two patients (n = 2/20; 10%) experienced a mucosal recurrence which resolved with conservative management. Forty-four patients were thus cured with sclerotherapy alone (n = 44/57; 77%). No patients undergoing sclerotherapy had an adverse event. Thirteen patients (n = 13/20; 65%) underwent rectopexy after failing at least one treatment of sclerotherapy. Three of these patients (n = 3/13; 23%) recurred following rectopexy and required an additional operation.Conclusions
Injection sclerotherapy for children with rectal prolapse resulted in a durable cure of prolapse in most children. Patients who recur following sclerotherapy tend to recur within 4 months. Another attempt at sclerotherapy following recurrence is reasonable and was successful half of the time. Sclerotherapy should be the preferred initial treatment for rectal prolapse in children and for the initial treatment of recurrence.Level of evidence
Level IV.Type of study
Treatment Study. 相似文献18.
Inna N. Lobeck Amir M. Alhajjat Phylicia Dupree John M. Racadio Mark M. Mitsnefes Rebekah Karns Greg M. Tiao Jaimie D. Nathan 《Journal of pediatric surgery》2018,53(9):1825-1831
Introduction
Renal artery occlusive disease is poorly characterized in children; treatments include medications, endovascular techniques, and surgery. We aimed to describe the course of renovascular hypertension (RVH), its treatments and outcomes.Methods
We performed literature review and retrospective review (1993–2014) of children with renovascular hypertension at our institution. Response to treatment was defined by National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents at most-recent follow-up.Results
We identified 39 patients with RVH. 54% (n = 21) were male, with mean age of 6.93 ± 5.27 years. Most underwent endovascular treatment (n = 17), with medication alone (n = 12) and surgery (n = 10) less commonly utilized. Endovascular treatment resulted in 18% cure, 65% improvement and 18% failure; surgery resulted in 30% cure, 50% improvement and 20% failure. Medication alone resulted in 0% cure, 75% improvement and 25% failure. 24% with endovascular treatment required secondary endovascular intervention; 18% required secondary surgery. 20% of patients who underwent initial surgery required reoperation for re-stenosis. Mean follow-up was 52.2 ± 58.4 months.Conclusions
RVH treatment in children includes medications, surgical or endovascular approaches, with all resulting in combined 79% improvement in or cure rates. A multidisciplinary approach and individualized patient management are critical to optimize outcomes.Type of Study
Retrospective comparative studyLevel of evidence
Level III 相似文献19.
Kohei Otake Keiichi Uchida Michiko Kubo Akira Yamamoto Yuka Nagano Ryo Uratani Kiyoshi Hashimoto Kohei Matsushita Mikihiro Inoue Hirofumi Sawada Masato Kusunoki 《Journal of pediatric surgery》2018,53(3):499-502
Background/purpose
The purpose of this study was to explore clinical characteristics and primary surgical diagnoses associated with in-hospital death in pediatric surgical patients admitted to the neonatal intensive care unit (NICU) of a tertiary hospital.Methods
This retrospective study includes all patients admitted to our NICU for pediatric surgical diseases between January 2001 and December 2015. Univariate and multivariate binary logistic regression were performed to assess independent factors associated with in-hospital death.Results
A total of 440 cases were included and 334 (83.5%) patients underwent one or more surgeries. Thirty six patients (8.2%) died while hospitalized in the NICU. The 5 most common surgical diagnoses were intestinal atresia/stenosis, anorectal malformation, congenital diaphragmatic hernia (CDH), esophageal atresia, and urinary system disorder. Necrotizing enterocolitis (NEC) had the highest mortality rate. Using logistic regression, in-hospital death was predicted by extremely low birth weight (ELBW) (odds ratio (OR) = 6.594; P = 0.006), CDH (OR = 13.954; P < 0.001), and NEC (OR = 8.991; P = 0.049).Conclusions
This study describes CDH, NEC, and ELBW are independent predictive factors associated with in-hospital death of pediatric surgical patients in our NICU. Novel approaches for those conditions are required to improve the survival.Type of study
PrognosticLevels of evidence
II. 相似文献20.
Michael Joseph Emma C. Hamilton Andrea Hayes-Jordan Winston W. Huh Mary T. Austin 《Journal of pediatric surgery》2018,53(1):169-173