改良Soave术治疗新生儿和婴儿先天性巨结肠

目的评价经肛门改良Soave术式治疗新生儿和婴儿先天性巨结肠的手术效果。方法 17例经组织学确诊为短段型及部分常见型先天性巨结肠患儿行经肛门改良Soave巨结肠根治术。在直肠后壁齿状线上1cm、直肠前壁齿状线上2～3 cm呈斜面切开直肠黏膜,向近端游离直肠黏膜管进入腹腔,切除腹膜外直肠肌鞘达肛提肌水平,残留肌鞘后壁做“V”形切除,游离近端结肠,拖出正常结肠与肛门斜行吻合。结果本组平均手术时间(160±45)min,术中平均出血(45±35)ml, 无术中并发症。术后未发现小肠结肠炎、吻合口漏、肛周感染及吻合口狭窄等并发症。随访4个月- 3年,所有患儿排便成形,无便秘、无污粪。结论经肛门改良Soave术式治疗新生儿和婴儿先天性巨结肠安全有效。     

三个月内婴儿巨结肠症腹腔镜Soave改良根治术探讨

目的:总结腹腔镜Soave改良根治术治疗3个月内婴儿巨结肠症的临床经验。方法:为45例巨结肠患儿施行腹腔镜Soave改良根治术并对术后发生并发症的21例进行分析。结果:45例均治愈出院,术后随访3个月至4年,患儿生长发育良好,食欲及大小便正常,无污粪。结论:腹腔镜下巨结肠Soave改良根治术对婴儿打击小,创伤轻,手术风险低,安全系数高,手术效果好。在腹腔镜辅助下可将巨结肠患儿的手术年龄提前至新生儿和小婴儿期,早期治愈有利于患儿身心健康及发育。     

腹腔镜Soave术治疗婴儿先天性巨结肠症的临床疗效

目的探讨腹腔镜Soave术治疗婴儿先天性巨结肠症的临床疗效。方法回顾性分析2005年6月至2012年6月江苏省徐州市儿童医院采用腹腔镜Soave术治疗368例先天性巨结肠症患儿的临床资料。368例患儿均采用3个0．5cm Trocar,经腹腔镜游离拖出结肠及分离结扎系膜,经肛门剥离直肠黏膜5～7cm,将腹腔镜下游离的病变结肠从直肠肌鞘内拖出。采用门诊随访,术后1、3、6、12个月了解患儿排便次数,有无污粪及肛门狭窄等,随访时间截至2013年6月。结果2例患儿中转开腹,其余366例顺利完成腹腔镜Soave术,手术时间为（1004-20）min,术中出血量为（5．4±1．5）mL,术后无切口感染,术后住院时间为（7．34±1．5）d,术后应用抗生素时间为（3．5±1．6）d,输液时间为（3．8±1．4）d。全部患儿术后获得随访,平均随访时间为4．5年（1．0～8．0年）。随访期间发生小肠结肠炎11例、便秘7例、肛门狭窄5例、污粪4例,均经保守及对症治疗后好转。结论腹腔镜Soave巨结肠根治术适用于治疗年龄〈2个月的婴儿先天性巨结肠症;该手术创伤小,瘢痕小,恢复快,外表美观,术后并发症少,有一定的优越性。     

应用腹腔镜与超声刀治疗小儿长段型先天性巨结肠

目的介绍腹腔镜与超声刀在长段型先天性巨结肠手术中的应用经验,探讨腹腔镜与超声刀配合在长段型先天性巨结肠手术中的应用前景。方法长段型先天性巨结肠7例,采用全麻气管插管,腹壁3个孔进镜及操作器械。腹腔镜直视下用超声刀游离病变的结肠及近端直肠系膜至盆底。转会阴手术,于肛门齿状线上5mm切开直肠黏膜,下拖并向上分离直肠黏膜至腹膜反折处,切断直肠肌鞘,切开保留的直肠肌鞘后鞘,分离直肠至腹内直肠游离处,拖出正常的结肠与直肠黏膜齿状线上切缘吻合。结果平均手术时间186min,术后24h能排气、排便。随访效果良好。结论腹腔镜配合超声刀行长段型先天性巨结肠根治手术创伤小、安全有效、有较好的应用前景。     

先天性巨结肠症腹腔镜Soave改良根治术的体会

目的:总结腹腔镜Soave改良根治术治疗新生儿及小婴儿先天性巨结肠症的临床经验。方法:为患儿施行腹腔镜Soave改良巨结肠根治术。结果:全组无中转开腹病例,平均手术时间125m in。患儿均在术后第1天开始喂水,术后应用抗生素2~5d,平均3d。输液3~5d,平均4d,腹部小戳孔,愈合好,无感染,术后6~10d出院,平均7d。近期随访效果良好。结论:腹腔镜手术后患儿进食早,输液及抗生素应用时间短,住院时间短,创伤小,康复快,腹部疤痕小,外观美观,与开腹手术相比有一定的优越性,新生儿及小婴儿同样适用。     

两种巨结肠根治术后肛门功能与直肠肛管测压的研究

目的探讨改良Swenson巨结肠根治术和经肛门Soave巨结肠根治术术后患儿排便控制及直肠肛管测压改变情况。方法回顾33例改良Swenson巨结肠根治术和20例经肛门Soave巨结肠根治术患儿,术后平均随访4年(3个月～8.5年),对患儿大便控制能力、便秘发生情况及肛门直肠测压结果进行比较。结果改良Swenson术组术后排便控制情况与经肛门Soave术组差异无统计学意义(P>0.05);肛门直肠测压检查:直肠肛管抑制反射恢复率改良Swenson术组较经肛门Soave术高,差异有统计学意义(P<0.05)。直肠静息压、感觉阈值和最大直肠耐受容量两组差异无统计学意义(P>0.05)。结论经肛门Soave巨结肠根治术治疗小儿巨结肠,具有创伤小、出血少、术后恢复快、无肠粘连等优点且术后可获得同样好的排便控制功能。     

腹腔镜辅助经肛门Soave拖出术治疗先天性巨结肠症及同类性疾病

目的 探讨腹腔镜辅助经肛门Soave手术治疗先天性巨结肠症及同类性疾病的可行性和效果.方法 2010年3月至2011年12月,对31例先天性巨结肠症及同类性疾病的患儿实施腹腔镜辅助经肛门Soave手术,作者改进这种技术,在经脐或经肛门腹腔镜监视下联合直肠肌鞘入路游离左半结肠或全部结肠,然后拖出体外完成直肠乙状结肠或次全结肠切除术. 结果 本组31例患儿均顺利完成手术,16例行直肠乙状结肠切除,15例次全结肠切除术,平均手术时间(117 ±13) min,切除肠段35 ～ 80 cm,术中估计出血5～20 ml,1例因小肠梗阻开腹探查.随访无吻合口狭窄和便秘复发,仅1例出现小肠结肠炎.结论 经脐或经肛门腹腔镜辅助Soave手术治疗先天性巨结肠及同类性疾病安全、有效,手术创伤更小.     

腹腔镜下应用超声刀行婴幼儿巨结肠根治术20例

目的 总结腹腔镜下应用超声刀治疗婴幼儿巨结肠根治术的价值。方法2003年2月-2006年1月，20例婴幼儿巨结肠在全身麻醉下行腹腔镜切除术，CO2人工气腹压力为10—12mmHg。腹部置3个trocar，腹腔镜直视下应用超声刀紧贴结肠壁将痉挛段、移行段和扩张段肠管肠系膜切断，环形切开盆底腹膜反折。会阴部采用改良Soave术，在肛管后壁齿状线上0．5cm处环形切开直肠黏膜并游离直肠黏膜呈管状，切断直肠侧韧带，打开盆底腹膜反折，进人腹腔，将游离的病变段结肠拖出，切除病变段结肠，其近端结肠与肛管齿状线切缘吻合。结果20例均顺利完成手术，手术时间120．210min．平均132min。切除病变段结肠肠管长度20-55cm，平均35cm。术中出血量5-20ml，平均14ml，均未输血。术后发生小肠结肠炎2例。20例随访3-36个月，平均12．5月，无并发症发生，排便控制在1-2次／d。结论腹腔镜下应用超声刀行婴幼儿巨结肠根治术具有创伤小、出血少、操作简便、安全可靠、术后恢复快、并发症少等优点。     

脐部小切口辅助完成Soave手术治疗婴儿长段型巨结肠的临床研究

目的：探讨脐部小切口在婴儿长段型巨结肠根治中的应用。方法：回颜性分析我院行脐部小切口辅助Soave手术治疗患儿长段型巨结肠11例。结果：切除结肠长度30—50cm，平均37。6cm；术中失血5—20mL，平均8mL；手术时间90—140min，平均110．5min。术后3例出现肛周轻度糜烂，无直肠回缩、吻合口瘘，脐部切口无感染、裂开，肠蠕动恢复时间16～24h，平均18．7h，术后7—14d出院。全部病例随访3．5—12个月，每日排便3—7次，其中轻度污粪1例，小肠结肠炎1例，经保守治疗后好转，无肛门狭5窄及粘连性肠梗阻。结论：婴儿长段型巨结肠根治术单纯性肛门拖出结肠困难，可辅加脐部小切口协助完成手术，具有损伤小、并发症少、恢复快、美容效果好、费用少等优点。     

保留扩张结肠的腹腔镜辅助先天性巨结肠根治术

目的:总结保留扩张而不肥厚结肠的腹腔镜辅助手术治疗先天性巨结肠的疗效及经验。方法:15例先天性巨结肠患儿在腹腔镜辅助下于腹腔内游离病变结肠,保留扩张而不肥厚的结肠,经直肠将病变结肠拖出肛门外切除,将近端扩张而不肥厚的结肠断端与齿状线上直肠粘膜切缘处吻合。结果:15例患儿均顺利完成腹腔镜手术,无中转开腹。平均手术时间约2h,术中出血20～50ml。术后1～2d排气,术后第3天进食,7～9d出院。切除结肠组织病理示扩张但不肥厚或轻度肥厚的结肠含正常神经节细胞。随访6～12个月,患儿6个月后每日大便1～2次,无便秘复发、污粪、狭窄等。12例术后3～6个月钡灌肠复查示扩张的肠管恢复正常。结论:腹腔镜辅助施行保留扩张但不肥厚或扩张伴轻度肥厚结肠的巨结肠根治术,手术游离、切除结肠范围缩小、创伤减轻,更具有手术创伤小、康复快的优点。     

Ocucrrence of Primary Spermatocytes in the Infant and Child Testis

Summary:  Light microscope and ultrastructural studies of normal infants and children testes revealed the presence of primary spermatocytes and occasional spermatids at 4, 8, 9, 11, 12 and 13 years of age, but not in all the boys of these ages. When they were found they appeared in both testes, but only in a 5–25% of the seminiferous tubules. These spermatocytes undergo degeneration or progress to abnormal spermatids which degenerate in turn. Spermatozoa were never found.
Zusammenfassung:  Das Auftreten primarer Spermatozyten in den Hoden von Kindern und Kleinkindern
Lichtmikroskopische und ultrastrukturelle Untersuchungen der Hoden normaler Kinder und Kleinkinder wiesen das Vorhandensein primärer Spermatozyten und gelegentlich Spermatiden im Alter von 4, 8, 9, 11, 12 und 13 Jahren nach, jedoch nicht bei alien Jungen der genannten Altersgruppen. Wenn diese Zellen nachgewiesen werden konnten, waren sie in beiden Hoden vorhanden, aber nur in 5–25% der Tubuli seminiferi. Diese Spermatozyten unterliegen einer Rückbildung oder einer Umwandlung in abnorme Spermatiden, die sich in der Folge zurückbilden. Spermatozoen warden nie gefunden.     

122例婴儿智力发展状态及影响因素的调查分析

目的：了解婴幼儿智力发展状态，探讨其影响因素。方法：对122名婴儿采用贝利婴幼儿发展量表进行评估并分析婴幼儿智力发展的影响因素。结果：122名婴儿智力发展总体状态良好，出生体重，家庭收入，每日睡眠时间和孕周与智力发展指数显著相关，父亲不同职业和不同文化程度，不同家庭类型和不同胎次的婴儿之间智力发展指数差异有极显著性意义（P＜0．001，P＜0．05），结论：加强孕产期保健，孕期合理用药，提高父母亲文化程度，积极发展社会经济对促进和保障婴幼儿的智力发展起重要作用。     

Randomized trial of the Terumo Capiox FX05 oxygenator with integral arterial filter versus Terumo Capiox Baby RX05 and Terumo Capiox AF02 arterial filter in infants undergoing cardiopulmonary bypass

The purpose of this clinical trial was to evaluate the effect of the Terumo Capiox FX05 oxygenator with integrated arterial filter during cardiopulmonary bypass (CPB) compared with the Terumo Capiox RX05 Baby RX and arterial filter on inflammatory mediators and blood product utilization. Forty patients weighing less than 10 kg who underwent congenital heart surgery utilizing cardiopulmonary bypass were randomized into either oxygenator group. The endpoints included measuring inflammatory markers at six different time points (preoperative baseline, CPB circuit being primed, 15 minutes after CPB initiation, status post protamine administration, prior to transport to intensive care unit, and within 12 to 24 hours post surgery), blood product utilization, extubation time, and days until discharge. The inflammatory mediators showed no significant differences between oxygenators at any time points. However, looking at the inflammatory mediators of both the FX and RX groups combined, a statistically significant difference was seen in interleukin (IL)-6 at 12/24 hour post surgery (p < .001) versus baseline and all other time points. IL-8 at status post protamine (p < .001) and 12/24 hours post surgery (p < .001) demonstrated significant differences versus all other time points, and IL-10 at status post protamine (p < .001) and prior to leaving the operating room (p < .001) were statistically different compared to all other time points. Cardiopulmonary bypass stimulates the systemic inflammatory response through various components of the extracorporeal system. This investigation did not find significant differences in cytokines interferon-gamma, IL-1beta, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p70, tumor necrosis factor (TNF)-alpha, and TNF-beta when comparing these two oxygenators. It is well known that various mechanisms contribute to the levels of cytokines circulating in a patient's blood volume and many manipulations throughout cardiac surgery have the ability to demonstrate anti-inflammatory interventions. Further investigation is needed as to how modification of the extracorporeal circuit may minimize increases in inflammatory mediators. Keywords: infant, bypass, cytokines, blood, infant perfusion strategy.     

Accuracy of urine output measurement with regular disposable nappies

Evaporation of urine from four types of disposable absorbent infant nappies (A, B, C, D) was assessed under a radiant warmer or in an incubator, with or without phototherapy. Each nappy was weighed dry and then 5, 10, 15 or 30 ml of urine were added. The nappy was immediately reweighed, placed in its study environment and then weighed 5, 15, 30, 60 and 120 min later. Unter all conditions, the percentage evaporation from each type of nappy increased during the 120 min and was inversely correlated with urine volume. Without phototherapy, the maximum evaporation at 120 min with a 5-ml urine sample was 15.9%±6.1% for nappy B in the incubator and 20.8%±4.0% for nappy A in the radiant warmer. Phototherapy was associated with slight but significant changes in evaporation in the incubator and the radiant warmer. Nappy D allowed the lowest percentage evaporation in the incubator with or without phototherapy and in the radiant warmer with phototherapy (8.8%±4.4%, 2.4%±1.8% and 16.0%±10%, respectively for a 5-ml urine sample).     

Rate of change of blood pressure in premature and full term infants from birth to 4 months

Systolic and diastolic blood pressures were evaluated in a cohort of 61 non-hypertensive premature [very low birth weight (VLBW),n=16; low birth weight (LBW),n=22] and full-term [normal birth weight (NBW),n=23] newborn infants admitted to a neonatal intensive care unit (NICU) and followed to their 4-month age-adjusted outpatient examination. All were receiving routine postnatal care by 7 days of age. Blood pressure was measured at 7 days of age, at discharge from the NICU, and at the outpatient examination. Simple linear regression of blood pressure on weight was used to fit a straight line to the three measurements for each infant and the average regression line for each birth weight group was then obtained. There was a significant correlation between systolic blood pressure and both weight and length at each of the measurement points and also between the change in systolic, blood pressure and change in weight from the discharge to the 4-month examination. Diastolic blood pressure tended to follow this same pattern. Gestational age was correlated significantly with the 7-day blood pressure, but postnatal age at the outpatient examination was not correlated with either systolic or diastolic blood pressure. The average slopes of systolic and diastolic blood pressure on weight (mmHg/kg body weight) were virtually identical for the LBW and NBW groups; in constrast, the average slope of the VLBW group was greater than the other two groups, and the difference was statistically significant for diastolic blood pressure. These results show significant group differences in mean blood pressure prior to 4 months of age between VLBW, LBW, and NBW groups and, for the VLBW infants, a steeper slope of the estimated regression line of blood pressure on weight between birth and 4 months.     

婴幼儿急性化脓性骨髓炎的特点及诊断

目的　探讨婴幼儿急性化脓性骨髓炎的特点及诊断方法。方法　分析 39例 <3岁的婴幼儿急性化脓性骨髓炎病程中的共同特征。结果　 39例中有 35例血源性感染 ,其中 31例 (31/ 35 ,88 6 % )发生于长骨的干骺端 ,合并化脓性关节炎 10例 (10 / 31,32 2 % ) ;3例直接蔓延感染 :枕骨 2例 ,肩胛骨 1例 ;1例原因不明。所有病例 10d后的X线平片均出现骨质变化。 2 2例行放射性核素 (99m锝 )扫描 ,均有病变骨的核浓聚 ,最早在发病后 2d出现。细菌学检查阳性 19例 (19/ 39,4 8 7% )。 2 7例保守治疗 (7例合并化脓性关节炎采用穿刺冲洗和腔内注射治疗 ) ,12例行切开引流术 (9例为病变骨开窗 ,3例为关节腔切开引流术 ) ,本组无死亡病例。结论　婴幼儿急性化脓性骨髓炎多由血源性感染引起 ,多见于长管状骨的干骺端 ,全身及局部反应较轻。早期诊断主要依据患肢的假瘫和发病部位的环压痛。同位素骨扫描可以提高早期的确诊率     

Juvenile xanthogranuloma: a case report of a preterm baby

This case report describes a preterm baby with juvenile extracutaneous xanthogranuloma that rapidly expanded. The tumor was excised because of rapid enlargement and extension into the thoracic inlet. To our knowledge, this is the first case of a preterm baby with extracutaneous juvenile xanthogranuloma. The case illustrates the need for careful surveillance of this lesion because it cannot always be managed conservatively.     

游泳对婴儿运动及语言发育的影响

目的探讨游泳对婴儿运动和语言发育的影响。方法将符合选取条件的400名新生儿按出生日期单双日分为观察组和对照组各200名，对照组新生儿出生后按常规进行护理，观察组在此基础上，于生后第1天即开始进行游泳训练并延续至出生后3个月。指导家长观察并记录婴儿第1次俯卧位抬头、独自坐稳、用拇指和示指远端夹取小物品、第1次发音和说单个字或近似字的时间。结果观察组婴儿第1次俯卧位抬头、独自坐稳、用拇指和示指远端夹取小物品、第1次发音和说单个字或近似字的时间较对照组显著提前（P〈0．01、P〈0．05）。结论新生儿和婴儿游泳对婴幼儿运动和语言发育有积极的促进作用。     

Characteristics and predictors of mortality in-hospital mortality following burn injury in infants in a resource-limited setting

PurposeBurn outcome data in infants is lacking from sub-Saharan Africa. We, therefore, sought to assess the characteristics and predictors of in-hospital burn mortality in a resource-limited setting.MethodsWe performed a retrospective study of the prospectively collected Burn Injury Surveillance database from June 2011 to December 2019. We performed bivariate analysis and Poisson regression to assess risk factors for mortality in our infant burn population.Results115 (7.3%) infants met inclusion criteria. The median age of 8 months (IQR: 6–10) and primarily male (n = 67, 58.8%). Most burns were from scald (n = 62, 53.9%). Infant burn mortality was 12.2%. Poisson multivariable regression to determine burn mortality risk in infants showed that increased %TBSA burns (RR 1.04, 95% CI 1.01–1.07) and flame burns (RR 3.08, 95%CI 1.16–8.16) had a higher risk of mortality. Having surgery reduced the relative risk of death for infants with burns.ConclusionWe show that factors that increase infant burn mortality risk include percent total body surface area burn, flame burn mechanism, and lack of operative intervention. Increasing burn operative capability, particularly for infants and other children, is imperative.