小儿同足趾顺行趾动脉神经蒂皮瓣的临床应用

目的报道小儿同趾顺行趾动脉神经蒂皮瓣的临床应用。方法2008年1月至2013年6月我们对8例拇趾端（腹）缺损的患者应用同足趾顺行趾动脉神经蒂皮瓣进行修复。其中趾端缺损3例,趾腹缺损5例,皮肤缺损面积在1．0cm×1．5cm～1．2cm×1．8cm。年龄为3～12岁,平均年龄5岁。结果皮瓣全部成活,无动、静脉危象发生。经1个月至半年随访,皮瓣外形饱满,色泽、供受区仅有线样瘢痕,趾端感觉正常,无不耐寒及趾端疼痛病例,患儿步态正常。结论同趾顺行趾动脉神经蒂皮瓣是修复小儿拇趾趾端（腹）缺损的良好方法。     

Repair of soft tissue defect in the heels of children with the perforator flaps of the posterior tibial artery with nerve anastomosis

目的 评价胫后动脉穿支皮瓣带神经修复小儿足跟软组织缺损的临床效果.方法 应用胫后动脉穿支皮瓣带神经修复9例足跟负重区软组织缺损,年龄:4～12岁(平均7.5岁).切取皮瓣面积最大12 cm×6 cm,最小6 cm×4.5 cm.供区创面行Ⅰ期全厚网状游离植皮.皮瓣携带的隐神经在足跟部与腓肠神经吻合.结果 所有的皮瓣完全存活,取得了满意的临床效果.随访1.5～4年,平均随访2.5年,皮瓣恢复了感觉,两点分辨觉为30～33 mm,受区未发生溃疡.结论 胫后动脉穿支带蒂皮瓣具有血管解剖恒定、血运丰富以及操作简单等优点,适宜修复小儿足跟负重区软组织缺损.     

吻合神经的臀股部带蒂皮瓣修复小儿足跟软组织缺损

目的 总结吻合神经的臀股部带蒂皮瓣修复小儿足跟软组织缺损的临床应用效果.方法 应用臀股部带蒂皮瓣修复8例足跟负重区软组织缺损,切取皮瓣面积最大5.5 cm×16 cm,最小4.5 cm×15 cm.供区创面Ⅰ期直接缝合,皮瓣携带的股后皮神经,在足跟与腓肠神经吻合.结果 所有皮瓣完全存活,取得了满意的效果.平均随访2.5年,皮瓣恢复了感觉,两点分辨觉为13～16 mm,受区未发生溃疡.结论 带感觉皮瓣具有血管解剖恒定、血运丰富及操作简单等优点,适宜修复小儿足跟负重区软组织缺损.     

扩大的足背动脉内侧皮瓣修复儿童足跟及其周围软组织缺损

目的 探讨扩大的足背动脉内侧皮瓣修复儿童足跟部皮肤缺损的效果.方法 2004年8月至2008年12月,共10例患儿足跟及其周围软组织缺损,男8例,女2例,年龄4～10岁.均为创伤所致.创面大小约6.5 cm×4.0 cm～9.5 cm×4.0 cm.10例小儿足跟及其周围软组织缺损采用对侧扩大的足背动脉内侧皮瓣修复.7例皮瓣行交腿皮瓣转移修复,3例皮瓣行游离移植,供区创面采用游离植皮修复.术中把皮瓣内隐神经与受区隐神经吻合.结果 扩大的足背动脉内侧皮瓣范用约7.0 cm×4.5 cm～12.0 cm×4.5 cm.所有皮瓣均完全存活.8例获随访9～18个月,再造足跟两点辨别觉5～9mm,外形良好、无溃疡发生.结论 扩大的足背动脉内侧皮瓣可修复对侧足跟及其周围软组织缺损.该皮瓣是隐神经的绝对支配区,移植后可重建精细感觉.     

应用腓肠神经营养血管皮瓣治疗儿童足踝部皮肤软组织缺损

目的 探讨腓肠神经营养血管皮瓣治疗儿童足踝部皮肤软组织缺损的手术方法及临床疗效. 方法 2006年6月至2012年2月我们采用腓肠神经营养血管皮瓣治疗儿童足踝部皮肤软组织缺损37例,患儿年龄2～13岁,平均7岁;足踝部皮肤软组织缺损范围3 cm×2cm～8cm×7 cm;受伤至手术时间1～5个月,平均2个月;切取皮瓣面积为3 cm ×2 cm～9 cm ×8 cm,皮瓣蒂长约4～7 cm（平均5 cm）,筋膜蒂宽3.0 ～5.0 cm. 结果 37例患儿术后腓肠神经营养血管皮瓣全部成活,其中4例皮瓣周围皮缘部分坏死,6例术后出现皮瓣远端部分皮下脂肪液化,均经换药后愈合;37例患儿均获随访,随访时间3 ～46个月,平均20个月,皮瓣无臃肿,外形满意,功能、感觉良好,两点辨别觉正常,皮肤感觉恢复良好,能穿鞋正常行走. 结论 腓肠神经营养血管皮瓣手术操作简单,损伤少,成功率高,是修复儿童足踝部皮肤软组织缺损的有效可靠方法之一.     

游离股前外侧双叶皮瓣修复儿童足踝部皮肤软组织缺损

目的探讨游离股前外侧双叶皮瓣修复儿童足踝部皮肤软组织缺损创面的临床疗效。方法自2015年7月至2020年6月, 对苏州大学附属瑞华骨科医院小儿骨科收治的6例足踝部皮肤软组织缺损创面的患儿采用游离股前外侧双叶皮瓣修复, 其中男5例, 女1例;年龄范围在3～12岁, 平均8岁;皮肤缺损大小范围在13. 0 cm×6. 0 cm～15. 0 cm×12. 0 cm;合并胫骨骨折1例、胫后动静脉断裂2例、腓浅神经断裂2例、合并肌肉及肌腱损伤的5例, 仅皮肤缺损的1例, 创面均有深部肌腱及骨外露, 但未有肌腱等组织缺损。一期行骨折复位内固定, 血管、神经、肌肉、肌腱修复, 创面VSD覆盖, 择期在静脉全麻下游离股前外侧双叶皮瓣修复。根据创面大小设计样布, 在股前外侧区纵行设计双叶皮瓣, 以方便皮瓣切取后供区能直接缝合, 皮瓣切取总面积22. 0 cm×4. 0 cm～29. 0 cm×7. 5 cm。如果两块皮瓣血管同源, 皮瓣内的主干血管直接与受区血管吻合并桥接受区血管;如果两块皮瓣不同源, 则先通过内增压的方式并连成一个血管蒂的双叶皮瓣, 再与受区血管吻合并桥接受区血管, 大腿供区直接缝合。...     

腹部带蒂皮瓣在修复儿童手部软组织缺损中的应用

目的报告应用腹部带蒂皮瓣修复儿童手部软组织缺损的临床效果。方法本院2001年至今收治26例手部皮肤软组织缺损患儿，均采用腹部带蒂皮瓣进行修复，皮瓣切取面积为2cm×1cm～7cm×4．5cm。结果26例皮瓣全部顺利存活，经6～30个月随访，皮瓣质地、外观优良，手功能恢复满意。术后供皮区伤口均Ⅰ期愈合，外形满意。结论腹部带蒂皮瓣是修复儿童手部皮肤创面的理想选择。     

吻合神经的邻指皮瓣修复儿童手指指腹软组织缺损22例

目的探讨采用吻合固有神经背侧支的邻指皮瓣修复儿童手指指腹软组织缺损的疗效。方法手指指腹软组织缺损患儿22例28指。男17例20指,女5例8指;年龄5～15岁。其中切割伤10例10指,挤压伤6例8指,机器绞伤6例10指。采用吻合神经背侧支的邻指皮瓣修复患儿指腹软组织缺损,术后3周断蒂。供区全厚皮片覆盖,缝合并留长线打结加压包扎。结果22例手指指腹软组织缺损患儿28指术后皮瓣及供区均成活。随访6～26个月,皮瓣皮片均生长良好,手指指腹饱满,色泽正常,静止2点辨别觉为3.5～6.5mm,创面均Ⅰ期愈合,皮肤色素沉着少许,手指伸屈功能无受限。结论采用吻合指固有神经背侧支邻指皮瓣修复儿童指腹软组织缺损不仅能修复指腹的外观,且能重建指腹感觉,是一种简单实用的手术方法。     

游离股前外侧皮瓣修复儿童足踝部皮肤软组织缺损

目的探讨游离股前外侧皮瓣修复儿童足踝部皮肤软组织缺损的临床应用及效果。方法自2000年6月至2011年6月,采取游离股前外侧皮瓣修复儿童足踝部皮肤软组织缺损20例,其中男12例,女8例,年龄6—14岁,平均11岁。新鲜创面8例,晚期感染创面12例。创面面积6cm×8cm～18cm×15cm,平均12cm×8cm,皮瓣切取范围7cm×8cm-18cm×16cm。结果20例均获随访,平均随访时间1年5个月。移植组织全部成活20例,愈合时间12～18d,皮瓣供区可采用游离皮片移植,各种组织移植供区无功能障碍。结论游离股前外侧皮瓣修复儿童足踝部皮肤软组织缺损,疗效可靠,是理想的治疗方法。     

胫前动脉皮瓣在小儿小腿及足部软组织损伤中的应用

报道８例以胫前动脉为蒂的足背或小腿外侧皮瓣翻转移位修复小儿小腿及足部软组织损伤，所有皮瓣全部成活。该皮瓣的优点是：其血管行走方向恒定，血管蒂有足够长度，皮瓣大小、形态可自由设计选择，血供丰富，血管分支多，适合于各种小腿和足部大面积深部损伤。     

肛门直肠畸形外科治疗前沿:机器人手术现状及未来趋势CSCD

As the most common digestive tract malformation in children, anorectal malformations (ARM) are one of the most representative diseases in pediatric surgery. Surgery is a sole therapy for ARM and surgical approaches have evolved dramatically from traditional open operation to mini-invasive procedure in recent decades. Traditional laparoscopic equipment has failed to meet the surgeon’s mastery of refined technique due to its limitations in operative accuracy and dimensions. Then robotic surgery system came into being. Robotic-assisted surgery, with its flexible handling and three-dimensional viewing, was initially introduced for adult surgery and then gradually extended to pediatric surgery. It has been applied to children with ARM. Based upon domestic and foreign literature reports, this review summarized the application status and recent advances of robotic systems in ARM. © 2022, Journal of Clinical Pediatric Surgery. All rights reserved.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

腹腔镜下十二指肠吻合术治疗新生儿十二指肠梗阻

Objective To evaluate the feasibility and indication of laparoscopie duodenoduoden-ostorny for neonates with congenital duodenal obstruction- Methods From May 2004 to Feburary 2008,6 newborns with duodenal obstruction underwent exploratory laparoscopy. With a lower-pressure pneumoperitoneum of 5～8 mmHg and a suspending suture for right liver elevator, the procedure was performed using 3 cannulas of 3.3 mm to 5.5 mm diameter. Under the laparoscopic vision, the cause of duodenal obstruction was diagnosed and a sutured anastomosis was performed after the duodenum mo-bilized. Results Findings at laparoscopy included duodenal diaphragm in 3 cases,annular pancreas in 2 cases, and preduodenal portal vein in 1 case. Three cases with duodenal diaphragmatic stenosis were en-countered a partial excision of the diaphragm after vertical incision of the anterior part of duodenum followed laparoscopically by a transverse suture. A diamond-shaped side-to-side duodenoduodenal anas-tomosis was successfully carried out in 2 cases of annular pancreas through a laparoseopic approach, but a duodenojejunostomy was converted to mini-laparotomy during the laparoscopic course of a predu-odenal portal vein. The average operative time was 102 16.5 min (85～135 min). Visualization was ex-cellent, and there were no intraoperative complications. Feedings were started on postoperative day 3 to 5. All cases were on full feedings after 8 to 10 days. Follow-up upper gastrointestinal tests showed no evidence of stricture or obstruction. Conclusions The duodenoduodenostomy with laparoseopy can be performed in neonates securely and appropriated for a full-term newborn with tolerance CO2 pneumo-peritoneum. It provides an excellent and micro-invasive way to evaluate and treat congenital duodenal obstruction.     

声控机器手在小儿腹腔镜手术中的应用

目的探讨声控机器手在小儿腹腔镜手术中应用的安全性与实用性。方法2003年10月～2006年12月应用美国摩星公司的声控机器手操控史赛克公司腹腔镜,共完成小儿腹腔镜手术147例,其中先天性巨结肠52例,腹股沟斜疝26例,先天性麦克尔憩室8例,胆总管囊肿7例,腹腔探查17例,腹腔囊肿手术11例,其他26例。手术年龄8个月～13岁,平均年龄2.7岁。结果147例手术均在机器手控制下顺利完成,术中机器手操控时间25～172min,平均47min,与常规手术比较,图像稳定清晰。全组病例均顺利康复,无手术并发症。结论声控机器手操控小儿腹腔镜手术视野图像精确、稳定,在大型手术时有助于减轻手术疲劳,提高手术精度。但其智能化程度有限,现阶段不能取代人工。