ObjectiveTo explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children. MethodThe data of children including preoperative, intraoperative, and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery, West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed. ResultsA total of 200 patients were collected in this study, 54 of whom were males and 146 were females. The male to female was 1∶2.70. The age was (46±33) months and the body weight was (15.77±7.10) kg. The main symptoms were abdominal pain (136 cases, 68.0%), jaundice (62 cases, 31.0%), abdominal distension (20 cases, 10.0%), and abdominal mass (23 cases, 11.5%). The diameter of cyst was (3.46±2.01) cm. There were 153 cases of type Ⅰa, 35 cases of type Ⅰc, 1 case of type Ⅱ, and 11 cases of type Ⅳ. The operation time was (179.9±10.3) min, the intraoperative fluid infusion was (397.4±26.4) mL, the intraoperative blood loss was (21.5±10.9) mL, the liquid intake time was (3.01±0.35) d, the solid intake time was (3.80±0.27) d, and the postoperative hospitalization time was (7.44±0.94) d. The intraoperative blood transfusion was performed in 4 cases (2.0%). There were 7 cases (3.5%) of postoperative complications, including 2 cases of biliary leakage, 2 cases of incomplete intestinal obstruction, and 1 case of anastomotic bleeding, which were improved by conservative treatment. Anastomotic stenosis occurred in 1 case, and the Roux-en-Y anastomosis was performed again. Biliary loop torsion obstruction occured in 1 case, which received reoperation restoring the biliary loop and closing the mesangial fissure. ConclusionsFrom the results of this study, Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children. It has the advantages of safe, beautiful incision, clear exposure, rapid recovery, and less complications.
ObjectiveTo investigate the effectiveness of soft tissue balance technique by flexor pollicis longus (FPL) tendon transfer for Wassel Ⅳ-D thumb duplication in children. Methods A clinical data of 14 children with Wassel Ⅳ-D thumb duplication met the selection criteria between January 2017 and January 2021 was retrospectively analyzed. There were 5 boys and 9 girls with an average age of 21.6 months (range, 18-35 months). Ten cases were left hand deformity and 4 cases were right hand deformity. During operation, the radial thumb was excised, and the FPL tendon of the radial thumb was used to reconstruct the soft tissue balance of the ulnar thumb. Postoperative evaluation included the range of motion (ROM) of passive flexion and extension of the interphalangeal joint (IP) and metacarpophalangeal joint (MCP), the alignments of the IP and MCP, the percentage of the width of the nail plate and the circumference of the thumb at the level of the IP to contralateral thumb. Results All operations were completed successfully, and all incisions healed by first intention. The children were followed up 12-36 months (mean, 21.7 months). At last follow-up, the ROM of passive flexion and the deviation of the IP, and the deviation of the MCP significantly improved when compared with those before operation (P<0.05); the ROM of passive extension of the IP and the ROM of passive flexion of the MCP did not significantly improve when compared with those before operation (P>0.05). The ROMs of passive extension of the MCP were 0° before and after operation. The width of the nail plate was 76.6%±4.1% of the unaffected side, and the circumference of the thumb at the level of the IP was 92.0%±9.1% of the unaffected side. ConclusionThe soft tissue balance technique by FPL tendon trasfer can effectively correct the alignment of the Wassel Ⅳ-D thumb duplication in children, and maintain the correction effect effectively, but further follow-up and comprehensive evaluation are needed to investigate the long-term effectiveness.
Children’s neurological diseases are complex. Common clinical diseases include autism spectrum disorder, cerebral palsy, attention deficit/hyperactivity disorder, etc. The rehabilitation methods in China mainly start with children’s language and cognition. Animal-assisted intervention is a kind of psychosocial intervention, including animal assisted therapy, animal assisted education or animal assisted activities under specific conditions. With its popularity in the world, this field is rapidly approaching a paradigm shift and can be used as a new supplementary and alternative treatment for children’s neurological diseases. By analyzing the literature on animal-assisted intervention and research on children’s neurological diseases, this paper summarizes the application methods and effects of various types of animals in clinical practice, aiming to provide new intervention methods with scientific theoretical basis for the rehabilitation of children with neurological diseases in China and promote the further development of rehabilitation in China.
ObjectiveTo investigate the effectiveness of internal and external lysis combined with Ilizarov external fixation technology for severe knee pathological flexion contracture deformity in children.MethodsA retrospective analysis was made on 12 children (12 knees) with severe knee pathological flexion contracture deformity who were treated with internal and external lysis and Ilizarov external fixation between August 2012 and January 2017. There were 9 boys and 3 girls with an age of 3-12 years (mean, 8.4 years). There were 8 cases of tuberculosis, 3 cases of haemophilia A, and 1 case of residual deformity after extensive hemangioma drug injection. The disease duration ranged from 5 months to 4 years, with an average of 20.3 months. The degree of knee contracture was (67.42±23.30)°, and the range of motion of knee was (38.33±14.98)°. The preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score was 78.42±15.57. The complication was observed after operation, and the degree of knee contracture, range of motion, and WOMAC score at 3 months and 1 year after operation were recorded and compared with those before operation.ResultsThe operations completed successfully in all children. All the 12 cases were followed up 9-24 months (mean, 14.5 months). All incisions healed by first intention after operation. The knee function of all children improved significantly and the weight-bearing walking function of the lower limbs restored. The degree of knee contracture, range of motion, and WOMAC score were significantly improved at 3 months and 1 year after operation (P<0.05), but there was no significant difference between 3 months and 1 year after operation (P>0.05).ConclusionFor severe knee pathological flexion contracture deformity in children, application of internal and external lysis combined with Ilizarov external fixation has advantages, such as small trauma, rapid recovery, and early postoperative knee function training, and good effectiveness.
Objective To explore the intervention effect of music therapy on children with autism spectrum disorder. Methods The China National Knowledge Infrastructure, Wanfang, Chongqing VIP, PubMed, Embase, Cochrane Library were searched by computer to comprehensively collect randomized controlled trials on the intervention effect of music therapy on children with autism spectrum disorder. The search period was from the establishment of the database to December 31, 2022. RevMan 5.4 software was used for meta-analysis. Results Finally, 20 articles were included, including 913 cases in the music therapy group and 811 cases in the control group, with a total sample size of 1724 cases. The meta-analysis results showed that the overall treatment effect [standardized mean difference (SMD)=?0.95, 95% confidence interval (CI) (?1.12, ?0.78)], the treatment effect of language [SMD=?0.71, 95%CI (?0.84, ?0.57)], behavior [SMD=?0.65, 95%CI (?0.78, ?0.52)], social interaction [SMD=?0.52, 95%CI (?0.63, ?0.40)], cognition [SMD=1.37, 95%CI (1.00, 1.74)] and sensory perception [SMD=?0.89, 95%CI (?1.03, ?0.74)] of the music therapy group were better than those of the control group (P<0.05). Conclusion The existing data show that music therapy applied to children with autism spectrum disorder can effectively improve their language, behavior, social interaction, cognition, and sensory perception, thereby having a positive impact on the overall treatment effect of children. However, due to the limitations of the number and quality of included studies, more high-quality studies are needed to verify.
Objective To analyze the case data of children with maxillofacial skin lacerations and provide a reference for the diagnosis and treatment of maxillofacial skin lacerations in children. Methods The medical records of children with maxillofacial skin lacerations who underwent emergency cosmetic suturing at the Lingang Branch of Yibin Second People’s Hospital between March 2023 and March 2024 were retrospectively collected. The clinical characteristics, diagnosis, treatment, and follow-up of the children were analyzed and summarized. Results A total of 210 children with maxillofacial skin lacerations were included, of which 142 were boys, accounting for 67.62%. The age of the children was most common at 3 years old, accounting for 18.57% (39 cases). A total of 5 children had two lacerations, 3 cases of which were in the same location and 2 cases were not in the same location. The most common site of skin laceration in children was the forehead, accounting for 46.23% (98 cases). The most common cause of maxillofacial skin lacerations was spontaneous falls, accounting for 51.43% (108 cases). The maxillofacial skin lacerations of the children were mainly minor injuries (168 cases, accounting for 80.00%). All children underwent modified vertical mattress suture, and the postoperative satisfaction of the children families was relatively high. Finally, 37 children were successfully followed up, and the follow-up results showed that the wound healing of the maxillofacial skin lacerations were good, the skin scars were not obvious, and the appearance of the skins were basically normal. Conclusion For children with maxillofacial skin lacerations, using the modified vertical mattress suture for emergency cosmetic suturing is beneficial for their injury recovery and facial aesthetics.
ObjectiveTo explore the feasibility and effectiveness of free transplantation of medial plantar Flow-through venous flap for primary repairing children’s finger wounds with digital artery defect.MethodsBetween July 2016 and October 2020, 9 children who suffered finger wounds with digital artery defect were primary repaired with free transplantation of medial plantar Flow-through venous flap. There were 6 boys and 3 girls, with an average age of 6.8 years (range, 4-13 years). The defects were caused by heavy weight puncture injury in 5 cases and strangulation injury in 4 cases. Among them, there were 3 cases of index finger wounds, 3 cases of middle finger wounds, 2 cases of ring finger wounds, and 1 case of little finger wounds. The wound area ranged from 1.8 cm×1.5 cm to 4.0 cm×2.5 cm. The time from injury to operation was 1.3-8.6 hours, with an average of 4.8 hours. The flap area ranged from 2.0 cm×1.6 cm to 4.2 cm×2.6 cm. After the flaps were inverted, the veins were used to bridge the finger arteries while repairing the wounds. The donor site of the foot was sutured directly in 4 cases, and repaired with full-thickness skin grafts in 5 cases.ResultsAll flaps survived, and hand wounds healed by first intention; 8 cases of foot donor site wounds healed by first intention, and 1 case had partial necrosis in the marginal area of the skin graft, which healed after dressing change. All 9 children were followed up 3-24 months, with an average of 9 months. The color and texture of the flap were similar to those of the surrounding normal skin, and the protective feeling was restored. The two-point discrimination of the flap was 7-10 mm, with an average of 8 mm. At last follow-up, according to the upper limb function evaluation standard of Hand Surgery Society of Chinese Medical Association, the finger function was excellent in 5 cases and good in 4 cases. There was no ulcer formation and scar hyperplasia in the foot donor site, which did not affect walking.ConclusionThe free transplantation of medial plantar Flow-through venous flap is an ideal repair method for repairing children’s finger wounds with digital artery defect. It has the advantages of simple flap extraction, thin flap, similar color and texture to the skin of the hand, and concealed donor site.
PURPOSE:To evaluate the B sean ultrasonic examination in diagnosis and prognosis of infectious endophthalmitis in children. METHODS:The hospital records of 44 children with infectious endophthalmitis were retrospectively analysed. The correlation between the initial B scan eehographic findings and the initial vision and the vision at discharge were analysed by t-test. RESULTS :The average visual, acuity was hand moving on admission,and 0.04 at discharge. Both the final vision and the initial vision were associated with the severity of vitreous opacity. The ultrasonic findings including retinal detachment and choroidal detachment were associated with poor vision outcomes. CONCLUSION :The ocular B scan ultrasonic examination was effective to predict the final vision in infectious endophthalmitis in children. （Chin J Ocul Fundus Dis,1997,13: 134-135）
Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.
ObjectiveTo evaluate the effect of rural alone-two-child policy (RAC policy) on zero population growth, high sex ratio at birth (SRB), and aging population in China. MethodsRural areas of cities which implement the RAC policy were included. Data from the fifth and the sixth population censes were used to analyze the variation of the total fertility rate (TFR), SRB, and the number of teenagers of every household (NTH) in context of different social and economic levels. ResultsThe implementation of RAC policy in rural areas with middle and upper social economic levels showed a long-term effect of increasing the TFR and decreasing the SRB. The implementation of rural girl policy mixed with RAC policy in areas with middle social economic level showed a long-term effect of decreasing the TFR and increasing the SRB; but the long-term effect in areas with low social economic level was uncertain. The NTHs were decreased in all included areas. According to the urban and rural birth preference, we made inferences that the implementation of alone-two-child policy in cities could result in the increase of TFR and the decrease of SRB. ConclusionThe long-term effect of RAC policy implemented in rural areas with middle social economic level could solve the problems of zero population growth and the high SRB, but the long-term effect of mixed policy implemented in rural areas with middle social economic level may aggravate the two problems above. The RAC policy cannot solve the aging population problem in rural area.