小儿喉阻塞与喉乳头状瘤

喉乳头状瘤是引起小儿喉阻塞的重要原因之一,且频繁复发,使临床医生颇感棘手。现虽已明确其发病与人类乳头状瘤病毒的感染有关,但具体发病机制尚未阐明。治疗上采取了手术切除,药物服用和其他一些辅助治疗,虽在一定程度上抑制了乳头状瘤的生长,但复发的问题仍未彻底解决,其根治方法有待进一步探讨。     

神经纤维瘤病合并小儿脊柱侧弯的外科治疗探讨

神经纤维瘤病(neurofibromatosis，NF)是一种以末梢神经纤维不典型增生为特征的常染色体显性遗传性疾病。神经纤维瘤病患儿中约10％～60％出现脊柱侧弯畸形。由于神经纤维瘤病小儿的脊柱侧弯具有特殊性，术中神经损伤、术后假关节等并发症发生率较高，为探讨其外科治疗效果及治疗原则，本文对1997年～2002年间治疗的16例神经纤维瘤病患儿的脊柱侧弯的资料进行总结，现报告如下。     

33例小儿喉阻塞的病因分析及治疗体会

小儿喉阻塞是常见的儿科急重症,病情凶险,如不及时正确诊治,将严重威胁患儿的生命。我院1995~2004年共治疗小儿喉阻塞33例,现分析总结如下。1资料与方法1·1临床资料33例喉阻塞患儿,男20例,女13例。年龄1个月~12岁。其中1度喉阻塞13例,2度喉阻塞12例,3度喉阻塞6例,4度喉阻塞2例     

鼻内镜下电动吸割器治疗小儿喉乳头状瘤临床分析

目的 探讨鼻内镜下电动吸割器在小儿喉乳头状瘤切除术中的应用和疗效.方法 回顾性分析52例小儿喉乳头状瘤的临床资料,采用支撑喉镜下喉钳咬除肿瘤29例,鼻内镜下电动吸割器切除肿瘤23例,对两种手术方式的疗效进行比较分析.结果 鼻内镜下电动吸割器切除喉乳头状瘤的患儿术后随访6个月至3年,症状明显减轻或消失,再次手术次数减少,复发间期延长,治疗有效率65.22%,单纯支撑喉镜下手术组治疗有效率为13.78%.两组疗效差异有显著性意义,卡方检验(x2=14.628,P<0.01).结论 鼻内镜下电动吸割器治疗小儿喉乳头状瘤具有视野清晰,病灶切除彻底,副损伤小,复发率低等优点,且能更好的保留喉的发声功能,值得临床推广.     

小儿颈纵隔淋巴管瘤的外科治疗

目的总结小儿颈纵隔淋巴管瘤的特点,探讨其手术方法。方法回顾性分析2005年8月-2011年7月本院收治经术后病理证实的颈纵隔淋巴管瘤患儿31例,男10例,女21例;年龄1个月～4岁,平均年龄11.0个月,肿瘤位于右侧11例,左侧20例。结果 7例经颈部锁骨上横切口手术;24例纵隔病变为主者经后外侧切口常规开胸手术。完整切除14例,其他病例行大部切除,囊壁破坏或囊肿揭顶引流,残留囊壁碘酊烧灼。术中损伤无名静脉1例,术后并乳糜胸5例、喉返神经损伤3例、膈神经损伤2例、复发3例,无死亡病例。结论颈纵隔淋巴管瘤一经诊断应立即手术,切口的选择很重要,应根据CT及MRI结果慎重选择,单一切口多可完成手术。术中不宜强求完整切除,残留囊腔敞向胸膜腔可减少术后复发。     

小儿硬膜下积液的外科治疗

目的探讨提高小儿硬膜下积液外科治疗疗效的方法。方法回顾性分析本院2011年8月至2012年8月收治的小儿硬膜下积液患儿32例临床资料,其中3l例采取持续硬膜下引流,1例开颅清除积液、切除囊壁后行持续硬膜下引流。结果患儿临床症状均明显好转,无死亡病例。结论颅骨钻孔持续性硬膜下引流治疗小儿硬脑膜下积液能取得满意疗效。     

小儿胰腺实性假乳头状瘤的诊断与外科治疗

目的 总结小儿胰腺实性假乳头状瘤(solid pseudo-papillary tumors of pancreas,SPTP)的诊断及治疗经验.方法 回顾性分析2002年1月至2011年12月9例胰腺实性假乳头状瘤患儿的临床资料.其中,男1例,女8例;中位年龄11岁5个月.结果 小儿SPTP无特异性临床表现,主要临床表现为腹痛或腹部不适,CT检查均提示胰腺囊实性或实性占位.手术证实肿瘤位于胰头、颈部4例,胰体部2例,胰尾部3例.肿瘤直径2.8～16.4 cm,无腹腔或肝脏转移.行胰十二指肠切除术(Child术)2例,肿瘤局部切除术4例,胰腺节段切除、胰肠吻合术1例、胰尾联合脾脏切除术1例,保留脾脏的胰体尾切除1例.9例肿瘤标本在显微镜下均具有SPTP的典型病理学表现.随访3个月～8年,均未发现肿瘤复发及转移.结论 CT是小儿SPTP重要的诊断方法,手术为其主要治疗方式,手术术式的选择应依据术前CT和术中对肿瘤部位、包膜是否完整和是否侵及周围组织的探查来决定.     

小儿闭合性肾损伤的治疗(附75例分析)

目的探讨小儿闭合性肾损伤的最佳治疗方案。方法回顾性分析75例小儿闭合性肾损伤临床资料。其中肾被膜下血肿29例,肾实质部分裂伤23例,肾实质完全断裂11例,肾实质碎裂7例,肾蒂伤2例,肾盂输尿管连接处断裂3例。合并其他脏器伤者16例。结果非手术治疗59例,手术治疗16例,切除伤肾11只。74例治愈,死亡1例。结论小儿肾损伤后应尽快判断出肾脏损伤的程度及出血情况,根据病情选择不同的治疗方案;绝大多数闭合性肾损伤可采用非手术治疗。     

外科治疗小儿急性重症胰腺炎1例

小儿急性重症胰腺炎少见,常继发于身体其他部位的细菌或病毒感染、消化道畸形、药物诱发或其它全身系统性疾病,易误诊漏诊。现将本院1例患儿外科治疗体会介绍如下。     

辅用锌硒宝治疗小儿反复呼吸道感染50例临床分析

反复呼吸道感染是小儿常见病、多发病,多与患儿免疫功能低下有关,不仅影响患儿生长发育和智力发育,也严重影响患儿的身心健康。我院在常规治疗基础上对50例反复呼吸道感染的患儿辅用锌硒宝片治疗,取得了较满意的疗效,同时测定了部分患儿T细胞亚类、免疫球蛋白及血锌值,现分析如下。     

Squamous-cell carcinoma arising in a non-irradiated child with recurrent respiratory papillomatosis

We describe a patient with recurrent respiratory papillomatosis (RRP) associated with human papilloma virus (HPV), who developed a fatal squamous cell carcinoma of the lung. At the age of 1 year he presented with hoarseness, dyspnoea and inspiratory stridor but the diagnosis of RRP was made only 1 year later. At the age of 4 years he was tracheostomized because of upper airway obstruction. In spite of multiple surgical excisions and topic treatment with 5-fluoruacil the papillomata extended to the lung parenchyma. At the age of 16 years he developed a squamous-cell carcinoma of the lung and died 4 months later. Transformation to pulmonary carcinoma is a rare complication in non-irradiated patients with lung papillomatosis. We found only 11 similar cases in the literature.     

Comparison of human fibroblast and leukocyte interferon in the treatment of severe laryngeal papillomatosis in children

The efficiency of human fibroblast interferon (IFN-) and human leukocyte interferon (IFN-) was evaluated in two children with recurrent laryngeal papillomatosis. Both children failed to respond to fibroblast interferon, however the laryngeal papillomatosis disappeared when leukocyte interferon was applied. Possible explanations for these findings are discussed.     

Pulmonary involvement in laryngeal papillomatosis

Pulmonary involvement by laryngeal papillomatosis may become extensive with only slight impairment in pulmonary function. The etiology, pathophysiology, course, and treatment of this entity are described.On Elective Pediatric Radiology Rotation at University of California, San Francisco     

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??Immaturity of the immune system and exposure to infectious agents contribute to the susceptibility of RRTIs in children?? and RRTIs are usually treated with immunomodulating agents. The administration of probiotics plays a role in modulation of immune responses by various methods, including colonization resistance?? increased number and activity of natural killer cells?? release of cytokines?? and enhanced antibody response?? et al. Data show that probiotics may be bene?cial to preventing respiratory tract infections??RTIs???? reducing the number of episodes of RTIs?? diminishing the severity of infection symptoms?? and reducing duration of episodes?? antibiotic use and the number of days absent from day care/school. Probiotics appear to be a feasible way to decrease the incidence of RTIs in children??but further well-designed studies are needed to evaluate the strains?? dosing?? and frequency in the use of probiotics for RRTIs.     

脾氨肽对儿童哮喘合并反复呼吸道感染的疗效观察

目的探讨哮喘合并反复呼吸道感染(RRI)经规律吸入糖皮质激素(ICS)症状控制不理想的儿童联用脾氨肽(复可托)口服的临床疗效及安全性。方法采用随机、双盲法将2004年8月至2005年8月在本院收治的56例哮喘合并RRI经系统ICS治疗控制不佳的患儿分为2组,两组均在ICS的基础上再分别给予复可托或安慰剂口服,观察两组患儿RRI和哮喘发作情况、血液淋巴细胞亚群百分比及不良反应。结果复可托组的呼吸道感染次数、哮喘发作次数、发热天数、抗生素使用天数、咳嗽及气喘天数均少于对照组,差异有显著性(P<0.05)。复可托组在治疗后6个月时CD3、CD4、CD8明显升高(P<0.05);对照剂组淋巴细胞亚群百分比治疗前后比较差异无显著性(P>0.05)。两组不良反应发生率差异无显著性(P>0.05)。结论哮喘合并RRI经ICS治疗控制不佳的儿童联用复可托能有效预防RRI,减少哮喘的发作次数和严重程度;复可托冻干粉疗效肯定、无明显不良反应,对RRI或哮喘合并RRI者可考虑使用。     

匹多莫德对儿童哮喘合并反复呼吸道感染的疗效观察

目的 探讨哮喘合并反复呼吸道感染(RRI)经规律吸入糖皮质激素(ICS)症状控制不理想的儿童联用匹多莫德口服的临床疗效.方法 将2007年5月至2007年7月收治的哮喘合并RRI经系统ICS治疗控制不佳的患儿65例采用随机数字表分为两组,实验组(33例)在ICS的基础上加用匹多莫德颗粒口服2个月,对照组(32例)仅给予ICS吸入治疗.两组均随访12个月,记录RRI和哮喘发作情况、血液淋巴细胞亚群检测结果及不良反应.结果 与对照组比较,实验组的上呼吸道感染次数(t=5.205),下呼吸道感染次数(Z=2.056),哮喘发作次数(t=3.876),每次发作的发热天数(t=2.746)、咳嗽天数(Z=3.036)和抗生素使用天数(t=2.399)均少于对照组,差异有统计学意义(P均<0.05).与治疗前比较,实验组在治疗后2个月时CD3、CD4、CD8百分比和CD4/CD8比值均升高(t=3.783～13.490,P均<0.01);对照组治疗后CD3、CIM和CD4/CD8均低于实验组治疗后水平(f=4.107～7.209,P均<0.01).两组不良反应发生率差异无统计学意义(校正x2=0.378,P0.05).结论 哮喘合并RRI经ICS治疗控制不佳的儿童联用匹多莫德能有效预防RRI,减少哮喘的发作次数.匹多莫德颗粒疗效肯定,无明显不良反应,对RRI或哮喘合并RRI者可考虑使用.     

Juvenile papillomatosis of the breast in male infants: two case reports

Juvenile papillomatosis of the breast (“Swiss cheese disease”) is a benign localized proliferative condition of the breast which occurs almost exclusively in young adult women. Patients with this lesion often have a family history of breast carcinoma, and rarely carcinoma may coexist with the lesion at the time of diagnosis. We present two cases of male infants with juvenile papillomatosis of the breast. The pathology and clinical management of this novel lesion is discussed. Accepted: 18 January 1999     

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??Objective To evaluate the efficacy and safety of bacterial lysates in the treatment of recurrent respiratory infections with asthma in children less than or equal to 5 years old. Methods A total of 40 children with recurrent respiratory tract infections and asthma admitted between January 2013 and December 2014 in Jing’an District Centre Hospital of Shanghai were randomly divided into the treatment group??n=20?? with bacterial lysates??and the control group??n=20?? with placeto. The clinical efficacy was observed and secretory immunoglobulin A??sIgA?? in the saliva samples and percentages of eosinophils in peripheral blood were detected at the indicated time point after treatment of 0?? 3?? 6 and 12 months. Results The clinical symptom of asthma and the incidence of infection were significantly less in treatment group than those in control group. The level of sIgA was obviously increased in the saliva samples of treatment group and had negative correlation with percentage of eosinophils in peripheral blood. There was not any adverse event. Conclusion Bacterial lysates can be an effective adjuvant therapy for recurrent respiratory infections with asthma in children less than or equal to 5 years old by increasing the immunity?? decreasing respiratory tract symptom and reducing the incidence of asthma.     

兰菌净对反复呼吸道感染患儿唾液分泌型免疫球蛋白A水平影响

目的　观察兰菌净对呼吸道黏膜免疫的激活效应及对反复呼吸道感染 (RRI)预防效果。方法　选择门诊病例 35例 ,根据年龄分为 3组 :<1岁 4例、1～ 3岁 18例、>3岁 13例 ,兰菌净预防呼吸道感染 ,由家长记录或门诊随访呼吸道感染发作次数、病程。收集用药前后患儿唾液标本经放免法 (DAB -PEG法 )检测分泌型免疫球蛋白A(sIgA)含量 ,并计算sIgA提高率。 结果　兰菌净明显提高患儿唾液sIgA含量 (P <0 .0 1) ,显著降低呼吸道感染的发病次数 ,缩短病程 ,减轻病情。用药前后唾液sIgA提高率以 <1岁组最高 ,>3岁组居中 ,1～3岁组最低。治疗过程中不良反应轻微。结论　兰菌净可有效激活呼吸道黏膜免疫 ,预防呼吸道感染。