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We describe the case of a 700-g neonate who presented with abdominal discolouration, distension, and rapid clinical deterioration.
At laparotomy, a perforation in the neck of the gallbladder was found, which was simply oversewn. Perforation of the gallbladder
should be considered in the differential diagnosis in such neonates. The surgical management should be direct repair, without
resorting to a cholecystectomy. 相似文献
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The impact of Down’s syndrome on the immediate and long-term outcomes of children with Hirschsprung’s disease 总被引:13,自引:0,他引:13
Hirschsprung’s disease (HD) in Down’s syndrome (DS) patients is stated to have a worse outcome than HD alone. In our study
we reviewed the immediate and long-term outcomes of these children and questioned whether DS should influence the operative
management. Data were collected on all children with HD (including total colonic aganglionosis), between January 1990 and
December 2000. They were divided into two groups based on the presence or absence of Trisomy 21 and compared retrospectively.
In this time period we treated 173 children with HD; 17 of these had DS. Both the groups were comparable in their mean gestational
age, birth weight and presentation except that the DS group had a significantly higher overall incidence of pre and/or postoperative
enterocolitis. A tota1 of 164 children underwent a Swenson pull-through and 9 had a Soave’s procedure. Follow-up ranged from
1 to 10 years. Continence assessed using the Wingspread scoring system in children over the age of 4 years showed no significant
difference. Although children with both HD and DS are predisposed to complications and required a more cautious management,
long-term outcome in terms of continence was not significantly worse than in HD alone. Thus the co-existence of DS should
not influence the decision to offer these children and their parents the choice of definitive repair. 相似文献
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Background
Traditionally, a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC). We compared the outcome of resection and anastomosis (RA) with stoma formation (RS).Methods
Sixty-eight neonates undergoing laparotomy for IIP (n = 20), NEC (n = 43), and indeterminate cause (n = 5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis- and stoma-related complications.Results
The median gestational age (GA) was 28.5 weeks and birth weight (BW) was 940 g. Thirty-seven neonates had RA (NEC 22, IIP 14, 1 unknown), 28 RS (NEC 21, IIP 6, 1 unknown), and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks (P = .008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g (P = .002). There was no statistically significant difference between the RA and RS groups for GA (P = .93), BW (P = .4), general complications (P = .96), anastomosis and stoma complications (P = .48), and deaths (P = .42).Conclusions
RA, rather than stoma, is an acceptable option in the surgical management of preterm neonates with IIP or NEC. 相似文献5.
Nick Lansdale Sobbia Gull-Zamir Emma Parkinson Javaid Sadiq Sean Marven 《Journal of pediatric surgery》2009,44(11):2126-2129
Purpose
Previous single-center studies have reported favorable outcomes when preformed silos (PFS) are used for the staged reduction of gastroschisis. The aim of this study was to assess the frequency and nature of complications associated with PFS in a large population and provide an insight into the practicalities of their routine use.Methods
A retrospective review was carried out of all cases of gastroschisis managed with PFS in 4 UK neonatal surgical units for a 6-year period.Results
One hundred fifty infants were included, and 139 (92.7%) silos were applied at cot side (no sedation, n = 93). Median silo size was 4 cm, and time of application was 2.5 hours. Enlarging the defect by incision of fascia was required in 17 (11%). Defect closure was performed at a median of 4 days (0-47) with 93 (62%) being at cot side. Methods of closure were adhesive strips/dressings (n = 94), sutures (n = 48), and patch (n = 8). Discoloration of the viscera occurred in 16 (11%), managed successfully by simple methods (change of PFS, aspirating the stomach, or incision of the defect fascia) (n = 8), conversion to operative silo (n = 3), and operative reduction (n = 1). Four required bowel resection. Other complications included missed atresia (n = 5; 3.3%) and nectrotizing enterocolitis (n = 11; 7%). There were 5 deaths in the series (3.3%).Conclusions
Staged reduction of gastroschisis with PFS is simple, convenient, and safe. The low rates of associated complications and mortality appear favorable when compared to infants managed with more traditional techniques. We recommend that PFS should be used for the routine management of gastroschisis. 相似文献
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