Non-pulmonary causes of acute respiratory distress in neonates: report of two cases

Acute respiratory distress (ARD) in neonates is a dangerous condition that is usually brought on by pulmonary dysfunction. Congenital diaphragmatic hernia and oesophageal atresia with tracheo-oesophageal fistula are examples of non-pulmonary causes of acute respiratory distress. Though rare, they are potentially fatal and successful management entails a multidisciplinary approach, which includes surgical intervention, use of critical care facilities such as the intensive care unit and paediatric supervision. We present two cases, each outlining one of the above named non-pulmonary causes of ARD, its management and outcome. Management of the congenital diaphragmatic hernia (CDH) was successful and the baby is still doing well. The baby with oesophageal atresia (OA) died during treatment, though the therapeutic procedures undertaken are presented here for academic purposes.     

Oesophageal atresia--the touch stone of paediatric surgery

Paediatric surgery has been grappling with oesophageal atresia with or without tracheo-oesophageal fistula for over 300 years. A very brief resume of the history of evolution of its treatment, anatomical types, clinical features and basic principles of treatment have been outlined. The immediate and long term complications have also been highlighted. The results of surgical treatment of this birth defect have tremendously improved in developed countries over last two decades, but the results in developing countries are yet to match that. The prevalent reasons for this discrepancy are also discussed.     

先天性食管闭锁及气管食管瘘16例临床分析

目的探讨先天性食道闭锁及气管食管瘘的早期诊断及冶疗。方法回顾性分析16例先天性食道闭锁及食管气管瘘患儿的临床资料。结果16例均行手术治疗,治愈10例(62.5%),死亡6例(37.5%)。术后随访6个月～3年,2例术后有食道吻合口狭窄,行球囊扩张治愈,其余8例进食良好。结论早期诊断和及时的手术治疗对提高先天性食道闭锁及食管气管瘘的手术治愈率有重要作用。     

Acquired tracheo-oesophageal fistula after ingestion of a mercury button-battery

We report the case of a nine-month-old girl with acquired oesophageal stricture and tracheo-oesophageal fistula after the ingestion of a mercury button-battery. In any child with suspected button-battery ingestion an x-ray examination should be carried out to exclude oesophageal impaction which necessitates immediate removal of the battery, as tissue necrosis may occur within hours.     

先天性肠闭锁、肠狭窄20年治疗回顾(附66例报告)

目的探讨各类型肠闭锁、肠狭窄的适用手术方式,并对疗效提高的原因进行分析.方法总结我院近20年经手术治疗的66例先天性肠闭锁、肠狭窄患者的临床资料.结果总治愈率为77.27%,其中前10年治愈率为67.44%,后10年治愈率为95.65%,疗效有极明显提高.结论①十二指肠及空肠近端膜式闭锁或狭窄应首选隔膜切除、肠管纵切横缝术;②十二指肠闭锁(除膜式闭锁)及环状胰腺应首选十二指肠-十二指肠菱形吻合术;③小肠、结肠闭锁(除膜式闭锁)应优先选择近端扩张肠管切除、端背吻合术.TPN的广泛应用、围手术期的综合管理、合理手术方式的选择及手术材料的改进对疗效的提高起到了明显作用.     

胸腔镜手术与开胸手术治疗先天性食管闭锁伴气管食管瘘的疗效对比

  目的  对比胸腔镜手术和开胸手术治疗先天性食管闭锁伴气管食管瘘的临床疗效。   方法  选取安徽省儿童医院2011年3月—2019年2月间行手术治疗的101例先天性食管闭锁伴气管食管瘘患儿,按手术方式分为胸腔镜组(50例)和开胸组(51例),分析2组患儿术前资料、围手术期相关指标及术后恢复情况。同时依据学习曲线将胸腔镜组患儿分为前期、后期(各25例),并对上述指标进行比较。   结果  (1) 2组患儿术前临床资料比较差异无统计学意义(均P＞0.05)。(2)围手术期指标:胸腔镜组平均手术时间[(191.42±48.56)min]长于开胸组[(129.02±25.08)min],差异有统计学意义(t=8.163,P＜0.001);胸腔镜组术后初次经口喂养时间[(11.98±2.92)d]短于开胸组[(16.88±4.33)d],差异有统计学意义(t=-2.364,P=0.020)。(3)2组术后吻合口漏、吻合口狭窄发生率及气管食管瘘管复发率比较差异无统计学意义(均P＞0.05)。(4)胸腔镜组后期手术时间、术后带机时间均较前期缩短,差异均有统计学意义(均P＜0.05),术后吻合口漏发生率也明显下降,但差异无统计学意义(P＞0.05)。   结论  胸腔镜手术治疗先天性食管闭锁与开胸手术效果相当,且随着手术技巧的不断改进和完善,临床疗效更为确切。      

先天性食道闭锁术后短期-中期疗效评定

 目的回顾性分析我院诊治的先天性食道闭锁病例,总结诊断、治疗经验,分析影响预后因素,探讨术后短期鄄中期并发症
及其处理经验、教训。方法随访并回顾性分析近3年来我院诊断、治疗、随访的先天性食道闭锁患儿,应用食道闭锁预后分级
方法总结分析影响预后的主要因素。结果2006 年初~2009 年10 月临床资料完整的先天性食道闭锁病例48 例（男33 例,女
15 例）,平均体质量2 667.86 g（1 700~3 800 g）;全部为玉期食道成形,主要术后并发症为肺炎、吻合口瘘（16%）、气管食管瘘、
切口感染（11%）、迟发型气管食管瘘（7%）、食道狭窄（10%）,胃食管返流（67%）。死亡率为12.5%,主要死亡原因为严重肺内感
染及复杂先天性心脏病。结论绝大多数食道闭锁患儿可以耐受玉期食道吻合术,术后短鄄中期预后良好;术前及术后影响预
后及导致死亡的主要原因为复杂心血管畸形、误吸、肺内感染;主要中期并发症为胃食管返流、食道狭窄。     

40 years' review of intestinal atresia

ＯｂｊｅｃｔｉｖｅＴｏａｎａｌｙｚｅｔｈｅ４０ｙｅａｒｓ’ｅｘｐｅｒｉｅｎｃｅｏｆｉｎｔｅｓｔｉｎａｌａｔｒｅｓｉａａｎｄｔｏｉｎｔｒｏｄｕｃｅａｎｅｗｄｅｓｉｇｎｏｆｌｏｎｇｏｂｌｉｑｕｅａｎａｓｔｏｍｏｓｉｓｆｏｒｄｉｓｐｒｏｐｏｒｔｉｏｎａｌ...     

TWENTY FIVE YEARS OF INTERACTION WITH ESOPHAGEAL ATRESIA AND TRACHEO-ESOPHAGEAL FISTULA

Clinical presentation and management modalities for 585 patients of esophageal atresia and/or tracheo-esophageal fistula reporting to Department of Paediatric Surgery, SMS Medical College, Jaipur over twenty five years (1972–1996) were analyzed in five phases of five years each retrospectively. Over the period of observation, the incidence of new cases as well the number of associated anomalies have shown a steady increase due to availability of modern diagnostic facilities. The operative mortality has shown a progressive decline from 95% early in the series to 40% in last few years. Post-operative anastomotic leaks occurred in 21% of cases, strictures in 8% and recurrent fistula in 1% of cases. The presence of severe associated anomalies, prematurity, pulmonary complications and sepsis still remain the major killers in our setup. Early detection and referral has lead to more infants reaching the specialized centres with less pulmonary complications. In the last decade, the survival rate for infants in Waterston''s risk group A has improved to 86% but there is still a substantial difference in the survival rate reported from developed countries. The various factors resulting in poorer results in our set up have been highlighted.KEY WORDS: Esophageal atresia, Tracheo-esophageal fistula     

U形多孔引流支架管在复杂性后尿道手术中的应用

目的 探讨复杂性后尿道手术中使用一种新的引流支架的方法。方法 对55例复杂性后尿道病人行手术治疗。其中复杂性后尿道直肠瘘15例，复杂性后尿道狭窄及闭锁35例，膀胱外翻5．例。术后均采用自制U形多孔引流支架管引流。结果 随访l～l0年，术后病人排尿正常，无尿道狭窄等并发症。结论 U形多孔引流支架管具有支架和引流双重作用，值得在复杂性后尿道手术中临床推广应用。     

肺癌外科治疗技术的改进

目的 为在肺癌的外科治疗过程中减少并发症的发生率,提高手术治疗效果。方法 对前期（１９７２年２月至１９８９年２月）与后期（１９８９年３月至１９９９年２月）的１１７８例肺癌病例在麻醉方法、手术入路、肺根及癌灶的处理、手术并发症的发生率和死亡率等方面进行了分析比较。结果 手术时间由平均２１７ｍｉｎ减少至１２９ｍｉｎ;术中输血量由平均８３０ｍｌ减少至４６０ｍｌ;呼吸衰竭发生率由３．４％降至１．５％;急性     

先天性食管闭锁及气管食管瘘麻醉的临床观察

目的探讨先天性食管闭锁及气管食管瘘的麻醉方法及术中管理。方法回顾性分析徐州市儿童医院近2年的先天性食管闭锁及气管食管瘘麻醉方法及术中管理。结果所有病例无一例术中死亡,术后随访3d无麻醉并发症发生。结论充夯的术前准备,严密的术中监测,细致的水电管理,协调的配合术者,有效的保暖措施,是先天性食管闭锁及气管食管瘘麻醉及术中管理的必要条件和有力保证。     

Endoscopic Nd-YAG laser therapy for palliation of upper gastrointestinal malignancy.

Endoscopic laser therapy with the neodymium-yttrium-aluminium-garnet (Nd-YAG) laser has been shown to provide good palliation of upper gastrointestinal obstruction caused by malignancy, and to be associated with a low morbidity and a low mortality rate. Fifty patients with inoperable upper gastrointestinal malignancy have been treated with this method: 22 had oesophageal carcinoma, 16 adenocarcinoma at the cardio-oesophageal junction, two carcinoma of the antrum and 10 recurrent tumours at the site of previous anastomoses. The main symptoms were dysphagia in 40 and vomiting in seven; three others had recurrent bleeding. An Nd-YAG laser was used to photocoagulate the tumours using power levels of 50-100 W and an average energy output per treatment of 10,000 J. Thirty patients (75%) with dysphagia improved with treatment but vomiting was relieved in only three of the seven patients with this symptom. Complications were infrequent--two patients (4%) developed a perforation and one had a respiratory arrest which was reversible. The 30-day mortality rate was 14% with 2% being related to the procedure. Endoscopic Nd-YAG laser therapy is an acceptable alternative to the more established methods of palliation such as surgical or endoscopic intubation.     

Imperforate anus associated with oesophageal atresia and tracheo-oesophageal fistula

This paper reports the concurrence of imperforate anus, oesophageal atresia and tracheo-esophageal fistula in a 24 hours old baby. The importance of the non-random coexistence of these anomalies is emphasised.     

Necrotizing fasciitis of the male genitalia (Fournier''s gangrene).

Necrotizing fasciitis of the male genitalia was first described 100 years ago. Although the mortality of this condition has generally been high, the last few years have seen dramatic therapeutic improvements. This paper details the treatment of necrotizing fasciitis in two patients and describes a plan of management, which includes early diagnosis, vigorous antibiotic treatment and radical débridement of the necrotic tissues, that should improve the prognosis of the condition.     

Reduction in mortality from upper gastrointestinal haemorrhage

A study of 2377 cases of haemorrhage from the upper gastrointestinal tract shows a significant fall in mortality rate--from 15.5% in the period of retrospective study from 1961 to 1970 to 7% in the prospective study from 1972 to 1982. The fall in mortality rate from non-variceal bleeding was from 12.8% to 5%. In the second five years of the prospective study, the total mortality rate was 5.8%, with 4.5% for non-variceal haemorrhage. This improvement occurred despite a significant rise in the proportion of patients of 60 years of age and over, and was particularly evident in patients with bleeding chronic gastric ulcers. There was also a significant reduction in mortality in the 60 years and over age group in the latter five years of the prospective study. The data suggest that there were three aspects of management which were important in the reduction of mortality. These were early fibreoptic endoscopic diagnosis, improved resuscitation and postoperative care, and early control of bleeding from oesophageal varices by balloon tamponade and surgery in selected cases. These complicated procedural aspects of management are best applied in a special unit for the treatment of patients with haemorrhage from the upper gastrointestinal tract. It is concluded that there has been significant progress in the treatment of this problem during the last decade.     

先天性肠闭锁88例诊疗体会

目的探讨新生儿肠闭锁的外科诊断、治疗及降低死亡率的影响因素。方法回顾性分析新生儿肠闭锁88例的临床资料、影像、病理类型、手术治疗及疗效。结果本组治愈76例,治愈率86.3%,其中8例进行了2次手术（包括6例粘连性肠梗阻、2例吻合口瘘）。术后死亡及放弃治疗12例（包括合并肠扭转3例,短肠综合征2例,胆道闭锁1例,肛门闭锁1例）。结论早诊断,增加患儿出生体重,降低合并严重畸形患儿出生率,选择合适的手术方式,根据闭锁两端肠管的病理改变拟定的肠切除范围可作为临床参考,可减少并发症发生,降低死亡率。     

新生儿食道闭锁术后并发症与生存率─—13年病例回顾

目的总结和讨论食道闭锁术后并发症的防治,以提高食道闭锁术后存活率。方法总结13年间29例先天性食道闭锁病例手术成活率的经验,分析并发症与存活率的关系。结果19例Ⅰ期食管气管疾管结扎切断、食管端端吻合,1例外院术后发生吻合口瘘转入的20例中15例获得痊愈（75％）,而1984～1990年间Ⅰ期手术治愈率为6／10（60％）,1991～1996年则提高为9／10（90％）。1996年度手术7例全部存活,其中2倒闭锁远近端食道距离大于2cm。结论加强术前术后的管理,积极有效的预防和治疗术后并发症是提高食道闭锁患儿存活率的关键。     

室间隔完整型肺动脉闭锁的个体化手术治疗

目的 探讨室间隔完整型肺动脉闭锁(PA/IVS)的个体化手术治疗.方法 1997年至2005年上海儿童医学中心外科治疗PA/IVS病例52例.(1)右心室依赖冠状动脉循环(RVDCC)组:共6例,均进行单心室修补.(2)非RVDCC组:46例.右心室重度发育不良(三尖瓣Z值＜-4)者13例,进行单心室修补.右心室轻、中度发育不良(三尖瓣Z值＞-4)者33例,除1例危重新生儿进行体肺分流外,另32例患儿均先进行右心室减压手术,右心室减压术后循环和血氧满意,完成双心室修补6例;对出现循环不稳定和/或低氧血症者,新生儿、小婴儿(0～2个月)增加体肺分流术13例;年龄≥3个月以上者增加腔肺分流术13例(1.5心室修补).结果 RVDCC组初期手术死亡1例,非RVDCC组初期手术死亡7例,总病死率15%.成功获得终期手术26例,占50%.随访1～10年,死亡3例.结论 依据患儿冠状动脉解剖、右心室发育程度和生长潜能以及手术中血流动力学和血氧情况,个体化地选择相应的手术方法,有利于提高患儿生存率.     

胸部食管穿孔的治疗

过去３０多年间,尽管在治疗食管穿孔等方面有了较大的进展,但食管穿孔的死亡率仍较高,而胸部食管穿孔的死亡率（２５％）在各段食管穿孔中又最高［１］。因胸部食管穿孔的原因、部位、诊断延误时间、患者年龄、循环系统状况、胸腔污染程度以及食管基础病变等不同,使得...