儿童快速房性心律失常的射频消融治疗

对传统方法和CARTO系统在指导导管射频消融儿童快速房性心律失常中的临床应用作初步探讨 ,前者为局灶性房速常规采用激动标测方法 ,后者则应用CARTO系统分别标测I型房扑和房缺在术后疤痕介导房内折返性房性心动过速靶点 ,并在房扑消融后重建三维电解剖图 ,判定峡部完全双向传导阻滞。结果显示3例成功消融 ,曝光时间(18±9)min。随访1月～3月无复发。由此经临床证实导管射频消融儿童快速房性心律失常安全有效 ,尤其对复杂快速房性心律失常 ,CARTO系统能在较少X线曝光下 ,易于标测和成功消融。     

Head trauma among children in Reykjavík

The incidence of head trauma (ICD9 850-854) among children in the Reykjavík area, aged 0-14 years, was studied over a 5-year period, 1987-1991, using hospital records. On average, 72 children with head trauma were admitted to hospital each year, indicating an annual incidence of 1.70 per 1000 population. Fourteen percent of children admitted to hospital with head trauma suffered the more severe forms of brain injury (ICD9 851-854) (annual incidence of 0.28 per 1000). Seven children died from brain injury, indicating an annual death rate of 0.03 per 1000. Falls were the most common cause of head trauma (62%), followed by traffic accidents (19%). On average, one to two severely brain-injured children received rehabilitation each year.     

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??Children with postoperative hydrocephalus and brain trauma are often left with varying degrees of neurological dysfunction??and the comprehensive rehabilitation therapy for children with postoperative hydrocephalus and brain trauma plays an important role in the field of children’s severe rehabilitation medicine. Accurate rehabilitation assessment and early rehabilitation intervention are closely related to the prognosis of children with postoperative hydrocephalus and brain trauma. The article will briefly introduce the rehabilitation evaluation??timing of rehabilitation intervention??rehabilitation treatment for the children with postoperative hydrocephalus and brain trauma and the methods for promoting wakefulness in children with consciousness disorder ??so as to help the doctors to correctly evaluate and treat the children with postoperative hydrocephalus and brain trauma.     

经内镜电灼术治疗小儿后尿道瓣膜症

目的 探讨内镜电灼术治疗小儿后尿道瓣膜的临床效果.方法 对45例经内镜电灼术治疗后的小儿后尿道瓣膜进行回顾性分析.本组病例均为男性,年龄2周～15岁,中位年龄3岁.婴幼儿用6/7.5F输尿管镜或9F膀胱尿道镜和Bugbee针状电极,大龄儿用12F或13F膀胱镜和钩状电极,在尿道的5点、7点和12点处电灼后尿道瓣膜.术后长期随访.结果 根据Young分型,本组患儿中I型44例,Ⅲ型1例,术中顺利,术后排尿通畅度改善(尿线明显增粗,最大尿流率均在16.50 ml/s以上),血肌酐水平恢复正常,尿白细胞消失,肾积水程度均不同程度减轻(35例肾积水患儿中12例轻度肾积水消失,16例中度肾积水转为轻度肾积水,7例重度肾积水转为中度肾积水),膀胱输尿管反流程度较术前均有明显改善(29例膀胱输尿管反流的患儿中16例患儿反流消失,6例反流程度由术前Ⅱ度转为Ⅰ度,4例患儿由术前Ⅳ度转为Ⅱ度,3例患儿由术前V度转为Ⅲ度).结论 内镜下电灼术治疗后尿道瓣膜症是一种可行的方法,疗效确切,术后并发症少,预后好.针状电极可明显减少尿道狭窄的发生率.

Abstract：

Objective The aim of this study was to assess the effectiveness of endoscopic ablation of posterior urethral valves. Methods We retrospectively reviewed a database of 45 patients with PUV treated by endoscopic valve ablation. In this study, all patients were diagnosed at the age of 3 years (range: 2 weeks to 15 years). 6/7. 5F ureteroscopy and 9F cystoscopy with needle electrode were used in infants,whereas 12F or 13F cystoscopy and hook electrode were used in older children.The valves were ablated mainly at the 5,7 and 12 o'clock positions. The patients were followed up after surgery. Results Based on Young's classification, there were 44 type Ⅰ and 1 type Ⅲ PUV in this study. Urine line became thicker, the maximum flow rate can be achieved more than 16. 50 ml/s. Serum creatinine returned to normal and white blood cells in urine disappeared. The degree of dilatation of hydronephrosis relieved (among 35 hydronephrosis patients, 12 cases disappeared, 16 mild hydronephrosis to moderate hydronephrosis and 7 severe hydronephrosis to moderate hydronephrosis). Compared to preoperation.vesicoureteral reflux had a significantly improved (among 29 cases, 16 reflux disappeared,6 grade Ⅱ to grade I ,4 grade Ⅳ to Ⅱ and 3 grade Ⅴ to grade Ⅲ ). Conclusions Endoscopic ablation in treating pediatric posterior urethral valves seems to be safe and is associated with low rate of postoperative complications. Needle electrode can reduce the rate of urethral stricture.     

Urethral trauma in children

We report our 12-year experience in the management of urethral injuries in nine children, six boys and three girls. The most common mechanisms of injury were motor vehicle accidents, followed by straddle injuries. All the injuries in boys involved the anterior urethra, and in girls the proximal or mid-urethra. There were associated injuries in five, including three pelvic fractures. All children were investigated with a retrograde urethrogram. Four were treated non-operatively with insertion of a urethral catheter. Of the remaining five, one had drainage of a penile haematoma, one cystourethroscopy, two insertion of urinary and suprapubic catheters, and one open cystotomy and passage of a guide wire with antegrade passage of a urethral catheter. Complications included one urinary tract infection, one urethral fistula, one urethrovaginal fistula, and two urethral strictures. Final outcome was satisfactory in all nine children. Accepted: 3 February 2000     

特发性室性心动过速儿童的射频导管消融治疗

目的评价射频导管消融术(RFCA)治疗儿童特发性室性心动过速(IVT)的临床疗效。方法对经RFCA治疗的IVT患儿35例进行分析。随机分为对照组与研究组。对照组采用激动顺序标测法和起搏标测法,研究组在对照组基础上结合多普勒组织成像技术(DTI)进行标测。观察两组放电次数、X线曝光时间及射频能量的差异。结果研究组与对照组比较,放电次数少、X线曝光时间缩短。两组射频消融能量、成功率、复发率无差异。结论RFCA是治疗儿童特发性室速安全、有效的方法。结合DTI进行标测可减少放电次数、X线曝光照时间。     

Blunt abdominal trauma in children

Blunt abdominal trauma is the commonest cause of intra-abdominal injuries in children. The use of computerized axial tomography and non-operative management of haemoperitoneum are two significant developments in the last two decades in the management of blunt abdominal trauma in children. The concept of non-operative management was introduced in late 1979 and wherever possible remains the optimum treatment. Computerized tomography scan for paediatric abdominal trauma was first described in 1980 and remains the investigation of choice. There is no substitute, however, for a good history, astute physical examination, and strict adherence to the principles of primary and secondary survey, prompt resuscitation, vigilant monitoring and repeated evaluation.     

Outcome of pull-in procedure in children with severe post-disruption posterior urethral strictures

 A total of 17 children aged 5 to 15 years with the diagnosis of posttraumatic posterior urethral stricture were operated upon using a pull-in procedure during the last 9 years. Among the diagnostic tools, synchronous inspection of both the anterior and posterior urethra by cystoscopy yielded the most valuable information. A success rate of 70% was achieved with the procedure plus postoperative re-catheterization. A pedunculated tube prepared from the scrotal skin cured 2 patients after a series of failed operations. Difficult voiding occurring after removal of the stent due to an inappropriate pressure gradient created between the bladder neck and urethra usually benefits from short-term catheterization. Mild chordee was present in 1 patient. Ejaculation and erection were present in 3 children who reached puberty. Accepted: 19 June 2000     

Laparoscopic diagnosis of blunt abdominal trauma in children

This study evaluates the safety and role of laparoscopy in the diagnosis of blunt abdominal trauma in children. Laparoscopy was performed in five patients aged 3 to 13 years because of persistent abdominal pain after blunt trauma. A laparotomy was not indicated from the physical examination, laboratory data, or radiologic findings. With the patient under general anesthesia, a 10-mm trocar was inserted through the umbilical fossa and the intra-abdominal organs were observed for 10–60 min under an insufflation pressure of 10–12 mmHg. The patients remained hemodynamically stable without pneumothorax development. Three patients underwent laparatomies: one, who had blood in the omental sac, had a duodenal injury with hemorrhagic necrosis and underwent a resection; one with ascites and high amylase levels had an injury of the main pancreatic duct and underwent resection of the pancreatic tail; and one who had fresh blood in the upper abdomen and Douglas' pouch had a splenic hemorrhage and underwent hemostasis. The other two had serous or serosanguinous ascites and recovered without surgery. In patient 1, the same amount of information might have been obtained from a barium study. In patient 2, the pancreatic transection might have been diagnosed from ascites shown on serial computed tomograms. Patient 3 might also have been treated successfully non-surgically. It hus appears that laparoscopy may be a safe diagnostic method for blunt abdominal trauma in children, however, this small series has yielded insufficient information to assess its usefulness in making the diagnosis and the decision for laparotomy. Further studies are required to ascertain whether it will make any significant difference in the form of management.     

儿童创伤生命支持培训课程的实践与思考

目的探讨儿童创伤生命支持(pediatric trauma life support,PTLS)培训课程对提高儿童创伤急救能力的作用。方法采用国际创伤生命支持学会的PTLS课程对从事儿童创伤急救的医护人员进行培训,培训分为理论课和实践课,注重于提高学员的现场判断能力和急救技能。结果培训后学员的理论测试成绩较培训前提高,合格率、优秀率也有提高,差异均有统计学意义(P0.01)。学员的技能考核和仿真模拟考核均达到合格,其中优秀率依次为,转运固定技能42.62%,初级、高级气道管理81.97%,休克判断和处理70.49%,仿真模拟考核72.13%。院内组的培训前理论成绩显著高于院前组(P0.01),培训后院内组仍高于院前组,差异有统计学意义(P0.01)。结论经PTLS培训后,学员的理论、实践和综合救治能力得到提高,团队合作精神得到加强。     

Blunt trauma causing diaphragmatic rupture in children

Six children have been admitted over the last 10 years with blunt abdominal trauma causing diaphragmatic rupture. Four were acute presentations, with the emphasis on cardio-respiratory symptoms. There was a high incidence of associated injuries. Early laparotomy and repair of the diaphragm was performed successfully, and three out of four patients survived. Two patients presented late with gastrointestinal tract symptoms. A thoracotomy was necessary to free the adherent herniated bowel in one case. The peripheral nature of the lesion in children suggests that avulsion, aggravated by the increased elasticity and recoil of the thoracic cage, may play a major role in pathogenesis. Diaphragmatic rupture must be excluded in all severe cases of blunt abdominal trauma. Offprint requests to: R. A. Brown     

儿童重度闭合性肾挫裂伤的处理

目的 探讨儿童重度闭合性肾挫裂伤的处理.方法 回顾性总结分析2000至2008年临床诊治小儿闭合性肾损伤33例,重点是其中的15例重度肾挫裂伤(3例系肾积水合并肾挫裂伤的特殊病例)的资料.结果 全组无死亡,无早期肾切除病例,18例轻度肾损伤经保守治疗愈合.15例重度闭合性肾挫裂伤患儿中,其中8例采用保守治疗成功,1例肾蒂血管损伤早期急诊行肾静脉修补术,3例行选择性肾动脉栓塞治疗,3例肾积水外伤后肾破裂.3例肾积水肾破裂中,2例行早期肾盂成形肾周引流术,1例因合并肾功能不全,对侧肾萎缩,早期作肾造瘘,延期肾盂成形术,重度肾损伤病例随访5～28个月(平均18个月).4例继发尿性囊肿,1例早期行肾盂输尿管吻合,3例延期做尿性囊肿剥离切除;1例6个月后出现高血压、受损肾萎缩行肾切除.结论 轻度的肾损伤采用保守治疗易于治愈,重度的肾损伤因应病情选用相宜的方法 处理,绝大多数不需早期手术探查,以减少肾切除,选择性肾动脉栓塞微创止血效果好,重度肾挫裂伤需要密切随访,以处理相续可能发生的尿性囊肿和高血压等并发症.     

Congenital urethral fistula

A case of congenital urethral fistula with an intact glanular urethra without chordee is reported with a discussion of the possible etiology and one-stage repair. Accepted: 18 January 1999     

76例小儿胸部损伤的急救处理

目的分析临床病例,探讨小儿胸部损伤的急救治疗原则。方法回顾我院小儿外科和胸心外科2000～2004年收治的76例胸部损伤患儿,其中男57例(75%),女19例(25%),总结其临床特点。结果76例患儿中,60例保守治疗,16例接受手术,无死亡病例。结论小儿胸部损伤的诊断和治疗有别于成人。正确及时的急救处理对抢救患儿生命尤为重要。     

Current management of liver and splenic blunt trauma in children

Thirty-nine children with blunt liver and/or splenic injury were treated in our department from 1979 to 1987; 23 had a splenic injury, 10 a hepatic injury, and the remaining 6 had both. The diagnosis was suggested by the history and physical examination and was confirmed by CT and radioisotope scanning. Every hemodynamically stable patient was initially managed non-operatively. The children who failed to respond to conservative treatment and had unstable vital signs indicating intractable hemorrhage were eventually operated upon. Every effort was made to preserve the liver and spleen during the operation. Liver repair, splenorraphy alone or in combination with splenic artery ligation, and autotransplantation of splenic tissue were widely used procedures. Sixteen patients were successfully managed nonoperatively, but the remaining 23 required surgery. Only 5 children became completely asplenic and no liver lobe resection was performed. It is suggested that conservative management of children with liver and/or splenic injury is both safe and effective. When surgical intervention is inevitable great effort should be made to preserve liver and spleen.Presented at the XII International Congress of Greek Association of Paediatric Surgeons in Rhodes, 1987 Offprint requests to: G. Tryfonas     

An original method of urethral catheter fixation in neonates and small children

The indications for use of a transurethral catheter are well known, but the type of catheter and type of external fixation used vary in the different pediatric age groups. In children under the age of 2 years we use a soft pediatric feeding tube for catheterization of the bladder and a silicone nipple for external fixation of the tube with excellent results. Correspondence to: A. Motovic