Objective:To evaluate the curative effects of early surgery for patients with severe acute pancreatitis (SAP).Methods:147 SAP patients were analyzed retrospectively.38 out of 147 patients with SAP presented single or multiple organ dysfuction (SAP-Ⅱ) in early stage of SAP.Among them 23 patients underwent early operation,and they were studied and compared with 15 patients treated non-surgically in early stage of SAP.Results:The mortality in the early operation group was 30.43%(7/23),compared with 66.67%(10/15) of those not receiving operation in early stage.Statistic analysis showed that there was significant difference between them.Conclusion:Early operation is necessary for some severe cases.In early stage of SAP surgery should be performed when patients present single or multiple organ dysfunction under routine conservative management in order to decrease the mortality of SAP.

ObjectiveTo study the main bacterial species,distribution and drug sensitivity of nosocomial bacterial infections after living donor liver transplantation (LDLT) in children.Methods The clinical data of the incidence,pathogen distribution and antibiotic-sensitivity of early postoperative bacterial infection occurring in 41 cases of LDLT were retrospectively analyzed.ResultsThe bacterial infections rate after LDLT was 80.5％,and 71.3％ of bacterial infections occurred in the first two weeks after LDLT. The most common sites of bacterial infection were lower respiratory tract,abdomen andbiliarytract, andPseudomonasAeruginosa, Staphylococcusepidermidis, and Escherichia coli were the most common bacterial pathogens. 101 microorganisms were found and gram-negative bacteria (73.3％) predominated over gram-positive bacteria (26.7％).The detectable rate of ESBLs in gram-negative bacteria was 81.1％.Moreover,the detectable rate of MRCNS in gram-positive bacteria was 59.3％,and 11.1％ of gram-positive bacteria were HLAR Enterococcus.Most gram-negative bacteria had high drug-resistance rate of β-lactam inhibitors and cephalosporins (more than 60％),but were sensitive to imipenem and meropenem (less than 10％). ESBLs and AmpC-lactam,mediated by Chromosomal and plasmid,could not damage the structure of imipenem and meropenem.Pseudomonas aeruginosa was highly resistant to imipenem,meropenem,and most antibiotics used for pediatrics. Coagulase-negative staphylococcus was sensitive to vancomycin,linezolid,quinupristin/dalfopristin.ConclusionThe bacterial infection rate was high after LDLT in children.Most of the pathogens were antibiotics multi-resistant.Effective prevention of infection,early diagnosis and appropriate use of antibiotics are the key to control the infection.

Objective To investigate the cause of jejunum perforation after infantile livingrelated liver transplantation (ILRLT) and summarize the experience of treatment. Methods The clinical data of 28 infants with biliary atresia who underwent ILRLT were analyzed and 4 of 28 infantile recipients (14. 3%) developed jejunum perforation after ILDLT. Results Four patients had 7 episodes of jejunum perforation after transplantation among 28 infantile recipients who underwent ILRLT because of biliary atresia. The median time between transplantation and perforation was 11 days.Perforation occurred at the point of silk in jejunum stoma (n = 3) and the Roux-en-Y limb (n = 1 ).None had a history of prior operation including Kasai in 4 patients. Clinical manifestation included fever, increased heart rate, abdominal distention, leukocytosis, and no free air on abdominal roentgenograrns. A simple repair was performed in three infants with silk: two developed recurrent perforation (67%) and underwent a re-exploration,and another had a third perforation and underwent a third repair because of re-perforation. Another child underwent a simple repair with prolene, and there was no recurrence. None died from the perforation in our study. Conclusion The occurrence and location of jejunum perforation after ILDLT suggests that the cause of the perforation is related to the jejunal anastomosis with silk, and the jejunum perforation may be avoided in the jejunal anastomosis with prolene. Early diagnosis and exploration may ensure better survival.

Objective To summarize the clinical experience of segmental living related liver transplantation for very small infant with biliary atresia. Methods The recipient was a 145-day-old male with congenital biliary atresia. The infant was 66 cm in height and weighed 3.08 kg. The donor was his 36-year-old mother. Her segment Ⅱ of the liver was excised and orthotopically transplanted into the infant's body as the graft. The portal vein of the graft was end-to-end anastomosed to the portal vein of the recipient, the hepatic artery of the graft was end-to-end anastomosed to the proper hepatic artery of the recipient with lateral superficial vein of left great saphenous vein from donor as a bridge, and the hepatic vein was end-to-end anastomosed to the hepatic vein of the recipient whose hepatic vein was conformed from right, middle and left hepatic vein. Biliary tract was reconstructed via Roux-en-Y operation. Results Segment Ⅱ (160 g) of liver from donor was resected, and there was no blood infusion. The donor retained her liver function within 5 days and was discharged on the eighth day. The operating time of graft implantation was 451 min. The blood loss was 250 ml. Non-liver stage was 71 min. The cold ischemic time was 132 min. Cyclosporine, mycophenolate mofetil (MMF) and prednisone were used for postoperative immunosuppression. The bilirubin level of the infant was decreased to the normal level one week after operation, and the liver function became normal in 9 days. Jejuno-leakage on the 7th day after the transplantation was recovered by mend and drainage and discharged on the 35th day. The donor and recipient were in satisfactory condition to present. Conclusion The segmental living related liver transplantation is advisable for very small infant with biliary atresia. Perfect operative technique and postoperative intensive care are the keys to ensure the success of the procedure.

Objective To study the clinical characteristics of immune tolerance after liver transplantation in children and to identify possible predictors.Methods The clinical data of 37 pediatric patients who underwent liver transplantation between April 2006 and April 2014 at the Children's Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into the no-drug (n =4),single-drug (n =16) and multi-drug (n =17) groups according to the status of their current immunosuppressant medications.The possible predictive factors were screened based on their clinical data,and statistical analysis was performed.Results The 37 liver transplantation recipients included 16 males (43.2％) and 21 females (56.8％).The factors that differed among the groups included age at transplantation and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) of the transplant recipients.Age,ALT level,and AST level of the transplant recipients were significantly different between the single-drug group and the multi-drug group (all P ＜ 0.05).However,only the ALT Ievel was significantly different (P ＜ 0.05) between the no-drug group and the multi-drug group.No significant differences were found in the various other factors between the no-drug and single-drug groups.Conclusion The age of the recipient at transplantation was a predictive factor affecting clinical immune tolerance in pediatric liver transplantation,while ALT and AST levels were potential predictors of postoperative immune tolerance.

Pediatric chronic pancreatitis (PCP) is one of the rare diseases in children.After the preferred expectant treatment,there are still many children who need surgery.The surgical procedures can be divided into 3 categories:drainage,resection or resection combined drainage.This paper mainly reviews the surgical pointer,surgical procedures and various surgical curative effect of PCP.

Objective To analyze the results of longitudinal pancreaticojejunostomy in treatment of paediatric chronic pancreatitis with dilated pancreatic ducts.Methods A retrospective study was carried out on 13 patients with paediatric chronic pancreatitis complicated with dilated pancreatic ducts treated with longitudinal pancreaticojejunostomy in Children's Hospital of Chongqing Medical University from December 2011 to January 2017.The perioperative morbidity and mortality rates,long-term treatment results and postoperative growth of these children were analyzed.Results The 13 patients all underwent successful surgery.In 11 patients,the serum and urine amylase levels returned to normal after 8 days of operation,and the abdominal pain disappeared completely.In 1 patient,the abdominal pain gradually disappeared in 1 year,and the serum and urine amylase levels gradually returned to normal.This patient gained weight well.In the remaining patient who had severe pancreatic atrophy,the patient took high-fat diets before and after surgery,and drank alcohol occasionally.The patient developed repeated attacks of abdominal pain with occasional increase in serum and urine amylase levels and had poor weight gain.There were no complications such as postoperative bleeding,pancreatic leakage and intestinal obstruction in this study.The body weight and growth rates of the whole group of patients before and 1 year after surgery were different.Conclusion Longitudinal pancreaticojejunostomy for paediatric chronic pancreatitis complicated with dilated pancreatic ducts was safe and effective in alleviating symptoms,improving quality of life,and resulted in normal growth of these children.

Objective:To study the strategies in the diagnosis and treatment of pancreatic tumors in children.Methods:The clinical data of 18 children with pancreatic tumor managed at the Children's Hospital Affiliated to Chongqing Medical University from March 2015 to September 2020 were retrospectively studied. There were 8 males and 10 females, age ranged from 3 months to 14 years and 11 months, with a median age of 8 years and 2 months. Clinical data including age, gender, pathological data, surgical methods, chemotherapy, tumor location and treatment outcomes were collected. Follow-up was conducted by outpatient visits and by telephone.Results:Abdominal ultrasound, enhanced CT and/or MRI examinations were performed on all these patients, with findings of either a cystic or solid lesion of pancreas. All patients were treated by laparotomy under endotracheal intubation and general anesthesia. The operations were all completed successfully. Among the 18 patients, there were 11 patients with solid pseudopapillary tumors and 7 patients with pancreatoblastoma (PBL). The tumors were located in the head of the pancreas in 13 patients (including 3 patients who underwent pancreaticoduodenectomy, 1 patient who underwent resection of the head of the pancreas with preservation of the duodenum, and 9 patients who underwent resection of the tumors). The tumors were located in the body and tail of the pancrease in 5 patients (including 3 patients who underwent resection of the body and tail of the pancreas with preservation of spleen, and 2 patients who underwent resection of tumors). Because of huge tumors, 1 patient had bilateral lung, left supraclavicular fossa lymph node and retroperitoneal lymph node metastasis, 3 patients were confirmed to have PBL by biopsy, and these tumors were resected completely after neoadjuvant chemotherapy. Postoperative pathology showed that all the 3 patients had PBL and were given systematic chemotherapy. Postoperative pancreatic fistula occurred in 1 patient and chylous fistula in another patient, both were discharged home successfully after conservative treatments. All patients were followed-up for 2-7 years, and all children were tumor-free.Conclusion:It is not difficult to diagnose pediatric pancreatic tumors by ultrasound, CT and MRI before operation, and postoperative pathology was needed to confirm the diagnosis. Function-preserving surgical resection was the treatment of choice for pancreatic tumors in children.