软组织扩张术在儿童下肢中的应用

报告软组织扩张术在儿童下肢的应用。本组５例儿童下肢组织缺损共９个部位，其中黑色素痣２个，皮肤瘢痕７个。置入皮肤扩张器到完成皮肤扩张时间７－１３周，其中有一个在完成皮肤扩张时扩张器外露。扩张的皮瓣在修复缺损时均采用推进皮瓣法。     

简易外扩张术在体表皮肤肿物切除术前的应用探讨

目的探讨简易外扩张术在体表皮肤肿物切除术前的应用效果。方法以2016年1月至2017年3月天津市儿童医院收治的71例体表皮肤肿物患儿为研究对象,所有患儿在行体表皮肤肿物切除术前应用简易外扩张术治疗。71例中男30例,女41例,年龄4个月至12岁。黑痣45例,皮脂腺痣19例,瘢痕7例。在术前2周,对病变局部皮肤手动揪起,起始可为每日3次,每次10 min,逐渐延长时间和次数,达到每日10次,每次20 min。患儿局部无不适,两侧正常皮肤可实现小张力下的对合。结果本组71例患儿手术效果均满意,直接切除两侧皮瓣均实现皮内缝合,术后恢复顺利,未发生与该缝合相关并发症。结论简易外扩张术操作简单易行,在体表皮肤肿物切除术前应用,具有缝合张力小、术后瘢痕少、对周围组织及器官外形影响小、并发症少等优点。     

术中快速皮肤软组织扩张在小儿整形外科中的应用

术中快速皮肤软组织扩张在小儿整形外科中的应用沈卫民，王顺荣，余品仪，潘新华我院对８例患儿施用了术中快速皮肤软组织扩张术，效果较佳。现报告如下。手术方法：我们选用避孕套自制扩张器，避孕套为广州第十一橡胶厂生产，用导尿管插入避孕套内，结扎入口。在病变边缘...     

球囊扩张术在现代儿科介入呼吸病学的应用

球囊扩张术主要用于儿童良性气道狭窄的治疗。是一项安全、简便、微创的治疗手段,在一些特殊异物取出及大咯血的治疗中也有重要作用。支气管镜下的介入治疗是一门综合治疗技术,球囊扩张术也需要与其他方法联合应用。     

皮肤扩张器在小儿颈胸部烫伤后瘢痕中的应用

小儿颈胸部烫伤在临床上较为常见，自2001年我们使用皮肤软组织扩张器治疗小儿颈胸部烫伤后瘢痕13例患儿，取得了良好效果，报告如下。     

肺动脉瓣球囊扩张术11例

肺动脉瓣球囊扩张术１１例南京市儿童医院（２１０００８）王大为，成建华，龚小平，胡宝珍肺动脉瓣球囊扩张术目前已成为中、重度肺动脉瓣狭窄的首选治疗方法。本院共做１１例，总结如下。材料与方法一、病例选择，１１例均经临床、胸片、心电图、超声心动图及右心造影证...     

封闭负压引流在儿童四肢皮肤软组织缺损中的应用

目的 探讨封闭负压引流(Vacuum Sealing drainage,VSD)技术在儿童四肢皮肤软组织缺损中的应用效果.方法 对30例四肢创伤性皮肤软组织缺损患儿先行清创及VSD治疗,再择期闭合创面.结果 30例患儿创面肉芽生长新鲜,均于肉芽组织大致覆盖创面后行游离植皮、直接缝合或组织瓣移植,获得成功.结论 儿童四肢...     

气囊扩张术治疗小儿包茎1112例临床观察

包茎是小儿常见病，常规治疗方法是包皮环切术。1991年何氏首创气囊扩张治疗小儿包茎，此法已在临床广泛使用。我院于1998年6月～2006年采用气囊扩张法治疗小儿包茎1112例，取得了很好的效果，现报告如下。     

软性导管尿道扩张治疗儿童尿道下裂术后尿道狭窄

尿道下裂术后尿道狭窄是尿道成形术后最常见的并发症之一，处理也比较困难，尿道扩张术是最常用的方法之一。1998年至2004年间，采用软性导管进行不定期多次尿道扩张方法治疗17例尿道下裂尿道成形术后尿道狭窄患儿。其中3例吻合口处狭窄的患儿先行钬激光尿道内切开术后再行软性导管尿道扩张术，临床效果好，现报道如下。     

Cardiac Tissue Engineering: Implications for Pediatric Heart Surgery

Children with severe congenital malformations, such as single-ventricle anomalies, have a daunting prognosis. Heart transplantation would be a therapeutic option but is restricted due to a lack of suitable donor organs and, even in case of successful heart transplantation, lifelong immune suppression would frequently be associated with a number of serious side effects. As an alternative to heart transplantation and classical cardiac reconstructive surgery, tissue-engineered myocardium might become available to augment hypomorphic hearts and/or provide new muscle material for complex myocardial reconstruction. These potential applications of tissue engineered myocardium will, however, impose major challenges to cardiac tissue engineers as well as heart surgeons. This review will provide an overview of available cardiac tissue-engineering technologies, discuss limitations, and speculate on a potential application of tissue-engineered heart muscle in pediatric heart surgery.     

小儿腹腔镜外科的临床应用

小儿腹腔镜外科起步于二十世纪七十年代，其标志为StevenGans[１]应用腹腔镜诊断胆道闭锁和性腺发育异常。小儿腹腔镜外科的发展经历了三个阶段：（１）七十年代Gans等积极倡导将内镜用于小儿腹部疾病的诊断[１]；（２）八十年代随着腹腔镜设备的更新与改进，小儿腹腔镜的应用日益广泛；（３）九十年代小儿腹腔镜外科技术趋于成熟。１９９０年Gotz首次报告了经腹腔镜行小儿阑尾切除术[２]，１９９２年Gilchrist和Lobe将其应用到阑尾切除术、疝囊高位结扎术以及其他手术[３]。从此小儿腹腔镜在世界各地开始兴起，到目前为止已经成为一种儿…     

腹腔镜在小儿泌尿外科中的应用

随着小儿泌尿外科腹腔镜技术运用的日趋成熟,腹腔镜诊治高位隐睾、发育不良肾、精索静脉曲张等疾病已成为常规.随着经脐无瘢痕腹腔镜技术、未来的机器人腹腔镜技术的开展,必将有更多的传统手术方式被腹腔镜手术取代.     

Tissue expansion for correction of baldness in aplasia cutis congenita

Aplasia cutis is a congenital absence of the skin, usually presenting on the scalp. In 20% of all cases, part of the skull is also absent. A residual area of baldness may still be present some years after surgical or conservative treatment. It is possible to excise the scarred hairless region and cover that area with expanded hair-bearing skin from the rest of the skull. We present three patients who underwent tissue expansion and discuss the indications and pitfalls of this procedure. Conclusion: Tissue expansion can be used to cover a residual alopecia defect in young children with aplasia cutis congenita and associated bone abnormalities. The quality of the bone appears to be normal in our three patients. We demonstrate that even in young children with aplasia cutis and an underlying bony defect, tissue expansion is a safe and effective modality as a second stage reconstruction procedure.     

功能性微创在小儿外科中的应用

1987年完成的腹腔镜胆囊切除术开创了微创外科的新时代,近年来开展的经脐腹腔镜手术及腹腔镜联合经自然腔道内镜手术进一步减小了创伤,而且更加美观。由此而展开的微创理念已深入人心,但腹腔镜技术并不是微创外科的全部,减轻患者的创伤应以保证治疗效果为前提。近年来,人们更加重视功能性微创的研究与应用,如术前充分的营养支持、各种手术入路的改良或手术方式的更新、术后康复治疗(尤其是心理治疗)等,通过这些综合措施,进一步减轻患儿在心理和身体的创伤,达到功能性微创的目的。     

Tissue Doppler-Derived Diastolic Myocardial Velocities Are Abnormal in Pediatric Cardiac Transplant Recipients in the Absence of Endomyocardial Rejection

The aim of this study was to evaluate diastolic function in pediatric cardiac transplant recipients free of acute rejection using tissue Doppler. E' and A' velocities at the mitral, septal, and tricuspid annuli in 31 pediatric heart transplant recipients free of acute rejection were compared with 28 controls and with previously published pediatric normative data. E' velocities were lower in the transplant group at the mitral (0.13 +/- 0.04 vs. 0.2 +/- 0.04 m/s, p < 0.0001), septal (0.1 +/- 0.03 vs. 0.14 +/- 0.03 m/s, p = 0.001), and tricuspid annuli (0.1 +/- 0.04 vs. 0.17 +/- 0.04 m/s, p < 0.0001). A' velocities were also lower in the transplant group at the septal (0.04 +/- 0.01 vs. 0.06 +/- 0.01 m/s, p = 0.001) and tricuspid annuli (0.06 +/- 0.02 vs. 0.1 +/- 0.03 m/s, p < 0.00001). E' and A' were abnormally low at the mitral annulus in 31% and 13%, septal annulus in 50% and 21%, and tricuspid annulus in 63% and 36% of the subjects, respectively. Abnormalities in tissue Doppler-derived diastolic myocardial velocities are common in pediatric cardiac transplant recipients free of acute rejection.     

Emergencies in Pediatric Surgery

Primary care physicians are often required to initially manage the children with surgical emergencies. Many neonates with congenital malformations delivered without supervision may also be managed initially by the family physicians. The role of the primary care physician in such cases should be to diagnose the condition correctly, provide immediate care and then refer the newborn or child to higher centre for appropriate management.     

Mediastinitis in Pediatric Cardiac Surgery

Mediastinitis is a serious postoperative complication following pediatric cardiac surgery. The objective of this study is to evaluate the cost-effectiveness of surgical treatment for mediastinitis in Guatemala. All children who underwent a median sternotomy and developed postoperative mediastinitis between January 2004 and December 2005 were evaluated. Type of surgical treatment for mediastinitis, hospital outcome, and costs were analyzed. Eighteen (3.3%) of the 535 children who underwent a median sternotomy developed mediastinitis. Two patients underwent debridement of the infected tissues and delayed sternal closure, whereas 16 patients had debridement, primary chest closure, and continuous antibiotic irrigation of the mediastinum. All 11 patients who had the diagnosis of mediastinitis within 2 weeks after the operation survived. Three of the 7 patients (43%) who had delayed diagnosis died (p = 0.0003); all 3 had osteomyelitis (p = 0.0007). Primary closure with antibiotic irrigation was associated to a lower mortality rate and proved less expensive in comparison to delayed sternal closure (p = 0.003) mainly due to the shorter intensive care requirement. Debridement followed by primary closure of the chest and continuous antibiotic irrigation of the mediastinum seems to be a feasible and less expensive method to treat selected cases of postoperative mediastinitis in children.