小儿腹腔镜与剖腹胆囊切除术比较

作者报道１９９２年４月～１９９３年１２月采用腹腔镜胆囊切除术（ＬＣ）治疗小儿结石性胆囊炎２９例，并与１９９１年１月～１９９２年３月对２３例施行剖腹胆囊切除术（ＯＣ）的患儿进行对比分析。两组中各有２例因同时行其他手术或检查被除外。平均年龄ＯＣ组为７．７岁（１～１６岁），ＬＣ组为１１．４岁（４～１７岁）；男女比例ＯＣ组１０：１１，ＬＣ组１１：１６；有腹痛者分别为９０％和９５％；病程以后组较长，分别是５．６±６．２和１１．８±：１４．３个月。全部病例均经日超证实有胆囊炎或胆囊结石。ＬＣ组中预防性使用抗…     

先天性主动脉缩窄球囊扩张术后疗效的探讨

报告１５例先天性主动脉缩窄球囊扩张术后的疗效，男１０例，女５例；年龄６．７±２．９岁。１４例为未经外科手术的先天性主动脉缩窄，其中１０例为局限性，４例为主动脉弓发育不良型，另１例为外科手术后再狭窄。采用的球囊平均直径１０．５±２．６ｍｍ，为缩窄区直径的２．７±０．６倍。术后平均压差（ΔＰ）由７．３±１．８ｋＰａ（５４．８±１３．５ｍｍＨｇ，１ｋＰａ＝７．５ｍｍＨｇ）降至２．３±２．１ｋＰａ，缩窄区直径由３．８±１．１ｍｍ扩大至８．４±２．５ｍｍ。１０例局限性主动脉缩窄及１例外科手术后再狭窄术后ΔＰ≤２．７ｋＰａ，术后平均随访５．６年，９０％病例ΔＰ仍持续下降，造影随访未见动脉瘤发生。４例发育不良型术后ΔＰ＞２．７ｋＰａ，３例进行外科手术。认为球囊扩张术对局限性及外科手术后主动脉缩窄是安全、有效的治疗方法。     

法乐四联症的早期外科治疗

探讨婴儿四联症手术和心肺转流技术要点及姑息手术指征，提出早期根治及必要姑息的观点。１１１例根治术在中度低温心肺转流下进行，１０例采用深低温停循环技术，４例采用低流量不停循环技术，５例处在缺氧发作状态行急症根治。另外１１例肺动脉闭锁或发育不良或冠状血管畸形者行姑息手术。本组病死率４％（５／１２５），１至２岁病死率为３．７％（４／１０９），１岁以下病死率５．８％（１／１７），５例急症手术无死亡。姑息术死亡１例，病死率９％（１／１１）。四联症在婴幼儿期根治其病死率不高于儿童期，如解剖条件许可应尽早行根治，如无根治条件也应尽早行姑息手术。四联症急症纠治术可能挽救处于缺氧持续状态的患儿。     

20例郎格罕细胞组织细胞增生症临床分析

郎格罕细胞组织细胞增生症（Ｌａｎｇｅｒ－ｈａｎｓ－ｃｅｌｌＨｉｓｔｉｏｃｙｔｏｓｉｓ,ＬＣＨ）,原名为组织细胞增生症Ｘ（ＨＸ）,是一种分化较好的组织细胞异常增生和浸润,小儿多见。现对我院１９８２－１９９８年收治２０例病人进行临床分析,同时对于治疗方法做一探讨。临床资料１．一般资料男１３例,女７例,男女之比为１．８：１。发病年龄：＜１岁,７例（３５％）,～３岁,６例（３０％）,～５岁,３例（１５％）,＞５岁,４例（２０％）。２．临床表现皮疹,１０例（５０％）,发热９例（４５％）,肝大和／或牌大１０…     

红细胞6—磷酸葡萄糖脱氢酶缺陷症50例分析(摘要)

我院儿科１９７８年至１９８７年收治５０例，占同期住院１３２８５人次的０．３８％，溶血性贫血７７人次的６４．９４％。年龄最小为出生３０小时，最大１１岁，５岁以下最多见４６例（９２％），男多于女，男：女＝１６．７：１。５０例中分型以蚕豆病多见３２例（６４％），其次药物、感染性溶血１０例（２０％），新生儿Ｇ－６－ＰＤ缺陷性溶血７例（１４％），非球形红细胞溶血性贫血Ｉ型１例。５０例中７例有家族史，２例有过去史。临床表现全部病例均有贫血、黄疸、血红蛋白尿，发烧２８例（６５．２４％），少数尚有疲乏、腹痛、呕吐、烦燥，肝大２０例（７１．４％），脾大仅２例。实验室检查．极重度贫血９例（１８％），重度贫血３２例（６４％），中度贫血５例（１０％），４例血红蛋白在１０克％以上皆为新生儿，网织红细胞＞５％２９例（５８％），１．５％～５％１５例（３０％），０．５％～１．５％６例（１２％）。白细胞计数＜１０×１０９／Ｌ５例（１０％），１０×１０９／Ｌ～２０×１０９／Ｌ２９例（５８），２０×１９９／Ｌ～３０×１０９／Ｌ９例（１８％），＞３０×１０９／Ｌ。７例（１４％）。     

自体外周血造血干细胞移植治疗小儿白血病,恶性肿瘤的临床研究

为探讨预处理方案对小儿自体外周血造血干细胞移植（Ａｕｔｏ－ＰＢＳＣＴ）疗效的影响，对１４例恶性肿瘤患儿（急性淋巴细胞白血病７例、急性髓系白血病４例、恶性淋巴瘤２例、神经母细胞瘤１例），在其完全缓解６个月后进行了Ａｕｔｏ－ＰＢＳＣＴ治疗。中位随访时间４．８年（３～７年）。结果无病生存率为５７％（８／１４），死亡率为４３％（６／１４）。初步资料结果表明，预处理方案采用全身照射（７．０±０．５Ｇｙ）联合３或４种化疗药物要比联合１～２或５种化疗药物为好，但在为每个患儿进行移植前制订预处理方案时，应注意个体化。     

血细胞分离机在小儿血液病治疗中的应用

应用血液细胞分离机治疗小儿血液病,具有年龄小、静脉细、血容量低的难点。我们尝试用ＣＳ３０００ｐｌｕｓ血细胞分离机对１０例血液病患儿进行治疗,报告如下。对象：１９９７年８月～１９９８年５月,本院１０例患儿,男８例、女２例;平均年龄７－４岁（３～１２岁）;体重１３～２８ｋｇ,平均１８ｋｇ。疾病类型和治疗方式：（１）去除白血病细胞：共６例,其中５例为急性白血病初发患儿（Ｍ２１例、Ｍ１１例、ＡＬＬ３例）;另１例为慢性粒细胞性白血病。采集前,６例患儿白细胞总数在（１３０～２４０）×１０９／Ｌ。（２）采集外…     

先天性后尿道瓣膜10例

先天性后尿道瓣膜１０例叶辉先天性后尿道瓣膜是男孩较常见的先天性下尿道梗阻性畸形。我院自１９８９年１月～１９９３年６月共收治１０例，均行经尿道电的瓣膜治愈。报告如下。１．临床资料：本组１０例。年龄３月～７岁（１岁以下３例，１～２岁３例，～３岁２例，～４...     

儿童陈旧性孟氏骨折的形成原因及手术治疗

１９８９年３月～１９９６年１０月我院采用早期切开复位环状韧带修补或重建、尺骨多种截骨术等方法治疗陈旧性孟氏骨折４２例，随访材料完整者２８例，疗效满意，现报道如下。临床资料：本组２８例，男２１例，女７例，年龄６～１２岁，平均７．５岁。左侧１３例，右侧１５例。骨折类型（Ｂａｄｏ分类）：Ⅰ型１５例，Ⅱ型６例，Ⅲ型７例，本组没有Ⅳ型。漏诊１０例，合并桡神经迟发性瘫痪４例。尺骨楔形截骨１８例，横形截骨７例，斜形截骨３例。环状韧带修补术１８例，环状韧带重建术１０例，其中阔筋膜重建术８例，肱三头肌肌腱重建术２…     

小儿神经症23例报告

小儿神经症２３例报告北京二六二医院儿科（１０００８８）李芳１临床资料２３例患儿中男１３例，女１０例。年龄６～１４岁，其中６～８岁５例，～１１岁７例，～１４岁１１例。知识分子家庭９例，干部５例，工人３例，个体户４例，农民２例；父母关系正常１３例，紧张６...     

肌电图联合磁共振诊断新生儿臂丛神经损伤的应用

目的 探讨神经肌电图及MRI在诊断新生儿臂丛神经损伤中的特点及应用.方法对30例临床诊断臂丛神经损伤的新生儿进行肌电图检查,测定臂丛神经的五大分支神经传导及其所主要支配肌肉的肌电活动,同时完善臂丛神经MRI检查,对比分析两种检查结果.结果 肌电图提示上(中)干型损害25例(83.3%),全干型4例(13.3%),下干型1例(3.3%),节前受累6例(20%),完全性损伤7例(23.3%),不完全损伤23例(76.7%).MRI提示节前损伤7例(23.3%),其中上(中)臂丛型损害5例(16.7%),全臂丛型1例(3.3%),下臂丛型损伤1例(3.3%).结论 神经肌电图与MRI在臂丛神经损伤定位上均有良好的提示作用,但对于轻度不完全损伤,肌电图检测结果更佳,二者联合能更好地进行诊断.     

Geburtstraumatische Armplexusparesen

Birth-related brachial plexus palsy is often considered unavoidable and untreatable. Hence the ideal time for potentially effective brachial plexus surgery is often missed. However, the majority of birth-related brachial plexus lesions are light traction injuries which recover without surgical reconstruction under physiotherapy. This is not true for severe injuries with loss of continuity due to disruption or avulsion of the brachial plexus. These lesions can leave severe functional losses of the upper extremity for the patient’s lifetime. Patients with non-recovering brachial plexus injuries should be referred to an interdisciplinary center for birth-related brachial plexus injuries within the first 3 months of life. A German working group on birth-related brachial plexus palsy based in Munich (Dr. von Haunersches Kinderspital) aims to offer competent advice and treatment for parents and patients. Patients can attend a monthly interdisciplinary clinic, preferably in the third month of life, where they are clinically and electrophysiologically examined and further therapeutic steps are initiated. The decision on whether direct brachial plexus surgery is recommended is taken by the 9^th month of life at the latest. According to the child’s development, other techniques, such as Botulinum toxin, tenolysis, tendon lengthening, as well as other tendon transfer methods, can be helpful in restoring everyday function in the affected limb. Since 2002, the working group on birth-related brachial plexus palsy has treated more than 150 patients on an interdisciplinary basis, including pediatrics, developmental neurology, neurology, hand surgery and plastic and reconstructive surgery. Their work as been very positively received both locally and nationally. The current article aims to review diagnostic and therapeutic options and strategies and to focus on the possibilities of both primary and secondary reconstruction of the brachial plexus.     

Diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury

Background Detailed evaluation of a brachial plexus birth injury is important for treatment planning. Objective To determine the diagnostic performance of MRI and MR myelography in infants with a brachial plexus birth injury. Materials and methods Included in the study were 31 children with perinatal brachial plexus injury who underwent surgical intervention. All patients had cervical and brachial plexus MRI. The standard of reference was the combination of intraoperative (1) surgical evaluation and (2) electrophysiological studies (motor evoked potentials, MEP, and somatosensory evoked potentials, SSEP), and (3) the evaluation of histopathological neuronal loss. MRI findings of cord lesion, pseudomeningocele, and post-traumatic neuroma were correlated with the standard of reference. Diagnostic performance characteristics including sensitivity and specificity were determined. Results From June 2001 to March 2004, 31 children (mean age 7.3 months, standard deviation 1.6 months, range 4.8–12.1 months; 19 male, 12 female) with a brachial plexus birth injury who underwent surgical intervention were enrolled. Sensitivity and specificity of an MRI finding of post-traumatic neuroma were 97% (30/31) and 100% (31/31), respectively, using the contralateral normal brachial plexus as the control. However, MRI could not determine the exact anatomic area (i.e. trunk or division) of the post-traumatic brachial plexus neuroma injury. Sensitivity and specificity for an MRI finding of pseudomeningocele in determining exiting nerve injury were 50% and 100%, respectively, using MEP, and 44% and 80%, respectively, using SSEP as the standard of reference. MRI in infants could not image well the exiting nerve roots to determine consistently the presence or absence of definite avulsion. Conclusion In children younger than 18 months with brachial plexus injury, the MRI finding of pseudomeningocele has a low sensitivity and a high specificity for nerve root avulsion. MRI and MR myelography cannot image well the exiting nerve roots to determine consistently the presence or absence of avulsion of nerve roots. The MRI finding of post-traumatic neuroma has a high sensitivity and specificity in determining the side of the brachial plexus injury but cannot reveal the exact anatomic area (i.e. trunk or division) involved. The information obtained is, however, useful to the surgeon during intraoperative evaluation of spinal nerve integrity for reconstruction.     

The odontoid synchondrotic slip: an injury unique to young children

We report seven children (three female, four male) diagnosed with traumatic synchondrotic slip of the odontoid. The clinical records, plain films, and CT scans were evaluated retrospectively. The patients ranged in age between 3 and 5 years. Their injuries resulted from a motor vehicle accident in four cases and from a fall from a height in three. The injury was isolated in five; it was associated with a closed head injury in one and with facial and brachial plexus trauma in another. Radiographs showed anterior angulation with or without displacement in all seven cases. Axial CT with sagittal reformation and 3D reconstructions were performed in six cases. This confirmed the synchondrotic slip and, in addition, identified a rotary component to the injury in three cases, with compromise of the canal in two. Other additional injuries were also noted. All cases were treated conservatively and the injuries healed. Only one child had a neurological deficit attributable to her head injury rather than to her cervical injury (MR of the cervical cord was normal). The presence of the synchondrosis between the dens and the body of C-2 makes this injury unique to children under 7 years of age; by the age of 7 the synchondrosis has fused.

     

膈神经移位治疗产伤性臂丛神经麻痹对呼吸功能的影响

目的 提高对膈神经移位治疗产瘫术后对呼吸功能影响的认识。方法对６８例产瘫患儿术后呼吸系统变化进行分组分析。结果 膈神经移位组术后摄胸片一侧膈肌均有胎高,透视下随呼吸呈矛盾运动,术后呼吸窘迫、肺炎、肺不张等明显高于非膈神经移位组。按年龄划分小于６个月手术并发症同于６个月以上组,呼吸窘迫均出现在小于３个月的手术组中,结论 膈神经作为移位神经被广泛应用的治疗产瘫手术中,临床上６个月以下取膈神经应慎重,尤     

Cause and effect of obstetric (neonatal) brachial plexus palsy

We have studied the causes and outcome of obstetric brachial plexus palsy in all children born in Malm? during the 10-year period 1973-1982. Forty-eight of 25,736 live-born children (0.19%) were neonatally diagnosed as having a brachial plexus paresis. Twenty-five percent of these, i.e., one child in 2,000 liveborn, had a persistent palsy. The obstetric history was characterized by high birthweight, vertex presentation with shoulder dystocia and multiparity; and in two cases the mother had two children with brachial palsy. The children who recovered totally did so during the first few months. The prognosis for the more common upper brachial plexus, or Erb's, was more favorable than that for entire brachial plexus palsy. All the children with persistent palsy were afflicted with considerable reduction in arm function, resulting in varying degrees of handicap, such as not being able to use the palsied arm at all or not being able to perform certain tasks--writing properly, playing a musical instrument, doing the hair, wearing clothing with shoulder straps, etc. We wish to point out that, in several cases, obstetric brachial plexus palsy results in a lifelong handicap and that prevention and therapy are essential both in obstetric and in pediatric management.     

Cause and Effect of Obstetric (Neonatal) Brachial Plexus Palsy

ABSTRACT. We have studied the causes and outcome of obstetric brachial plexus palsy in all children born in Malmö during the 10-year period 1973–1982. Forty-eight of 25736 live-bom children (0.19%) were neonatally diagnosed as having a brachial plexus paresis. Twenty-five percent of these, i.e., one child in 2000 liveborn, had a persistent palsy. The obstetric history was characterized by high birthweight, vertex presentation with shoulder dystocia and multiparity; and in two cases the mother had two children with brachial palsy. The children who recovered totally did so during the first few months. The prognosis for the more common upper brachial plexus, or Erb's, was more favorable than that for entire brachial plexus palsy. All the children with persistent palsy were afflicted with considerable reduction in arm function, resulting in varying degrees of handicap, such as not being able to use the palsied arm at all or not being able to perform certain tasks—writing properly, playing a musical instrument, doing the hair, wearing clothing with shoulder straps, etc. We wish to point out that, in several cases, obstetric brachial plexus palsy results in a lifelong handicap and that prevention and therapy are essential both in obstetric and in pediatric management.     

Perinatal brachial plexus palsy

Perinatal brachial plexus palsy (PBPP) has been traditionally classified into three types: upper plexus palsy (Erb's) affecting the C5, C6, and +/- C7 nerve roots, lower plexus palsy (Klumpke's) affecting the C8 and T1 nerve roots, and total plexus palsy. Although most cases will resolve spontaneously, the natural history of the remaining cases is influenced by contractures of uninvolved muscle groups and subluxation or dislocation of the shoulder and elbow. Microsurgical nerve repair has demonstrated to provide improved outcomes compared to conservative treatment, while advancements in secondary reconstruction have offered significant improvements in the performance of activities of daily living for older children with unresolved plexus palsy.     

Frühe mikrochirurgische Rekonstruktion nach schwerer kindlicher Plexuslähmung

Based on over 120 surgeries performed in children since 1997, we describe our treatment concept for severe infantile plexus paralysis, which necessitates early microsurgical reconstruction of the torn (avulsed) nerve structure in the brachial plexus. If functional remission does not ensue during the first few months of life, complete plexus paralysis should be operated when the child is 3 months old and an upper lesion at the latest at the age of 9 months by microsurgical reconstruction of the nerve pathways.     

Arachnoid cyst masquerading as obstetric brachial plexus palsy

Obstetric brachial plexus palsy is not uncommon. However, lesions masquerading as obstetric brachial plexus palsy are rare. A child with a cervicothoracic arachnoid cyst masquerading as obstetric brachial plexus palsy is presented, and the relevant literature is reviewed. A girl born by vaginal delivery at full term without any antecedent risk factors for obstetric brachial plexus palsy was noted to have decreased movements of the right upper extremity. After 7 months, there was no improvement. An MRI scan was obtained, which revealed a cervicothoracic spinal extradural arachnoid cyst. During surgery, the cyst was found to communicate with the dura at the axilla of the C-7 nerve root. The cyst was excised in toto. Six months later, there was improvement in the infant's neurological status. This case illustrates that spinal arachnoid cysts should be entertained in the differential diagnosis when a child presents with obstetric brachial plexus palsy without known antecedent risk factors for obstetric palsy.