According to the reality of outpatient clinic service,expanding the service items,laying off solid foundation,making the working procedures more concrete in details and establishing suitable polices,the professionalization of specialists and special diseases in outpatient clinic of multiple branches hospital,even resources of outpatient clinic of multiple branches hospital,diversified service pattern of outpatient clinic,refined outpatient clinic service procedure,informationization of treatment procedure of outpatient service,and different requirements of people of different levels are realized.

Objective:To investigate the curative effect and safety of Stoppa approach combined with iliac fossa approach in the treatment of the patients with coxafossa anterior column or coxafossa dual column bone fracture, and to provide a scientific evidence for its application in the treatment of the patients with coxafossa anterior column or coxafossa dual column bone fracture.Methods:Sixty-three patients with coxafossa anterior column or coxafossa dual column bone fracture were selected;among them 32 cases were treated with stoppa approach combined iliac fossa approach(Stoppa group),and 31 patients were treated with ilioinguinal approach(control group).The intraoperative blood loss volume,the operaton time,the reset quality of fracture and hip joint function after operation of the patients in two groups were evaluated.Results:The intraoperative blood loss volume of the patients in Stoppa group was lower than that in control group, and the difference was statistically significant (P<0.05).The operation time of the patients in Stoppa group was shorter than that in control group, and the difference was statistically significant (P<0.05).The reset quality of fracture of the patients in stoppa group was higher than that in control group, and the difference was statistically significant (P<0.05).The hip joint function of the patients in Stoppa group was higher than that in control group, and the difference was statistically significant (P<0.05).Conclusion:Stoppa approach combined with iliac fossa approach is an effective method in the treatment of the patients with coxafossa anterior column or coxafossa dual column bone fracture with sufficient exposure and tiny tissue damage.Stoppa approach combined with iliac fossa approach in the treatment of the patients with coxafossa anterior column or coxafossa dual column bone fracture has the advantages of shorter operative time,less blood loss, higher rate of anatomic reduction,and good joint function.

Objective:To explore the possibility of laparoscopic simple oblique duodenoduodenostomy in the management of congenital duodenal obstruction in neonates.Methods:The clinical data of neonates with congenital duodenal obstruction undergoing laparoscopic simple oblique duodenoduodenostomy at Huaian Women and Children′s Hospital from February 2015 to February 2018 were retrospectively reviewed.By a lower-pressure pneumoperitoneum of 5-8mmHg and a suspending suture for right liver elevator, the procedure was performed using 4 ports: a transumbilical 5-mm port for the camera and another three 3-mm ports for instruments.After kocherizing of the proximal and distant part of the duodenum, the lower duodenum was incised longitudinally 0.5-1cm distal to the blocked end, the upper duodenum incision was placed 0.5cm away from the blocked end extended downward obliquely.The duodenoduodenostomy was performed as a " simple" " oblique" anastomosis with 5-0 PDS suture.Results:Fifteen patients were identified with a median age at operation of 2 days.Of all the cases, 4 cases were duodenal atresia (type Ⅲ), 11 cases were annular pancreas, and 7 cases of them were annular pancreas complicated with congenital intestinal malrotation.All cases were treated with laparoscopic simple oblique duodenoduodenostomy.Ladd procedure was accomplished in 7 cases with congenital intestinal malrotation in the meantime.The average operative time was (115.0±25.5) min (70-145 min). Feedings were started on postoperative 4-10d (mean 6.0d), without abdominal distention and vomit, all patients were discharged in good health with a median postoperative hospital stay of 7-14d(mean 10.6d). There was no mortality rate, no conversion to laparotomy, and no intraopertive complications in the group.The cases were followed-up for 2-36 months (mean 15.6 months), and all cases were doing well.Conclusion:Laparoscopic simple oblique duodenoduodenostomy is safe and efficacious in neonatal period, and can be a viable option in the treatment of neonates with congenital duodenal obstruction.

Objective To explore the clinical value of portal exposure in laparoscopic treatment of children with type Ⅲ biliary atresia (BA).Methods From June 2013 to October 2017,30 infants with type Ⅲ BA who treated with laparoscopic portoenterostomy in Huai'an Women and Children's Hospital were selected.A percutaneous suture was used to snare the round ligament and retract the liver,other percutaneous stay sutures were then introduced and fundus and neck of gallbladder were sutured to elevate the liver to expose the portal hepatis.The fibro cord and hepatic vessels were mobilized,and then two rubber bands were put around the left and right portal veins and hepatic arteries.The portal hepatis was exposed by laterally stretching the two elastic rubber bands.The fibro cord was removed and then laparoscopic portoenterostomy was accomplished.In 20 cases,the liver was enlarged,part of hepatic lobus quadratus was removed laparoscopiclly for exposure of the portal hepatis.Results There were 30 cases in this group,2 cases were converted to open surgery by a micro transverse incision.There was no surgical death.Time of laparoscopic procedure varied from 210 to 280 min.All cases survived the surgery without any intraoperative complications.Blood loss during operation was minimal,without necessity for blood transfusion.One case died of respiratory failure one week after surgery.Two cases were lost follow-up.Twenty-five cases were followed up for 3～51 months(mean 22.4 months).Three cases died because of repeated cholangitis and liver failure at 10,16,35 months postoperatively.Nineteen patients' total bilirubin had dropped to normal,three others' bilirubin levels dropped significantly after surgery.Conclusion The technique of laparoscopic hepatic porta exposure can help to complete hepatic portoenterostomy successfully,reduce the conversion rate of laparoscopic surgery,and improve the surgical effect.