阑尾原位造口可控性顺行灌肠的临床评价

Objective To evaluate the clinical results of antegrade continence enema via appendi-costomy in situ to treat neurogenic faecal incontinence. Methods 13 patients with tethered cord syn-drome complaeated neurogenic faecal incontinence were performed appendicostomy in situ with intus-susception valve between June 1998 and December 1999 (male 9, female 4, age 6～13 years). After operation,enema were performed via stoma. Results All patients were followed up 2 to 6 years later. All stomas are continent of faeces and flatus. Stoma stricture developed in 2 patients, and atresia in an-other 2 patients. Anus function were increased in 11 patients. Conclusions Antegrade continence ene-ma via appendicostomy in situ is a effective method to treat neurogenic faecal incontinence. It can devel-oped life quality of patients.     

阑尾原位造口可控性顺行灌肠的临床评价

Objective To evaluate the clinical results of antegrade continence enema via appendi-costomy in situ to treat neurogenic faecal incontinence. Methods 13 patients with tethered cord syn-drome complaeated neurogenic faecal incontinence were performed appendicostomy in situ with intus-susception valve between June 1998 and December 1999 (male 9, female 4, age 6～13 years). After operation,enema were performed via stoma. Results All patients were followed up 2 to 6 years later. All stomas are continent of faeces and flatus. Stoma stricture developed in 2 patients, and atresia in an-other 2 patients. Anus function were increased in 11 patients. Conclusions Antegrade continence ene-ma via appendicostomy in situ is a effective method to treat neurogenic faecal incontinence. It can devel-oped life quality of patients.     

CD4+T细胞因子在胆道闭锁患儿肝脏组织中的表达及其意义

目的 检测T淋巴细胞中的11种CD4+T细胞因子在胆道闭锁(biliary atresia,BA)患儿肝脏组织中的表达,以探讨其在胆道闭锁发病机制中的意义.方法 在病理的基础上,采用流式微球技术对29例BA及9例对照组患儿肝脏组织CD4+T细胞表达的11种细胞因子(IL-12p70、IFN-γ、IL-2、IL-10、IL-8、IL-6、IL-4、IL-5、IL-1β、TNF-α和TNF-β)同时进行定量检测,并对其代表因子IFN-γ进行免疫组化定位分析.结果 CD4+T细胞表达的11种细胞因子中,BA组患儿肝脏组织中IL-1β、IL-2、IL-6、IL-8、IFN-γ、TNF-α以及Th1细胞因子总量(IL-1β、IL-2、IL-8、IL-12p70、IFN-γ、TNF-α、TNF-β)与促炎因子总量(IL-1β、IL-2、IL-6、IL-8、IL-12p70、IFN-γ、TNF-α、TNF-β)分别为2920.69、1 106.01、152.22、12 614.22、834.18、161.29、19 504.55、19653.06,数值明显高于对照组的1 096.00、243.68、5.98、965.17、147.28、30.56、2 617.93、2 623.91,差异具有统计学意义(P＜0.05).结论 由CD4+Th1细胞及其细胞因子所介导的针对胆道上皮细胞的免疫炎症性疾病可能是造成胆道闭锁的主要原因之一.     

CD4+T细胞因子在胆道闭锁患儿肝脏组织中的表达及其意义

Objective To investigate the cytokines produced by CD4 + T cells in liver tissues of the patients with biliary atresia (BA). Methods The liver tissues of the 29 patients with BA were grounded and centrifuged. Then, the supernatants were collected. Nine patients not affected BA served as controls. The 11 cytokines produced by CD4 + T cells including IL- 12p70, IFN-γ, IL-2, IL- 10, IL-8,IL-6, IL-4, IL- 5, IL-1 β, TNF-α and TNF-β were detected using microsphere-based flow cytometry. Results Of the BA patients, the amount of IL-1β, IL-2, IL-6, IL-8, IFN-γ and TNF-α were 2 920. 69,1 106. 01,152. 22,12 614. 22,834. 18 and 161.29, respectively. The total amount of the Th1 cytokines including IL-1β, IL-2, IL-8, IL-12p70, IFN-γ, TNF-α and TNF-β was 19 504. The total amount of the proinflammatory cytokines including IL-1β, IL-2, IL-6, IL-8, IL-12p70, IFN-γ, TNFα and TNF-β was 19 653. 06. The amounts of these cytokines were significantly higher than those of the control group,which were 1 096.00,243.68,5.98,965.17,147. 28,30.56,2617.93, and 2 623.91, respectively. Conclusions The increased expressions of the cytokines expressed by the CD4 + Th1 cells may be one of the main causes of BA.     

小儿消化道化学性烧伤后瘢痕性幽门狭窄的外科治疗

目的探讨小儿消化道化学性烧伤后瘢痕性幽门狭窄的外科治疗效果。方法回顾性分析2008年4月至2012年10月间广州市妇女儿童医疗中心收治的11例化学性烧伤后瘢痕性幽门狭窄患儿的临床资料。所有患儿均经规范的内科治疗和介入下球囊扩张及放置支架无效后,予以幽门切除并胃十二指肠吻合术。记录术中及术后情况。并比较术前1d与术后3月时患儿血清白蛋白、血红蛋白和转铁蛋白等营养指标。结果11例患儿男10例,女1例,平均年龄4．5岁。病变早期累及食管和胃,4周后集中在幽门。表现为瘢痕性幽门狭窄和完全性幽门梗阻。11例患儿均成功施行幽门切除并胃十二指肠吻合术,手术时间（134±26）min,术中出血量（5±2）ml,术后住院时间（10±3）d;无一例手术并发症出现。术后随访3个月,11例患儿均能正常进食,身高、体质量和智力发育正常,血清白蛋白、血红蛋白和转铁蛋白较术前显著改善（均P〈0．05）。术后6个月消化道钡餐显示,胃十二指肠吻合口通畅,无狭窄、溃疡等病变。结论幽门切除并胃十二指肠吻合术是治疗小儿化学性烧伤后瘢痕性幽门狭窄的有效治疗手段,近期效果良好。     

经脐单孔腹腔镜辅助下Swenson-like巨结肠根治术38例

目的 探讨经脐单孔腹腔镜辅助下采用Swenson-like巨结肠根治术治疗儿童先天性巨结肠的安全性、可行性. 方法 回顾性分析广州市妇女儿童医疗中心胃肠外科2018年6月至2019年6月收治的38例先天性巨结肠患者临床资料,术式为单孔腹腔镜辅助下Swenson-like巨结肠根治术.男21例,女17例;平均手术年龄(7...     

男童腹股沟斜疝的解剖及临床特点

目的 了解腹股沟斜疝患儿腹股沟管解剖特征、发病特点及治疗方案的关系。方法 对本院2年收治的274例男童腹股沟斜56患儿进行腹股沟管长度的测量并对结果分析。结果 患儿身高与腹沟股管长度之间存在直线关系。发病晚者较发病早者嵌顿发病率明显升高，而腹股沟管长度较长，两组比较P均＜0．01。结论 腹股沟管发育较差的病例，术中应行腹股沟管加强。     

阑尾原位造口可控性顺行灌肠的临床评价

Objective To evaluate the clinical results of antegrade continence enema via appendi-costomy in situ to treat neurogenic faecal incontinence. Methods 13 patients with tethered cord syn-drome complaeated neurogenic faecal incontinence were performed appendicostomy in situ with intus-susception valve between June 1998 and December 1999 (male 9, female 4, age 6～13 years). After operation,enema were performed via stoma. Results All patients were followed up 2 to 6 years later. All stomas are continent of faeces and flatus. Stoma stricture developed in 2 patients, and atresia in an-other 2 patients. Anus function were increased in 11 patients. Conclusions Antegrade continence ene-ma via appendicostomy in situ is a effective method to treat neurogenic faecal incontinence. It can devel-oped life quality of patients.     

先天性巨结肠根治术后再次手术原因分析

目的 :探讨巨结肠根治术后再手术的原因和预防方法。方法 :对本院近 18年巨结肠根治术后再手术病例进行回顾分析。结果 :从 1984年～ 2 0 0 1年我院共行巨结肠根治术 889例 ,其中 5 8例 69次需根治术后再次手术 ,再手术率为 7 7%。再手术原因包括黏膜脱垂 ( 15例 )、粘连梗阻 ( 10例 )、便秘复发 ( 8例 )、瘢痕狭窄 ( 7例 )、大便失禁 ( 4例 )、夹层感染和肛瘘 ( 9例 )、小肠结肠炎 ( 2例 )、伤口裂开 ( 6例 )、吻合口漏 ( 4例 )、其他 ( 4例 )。结论 :随着围手术期处理水平的提高和新术式的运用 ,很多再手术的情况可避免     

腹腔镜下超声刀小儿先天性巨结肠根治术

目的介绍腹腔镜下超声刀小儿先天性巨结肠根治术的应用经验.方法先天性巨结肠患儿36例,手术年龄3月～9岁,体重4～26公斤.手术中建立人工CO2气腹,腹部置3～4个套管,腹腔镜直视下使用超声刀,分离病变的结肠及直肠至盆底.于肛门齿状线上1.5cm环形切开直肠粘膜并向近端游离,完整剥出粘膜长约6～8cm,切断直肠肌鞘,拖出已游离的结肠,切除病变肠管,结肠近端与直肠粘膜齿状线上切口吻合.结果平均手术时间172min,手术出血最多1例20ml,余均小于5ml,术后近期随访效果良好.结论腹腔镜巨结肠根治术手术打击少,术后恢复快,应用超声刀有助于手术的施行.本法对先天性巨结肠是安全有效的.