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Objective To summarize the clinical efficacy of programmed management for H-type congenital tracheoesophageal fistula (H-TEF). Methods From March 2017 to March 2022, clinical data were retrospectively reviewed for 10 H-TEF children under programmed management.Six neonates developed recurrent cough after feeding and 4 infants had recurrent pneumonia.One case was associated with congenital heart disease and another had hemivertebra deformity of thoracic vertebra.After a definite diagnosis was confirmed by esophagography and/or fiberbronchoscope, gastric tube feeding was initiated.After inflammatory parameters normalized completely or partially and pneumonic change disappeared on chest film, a catheter was placed in fistula under a guidance of fiberbronchoscope.The position of fistula was confirmed by bedside radiography; H-TEF was repair through a cervical approach when fistula was located above T2 level and thoracoscopically below T2. Results Seven cases were confirmed by esophagography and 3 cases by fiberbronchoscope.Catheter was successfully deployed in fistula in all cases before surgery.Seven cases of fistula above T2 were repaired through a right cervical route and 3 cases of fistula below T2 underwent thoracoscopy.Feeding through a gastric tube resumed the next day and esophagography 1 week later.There was no leakage or recurrence during a follow-up period of (8-60) month.Three cases of hoarseness occurred after cervical surgery and recovered at (1-6) month.No dysphagia or recurrence was noted. Conclusion An integrated strategy for H-TEF yields satisfactory outcomes under programmed management. [ABSTRACT FROM AUTHOR]

Too many types of congenital esophageal atresia with a great diversity and variability bring dilemmas to clinical management. In clinical cases of first-stage end-to-end esophageal anastomosis, operative failure and error occur frequently due to inaccurate preoperative examinations and evaluations. Subsequent treatment becomes extremely difficult so that therapeutic efficacy is poor. Subsequent complications and sequelae adversely affect the quality of life. Based upon an etiological analysis of actual clinical cases, this review proposed practical and feasible clinical measures of avoid surgical failures and operative errors to improve the therapeutic outcomes of esophageal atresia. [ABSTRACT FROM AUTHOR]

Fetal structural defects are the leading cause of death and congenital disability in infants and toddlers children. With the deeper understanding of fetal structural defects and recent advances in various of prenatal diagnostics methods, some fetal structural defects may be diagnosed prenatallybefore birth. With the rapid development of "maternal-fetal medicine", some fetal structural defects are managed early through fetal surgery for achieving better infants' prognosis and quality- of- life. Currently, maternal-fetal medicine and fetal surgical intervention have remained in their infancy in mainland China. There are differences exist in the understanding, diagnosis and treatment of fetal structural defects. This review paper focuseds up the epidemiology of fetal structural defects, the development of maternal-fetal medicine, and fetal surgery to offer a references for clinical practices. [ABSTRACT FROM AUTHOR]

Objective To explore the causes and outcomes of delayed fracture union after elastic stable intramedullary nailing (ESIN) for pediatric long bone fractures of extremities to minimize the occurrence of this complication and provide clinical rationales for managing delayed fracture union. Methods From July 2015 to April 2020, clinical data were retrospectively reviewed for 233 children with long bone fractures of extremities after ESIN.Nine cases of delayed fracture union were found during follow-ups.Age, injury mechanism, fracture site, surgical approach, post-discharge management and subsequent rehabilitation were recorded.For various causes of delayed fracture union, the corresponding treatment was offered. Results Two cases of delayed fracture union of double fracture of radius and ulna healed after prolonged plaster fixation and immobilization.Two cases of delayed tibial fracture union received proper weight bearing under brace protection.One case of delayed fracture union of femoral fracture healed after external fixation of hip with heriform plaster and removal of elastic intramedullary nail.One case of delayed fracture union of tibia (n=1), humerus (n=1) and femur (n=1) healed after anti-infection and immobilization of affected limb.One case of delayed tibial union underwent autologous bone grafting and plaster fixation. Conclusion Treatments of delayed bone union vary for different and different types of fractures.In this cohort, strengthened fixation, greater stress stimulation at broken end, anti-infection, bone graft reconstruction and other means have been adopted for attaining bone union.Removing the influencing factors of delayed healing and re-stabilizing fracture end are vital for successful treatments. [ABSTRACT FROM AUTHOR]

Objective To summarize clinical experience of elongating esophageal segments through Bougienage stretching technique for pure esophageal atresia (EA) to achieve delayed primary anastomosis. Methods From January 2015 to December 2018, 32 children of pure EA underwent Bougienage stretching technique before esophageal anastomosis. Results All of them survived postoperatively.Initial assessment revealed a proximal-distal length of (5.5±1.5)cm.After elongating for (68.2±41.3) days, the length shortened to (-0.5±0.9)cm.Reconstruction was performed by thoracoscopy (n=27) and thoracotomy (n=5). The postoperative complications included anastomotic leakage (n=9), stenosis (n=30), hiatal hernia (n=9), malnutrition (n=8) and developmental delay (n=6). Conclusion Bougienage stretching technique for pure EA is feasible with satisfactory clinical outcomes with autogenous esophagus for primary anastomosis.It is ideal for restoring esophageal function and enhancing quality-of-life of EA children. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical efficacy and prognosis of neonatal primary anoplasty through a retrospective comparison of the results of defecation function and anorectal manometry after one-stage anoplasty. Methods From January 2006 to August 2019,a total of 132 children with intermediate anorectal malformation were recruited as study subjects. All of them underwent modified posterior sagittal anorectoplasty (mini-Peña).According to operative period, they were divided into two groups. Group 1 included 22 children diagnosed with intermediate anorectal malformation during neonatal period undergoing primary anoplasty. And group 2 had 110 children undergoing traditional staged anoplasty. Both groups were followed up for 15 years to evaluate long-term defecation functions and complications. During follow-ups, Rintala score was employed for evaluating postoperative defecation function and the grades were excellent, good, moderate and poor. All cases were examined by anorectal manometry, including anal resting pressure, anal length, internal sphincter resting pressure and length, external sphincter resting pressure and length and rectoanal inhibitory reflex (RAIR),etc. Results No significant inter-group differences in gender ratio or birth weight (P>0.05).Duration of postoperative hospital stay was longer in group 1 than that in group 2[(17.1±3.9) vs.(10.4±3.4) d, P<0.05].Hospital stay and operative duration were markedly shorter in group 1 than those in group 2[(19.6±5.5) vs.(37.5±10.7) days;(128.9±29.0) vs.(287.9±61.2) min, P<0.05].No significant inter-group difference existed in anal length or internal/external sphincter length(P>0.05).Anal resting pressure, internal sphincter resting pressure and external sphincter resting pressure of group 1 were higher than those in group 2[(53.8±15.5) vs.(36.7±10.4) mmHg;(53.5±15.1) vs.(34.6 ±8.7) mmHg;(45.7±16.9) vs.(33.9±11.8) mmHg, P<0.05].Extraction rate of rectal inhibitory reflex was significantly higher in group 1 than that in group 2 (66.7% vs.0%,P<0.05).No significant statistical difference existed in other anorectal pressures(P>0.05). Rintala score of two groups showed no obvious difference in rate of excellent/good(83.3% vs.88.0%,P>0.05).(83.3% vs.88.0%,P>0.05).No significant inter-group differences existed in the incidence of constipation, soiling or postoperative complications(25% vs.28.0%;16.7% vs.16.0%;33.3% vs.50.7%,P>0.05).Conclusion Neonates with intermediate anorectal malformations undergoing one-stage anoplasty can also have good postoperative stool control ability. Early one-stage anoplasty may avoid operative wound and closure of stoma. [ABSTRACT FROM AUTHOR]