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971.
David I. Chu Jonathan M. Tan Peter Mattei Allan F. Simpao Andrew T. Costarino Aseem R. Shukla Joseph W. Rossano Gregory E. Tasian 《Journal of pediatric surgery》2018,53(10):1980-1988
Background
Children with congenital heart disease (CHD) often require noncardiac surgery. We compared outcomes following open and laparoscopic intraabdominal surgery among children with and without CHD.Methods
We performed a retrospective cohort study using the 2013–2015 National Surgical Quality Improvement Project-Pediatrics. We matched 45,012 children < 18 years old who underwent laparoscopic surgery to 45,012 children who underwent open surgery. We determined the associations between laparoscopic (versus open) surgery and 30-day mortality, in-hospital mortality, 30-day morbidity, and postoperative length-of-stay.Results
Among children with minor CHD, laparoscopic surgery was associated with lower 30-day mortality (Odds Ratio [OR] 0.34 [95% Confidence Interval 0.15–0.79]), inhospital mortality (OR 0.42 [0.22–0.81]) and 30-day morbidity (OR 0.61 [0.50–0.73]). As CHD severity increased, this benefit of laparoscopic surgery decreased for 30-day morbidity (ptrend = 0.01) and in-hospital mortality (ptrend = 0.05), but not for 30-day mortality (ptrend = 0.27). Length-of-stay was shorter for laparoscopic approaches for children at cost of higher readmissions. On subgroup analysis, laparoscopy was associated with lower odds of postoperative blood transfusion in all children.Conclusions
Intraabdominal laparoscopic surgery compared to open surgery is associated with decreased morbidity in patients with no CHD and lower morbidity and mortality in patients with minor CHD, but not in those with more severe CHD.Level-of-evidence
Level III: Treatment Study. 相似文献972.
Jigar N. Patel Amit Kumar Partap Singh Yadav Rajiv Chadha Vikram Datta Subhasis Roy Choudhury 《Journal of pediatric surgery》2018,53(8):1560-1565
Background/purpose
The anal position index (API) defines the normal anal position as the ratio of fourchette–anal distance to fourchette–coccyx distance for females and the scrotum–anal distance to scrotum‐coccyx distance for males. In this study, measurement of the API in newborns and infants with anorectal malformations (ARM), using the center of the midline anal dimple (AD) to represent the center of the proposed neoanus, was performed to assess whether or not the AD was located in a significantly abnormal position as correlated with the normal anal position.Methods
The cases comprised 65 consecutive newborn and infants with ARM, divided into 2 age-based groups (Group A: 1st day to 1 month; Group B: 1–12 months), without sacral or significant perineal abnormalities. Controls included an equal number of age and gender matched patients admitted for other conditions. The characteristics of the AD (‘well developed’ or ‘moderately developed’) as well as those of the midline perineal raphé in males and the perineal groove in females were also recorded.Results
Combining both age groups, the mean API ± SD was 0.41 ± 0.012 in male cases and 0.53 ± 0.07 in male controls (p value 0.003). The corresponding values for female cases and controls were 0.31 ± 0.09 and 0.36 ± 0.07 respectively (p = 0.040). In male newborns, the API in cases was significantly lower than the API in controls (p < 0.001). Combining both males and female newborns, the differences between the API in cases and controls was also statistically significant (p < 0.001). In older boys as well as in girls from both age groups, apart from cases of persistent cloaca, the API was lower in cases than in controls, especially in boys, although the difference was not statistically significant. On comparing the API in individual male ARM with that in male controls, cases of rectobulbar urethral fistula (RBUF) and rectovesical fistula had a statistically significant lower API (p < 0.001). In the 4 cases of persistent cloaca, the mean API (0.40 ± 0.1) was higher than the mean API in female controls and the AD was well developed with a well-delineated, narrow perineal groove. The majority (53/65; 81.53%) of patients had a ‘well developed’ AD. Twelve patients (18.47%) had a ‘moderately developed’ AD including 10 females and 2 males. There were 15 patients with a depressed AD (anal fossette); of these 12 (80%) were females. All boys had a well delineated perineal raphé in contrast to 10 girls (29.4% of total female ARM) who had a poorly delineated midline perineal groove.Conclusions
During definitive surgery for ARM, if the AD is taken as the site of the proposed neoanus, the neoanal position is likely to be anterior to the normal anal position in both males and females and especially so in males. Overall, girls with ARM appear to be more likely to have a relatively poorly developed and/ or depressed AD and a poorly delineated perineal groove.Type of study
Clinical Research.Level of evidence
Level III. 相似文献973.
974.
Heather R. Nolan Juan Gurria Jose L. Peiro Sammy Tabbah Ramiro Diaz-Primera William Polzin Mounira Habli Foong-Yen Lim 《Journal of pediatric surgery》2019,54(6):1153-1158
PurposeCongenital high airway obstruction syndrome (CHAOS) is a devastating fetal condition of complete airway discontinuity resulting in significant hydrops and extreme lung hyperplasia. It is universally fatal with survival reported only in the rare spontaneous fistulization or EXIT intervention (Ex Utero Intrapartum Treatment). Even in these cases, mortality remains high, and current investigations are targeting prenatal interventions. This report describes our experience with management and fetal interventions for CHAOS, including laser laryngotomy.MethodsWe retrospectively reviewed all patients diagnosed with CHAOS at a single academic institution between 2006 and 2017.ResultsFifteen patients were identified. Eight had obstruction at the trachea and seven at the larynx. In the laryngeal obstructions, three expired shortly after birth, and one survived after spontaneous fistulization and subsequent EXIT to tracheostomy. The remaining three underwent in-utero treatment with laser laryngotomy. One had preterm premature rupture of membranes (PPROM), delivered 3 days post-operatively, and died. Two underwent EXIT to tracheostomy with one surviving to discharge and is currently 2 years old.ConclusionOur study demonstrates the outcomes of a large series of patients diagnosed with CHAOS. While mortality remains high, options for fetal intervention are being explored to allow alterations in the prenatal natural history and improve postnatal outcomes.Type of StudyRetrospective Treatment Study.Level of EvidenceLevel IV. 相似文献
975.
Benlong Shi Qinghua Zhao Liang Xu Zhen Liu Xu Sun Zezhang Zhu Yong Qiu 《The spine journal》2018,18(11):2059-2064
Background Context
Several osteotomy techniques including pedicle subtraction osteotomy and vertebral column resection have been employed in the correction of congenital kyphosis (CK) and satisfying outcomes have been demonstrated. However, the Scoliosis Research Society (SRS)-Schwab Grade 4 osteotomy, defined as resection of posterior elements, partial vertebral body, and superior adjacent disc, is rarely reported in the treatment of CK.Purpose
The present study aimed to evaluate the efficiency and safety of SRS-Schwab Grade 4 osteotomy in patients with CK, and to propose its optimal indication.Study Design
This is a retrospective analysis of clinical and radiographic outcomes of patients with CK undergoing SRS-Schwab Grade 4 osteotomy.Patients Sample
Patients with thoracolumbar CK undergoing SRS-Schwab Grade 4 osteotomy from January 2010 to May 2015 followed up for at least 2 years were retrospectively reviewed.Outcome Measures
The thoracic kyphosis, lumbar lordosis, segmental kyphosis (SK), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt, and sacral slope were measured on lateral spinal x-rays. Patients were required to fulfill the SRS-22 questionnaire at preoperation and the last follow-up.Materials and Methods
The sagittal spinal-pelvic parameters were assessed at preoperation, postoperation, and last follow-up. The comparison between preoperation and postoperation was performed by paired samples t test.Results
A total of 38 patients with CK (17 male and 21 female) with an average age of 16.5±9.9 years were included. The mean operating time was 242.7±88.1 minutes and blood loss was 634.5±177.8?mL. The mean follow-up was 38.8±20.3 months. The SK was 49.5±11.7° at preoperation, 6.8±7.4° at postoperation (p<.001), and 8.0±8.1° at the last follow-up. No significant correction loss during follow-up was found in SK (p=.125). The SVA was improved from ?36.0±18.3?mm at preoperation to 3.7±17.8?mm at postoperation (p<.001), and the correction was well maintained during follow-up (p=.113). Compared with preoperation, the mean postoperative scores of each domains of SRS-22 questionnaire improved at different levels. Intraoperative complications included one case with incidental dural tear and another with transient root injury. Proximal junctional kyphosis occurred in three patients at 6 months after operation and remained stable during the follow-up. At the last follow-up, all patients were identified to have achieved solid bony fusion.Conclusions
The SRS-Schwab Grade 4 osteotomy, if selected appropriately, could provide satisfying correction of congenital kyphosis. The correction could be well maintained during the longitudinal follow-up. 相似文献976.
目的:评估分期手术治疗先天性脊柱侧凸合并脊髓纵裂和脊髓拴系患者的安全性与近期疗效。方法 :回顾性分析我院2009年1月~2014年1月收治的66例先天性脊柱侧凸合并脊髓纵裂和脊髓拴系患者的临床资料。其中男20例,女46例,年龄17.2±4.5岁(7~26岁)。5例患者术前存在下肢神经功能障碍。脊柱侧凸冠状位主弯Cobb角97.6°±23.5°(50°~165°),主弯位于颈胸段1例,胸段58例,胸腰段7例。23例同时存在矢状位后凸畸形,Cobb角89.5°±13.9°(47°~165°)。伴有Ⅰ型脊髓纵裂45例,Ⅱ型脊髓纵裂21例,均合并脊髓拴系。所有患者均行分期手术治疗:Ⅰ型脊髓纵裂组患者一期切除骨性分隔、松解脊髓拴系,Ⅱ型脊髓纵裂组患者一期松解脊髓拴系;一期术后3~4周,二期行侧凸矫形手术。结果:一期手术时间208.7±107.2min(60~505min),术中出血量297.1±192.6ml(20~2000ml);二期手术时间392.6±150.7min(196~600min),术中出血量2158.8±1158.4ml(450~6000ml)。术前存在下肢神经功能障碍的5例患者中,1例术后下肢肌力提高2级,感觉功能有所恢复;其余4例术后神经功能无明显变化。2例术前神经功能正常患者二期术中出现脊髓损伤(3.0%,2/66),其中1例术后双下肢肌力降为4级,感觉稍减退,术后1周感觉、运动功能完全恢复正常;另1例术后双下肢肌力降低至2级,双下肢及会阴部感觉减退,经脱水、激素冲击治疗及高压氧治疗,术后1个月双下肢肌力恢复至3级,术后2年随访时双下肢肌力恢复至4级,双下肢残留轻度麻木感,大小便功能正常。4例(6.1%,4/66)患者二期术后并发胸腔积液。均获得随访,随访时间12.4±3.5个月(6~24个月)。随访期间未发现椎弓根螺钉松动及断裂现象。脊柱侧凸矫形术后冠状位Cobb角为41.6°±17.8°(12°~107°),矫正率为(61.3±14.3)%;末次随访时冠状位Cobb角为43.7°±16.6°(15°~108°),丢失率为(1.9±1.1)%。术后矢状位后凸Cobb角为38.4°±11.0°(2°~78°),矫正率为(67.6±23.4)%,末次随访时矢状位Cobb角为39.7±11.2°(3°~87°),丢失率为(2.3±1.3)%。结论:分期手术治疗合并脊髓纵裂和脊髓拴系的先天性脊柱侧凸具有较高的手术安全性,并可获得较满意的矫形效果。 相似文献
977.
目的总结腔内治疗高流量先天性血管畸形的经验。方法 2009年7月~2013年7月,对高流量先天性血管畸形30例,采用经动脉无水酒精栓塞9例,经动脉乙烯-乙烯基醇共聚物(ethylene vinyl alcohol copolymer,Onyx)栓塞19例,经动脉弹簧圈栓塞2例。结果随访6~54个月,平均26.6月。治愈9例(30.0%),显效16例(53.3%),好转5例(16.7%)。20.0%(6/30)术中发生一过性病灶疼痛。结论腔内治疗是高流量先天性血管畸形的有效治疗方案。 相似文献
978.
目的:评估儿童下腰椎及腰骶段半椎体畸形冠状面平衡情况,分析不同外科矫形方式的选择和临床疗效。方法:回顾分析2005年1月~2013年12月我院收治的14例先天性脊柱侧凸患者,平均年龄7.8±3.3岁(3~10岁)。L4半椎体4例,L5半椎体7例,S1半椎体3例。根据术前冠状面平衡情况分为3组:A组冠状面平衡,C7铅垂线偏离骶骨正中平分线(CSVL)≤2cm;B组为C7铅垂线位于半椎体的对侧(偏离CSVL2cm);C组为C7铅垂线位于半椎体的同侧(偏离CSVL2cm)。所有患者均采用一期后路半椎体切除联合椎弓根螺钉内固定矫形植骨融合术式。矫形方式:A组中凸侧与凹侧撑开、压缩力均等;B组半椎体侧单纯压缩;C组增加L5/S1节段"反向"凸侧撑开、凹侧压缩的矫形操作。随访观察各组患者畸形矫正情况。结果:所有病例随访24~68个月,平均33±12个月。术前冠状面排列中平衡4例(29%),失平衡10例(71%)。术前冠状面Cobb角平均36.8°,末次随访时平均12.1°±8.0°(P=0.000),最终矫正率67.1%。术前的冠状面平衡为6~53mm,平均30.6±14.9mm,末次随访时冠状面平衡为0~44mm,平均10.7±10.9mm(P=0.001)。其中,A组患者4例,术前与术后均维持了冠状面平衡;B组患者6例,术后有1例患者冠状面仍然失平衡;C组患者4例,术后均恢复了冠状面平衡。结论:儿童下腰椎和腰骶段的半椎体畸形冠状面失平衡发生率较高,一期后路半椎体切除联合椎弓根内固定、结合不同冠状面排列情况采取恰当矫形方式,可能获得满意的冠状面平衡和临床疗效。 相似文献
979.
目的:评价经后路截骨内固定术治疗低龄(10岁以下)先天性脊柱后凸畸形的临床效果。方法:2009年10月~2013年5月采用经后路截骨椎弓根螺钉内固定治疗先天性脊柱后凸患者17例,男6例,女11例,手术时年龄64±21个月(37~109个月)。根据Winter分型:Ⅰ型8例,Ⅱ型4例,Ⅲ型5例。后凸顶椎均位于T10~L2之间。5例伴神经系统畸形。8例行后路椎体切除(PVCR),5例行经椎弓根截骨(PSO),4例行Ponte截骨,截骨后均采用后路自体骨或同种异体骨植骨椎弓根螺钉内固定。统计手术时间、术中出血量及手术并发症,观察矫形效果、内固定并发症、椎体融合情况等。结果:手术时间210±46min(130~300min),出血量650±330ml(200~1300ml);固定融合节段4.9±0.8个(4~6个)。随访34.7±10.4个月(24~51个月),矢状面节段性后凸Cobb角由术前61.5°±14.3°(42°~92°)矫正至术后20.7°±9.0(5°~42°),矫正率为(66.3±8.7)%,末次随访时为17.5°±9.5°(1°~36°),矫正率为(71.5±10.7)%,手术后Cobb角得到显著性改善(P0.01);矢状面平衡术前为-41.3±31.8mm,术后为-43.5±30.4mm,与术前比较无显著性变化(P0.05),末次随访时为-25.6±26.7mm,较术前明显改善(P0.05)。术后出现双下肢无力1例,排尿困难1例,术后2周恢复。术前腰背痛5例、排尿异常1例,术后6个月症状好转。1例患者术后7个月出现近端交界性后凸。随访期间未发现假关节及内固定相关并发症。结论:对低龄先天性脊柱后凸畸形患者早期行后路截骨、椎弓根螺钉内固定可显著改善后凸畸形,但术后不能立即达到脊柱矢状面平衡,而是在术后随生长发育逐渐恢复矢状面平衡。 相似文献
980.
目的 探讨射频消融术治疗舌部静脉畸形的效果.方法 回顾性分析2013年7月至2014年7月收治的30例舌部静脉畸形的病例资料,从单侧病变到弥漫性广泛病变,其中23例接受了射频消融术,选取直径为0.5 mm的工作尖端的射频消融电极针,功率调至25 W,将工作尖端刺入距病变最底部即最深处约1 mm处,通电行消融工作15 ～30 s,其后依次退出电极针1 mm,直至距病变表面1 mm处,分别行多点消融.结果 15例单侧病变一期手术彻底消融;8例双侧均受累及病例,一期行一侧病变射频消融术,术后3～6个月再行二期射频消融手术,其中5例彻底消融.23例术后随访3个月至1年半,手术消融20例,无复发,且舌两侧对称,无明显瘢痕,外观满意.另外3例仍有部分残余.结论 射频消融术弥补了传统手术的不足,治疗舌静脉畸形基本达到治愈,无明显并发症,且外观良好. 相似文献