Splenic cyst is clinically rare.It can be classified as either true or false.Ultrasound,CT and MRI scan are helpful in diagnosing splenic cyst.Indication for a treatment depends mainly on clinical symptoms and diameter of the cyst.Now,there is a more conservative attitude on splenic surgery and the patient should be offered laparoscopic approach.Both nonoperatively treated patients and surgically treated patients should be given ultrasound examination regularly,in order to check the cyst size and exclude reappearance.

Objective To retrospectively analyze the therapeutic effect of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to cavernous transformation of portal vein (CTPV).Methods Retrospectively analyzed 30 cases of children with CTPV admitted by Beijing Children's Hospital in General Surgery Department from Jan.2005 to Dec.2012,and evaluated the clinical efficacy of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to CTPV.Results All of 30 cases admitted operation without serious complication.All children admitted follow-up from 6 to 60 months.Seven cases of 22 patients with gastrointestinal bleeding relapsed bleeding post operation and were cured by conservative treatment.Four cases of 7 relapsing bleeding children had NSAID.All cases of 8 children with simple hypersplenism suggested normal results of blood routine post operation,2 children occurred bloody stools who were cured by conservative treatment.None of patients had serious infection correlating with splenectomy.The size of spleen of patients with gastrointestinal bleeding is larger than patients with simple hypersplenism.Conclusions (1) Ligaturing pericardial blood vessel combined splenectomy is a good choice for children with gastrointestinal bleeding and hypersplenism secondary to CTPV.(2) NSAID may increase the recurrence rate of gastrointestinal bleeding post operation.(3) There may be a negative correlation between the size of spleen and the risk of gastrointestinal bleeding for children with CTPV.

Purpose To study the radioactive purity and activity of 131I labeled human single chain variable fragments antibodies (scFv) against anaplastic thyroid carcinoma (ATC),and to explore its distribution and radioimmunoimaging characteristics in tumor bearing nude mice model in vivo so as to provide a new method for anaplastic thyroid carcinoma diagnosis and treatment.Materials and Methods The nude mice model bearing human anaplastic thyroid carcinoma was constructed.The chloramine T method was used to label scFv with 131I and the Sephadex G25M was used for purification of labeled scFv.Labeling rate was determined by trichloroacetic acid method;radiochemical purity,room temperature stability and serum stability were examined using paper chromatography.131I-scFv was injected via tail vein in mice,and the distribution of 131I-scFv in body tissues and organs was analyzed at 12,24,48,72 h after injection.Static SPECT imaging was performed at 12,24,48,72 h after injection to observe the intratumoral accumulation of radioactivity.The SPECT/CT image fusion was performed when the tumor tissues were clearly visible.Results 131I-scFv was purified,and the labeling rate was 91.64％;the radiochemical purity was (93.3 ±0.3)％.The radiochemical purity of 131l-scFv placed at room temperature and the serum for 1,6,12,24 h were all ＞90％.The radioactive distribution of 131I-scFv in tumor,liver,kidney,intestine and blood was high.SPECT imaging showed 131I-scFv was selectively concentrated in tumor tissue;the target/non-target ratio was the highest at 48 h,and the imaging was most satisfactory.Conclusion 131I-scFv can be successfully prepared.SPECT imaging of 131I-scFv in nude mice model is satisfactory,which lays the foundation for further research in ATC diagnosis and treatment.

Objective To evaluate the prognostic value of 18F-FDG PET/CT-based metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in stage Ⅱ-Ⅲ non-small cell lung cancer (NSCLC).Methods All of 47 patients with pathological stage on Ⅱ or Ⅲ NSCLC who underwent PET/CT before treatment were retrospectively reviewed.Kaplan-Meier method,Log-rank test and COX proportional hazard model were used to analyze the relationship between metabolic parameters and overall survival (OS),progression free survival (PFS).MTV were measured using a cutoff of 40％ maximum standard uptake value (SUVmax).Results The median OS and PFS was 28.93 and 17.37 months,and the 1-,2 and 3-year overall survival rate was 80.85％ (38/47),59.57％ (28/47),38.30％ (18/47),respectively.Univariate analysis suggested that SUV MTV and TLG had significant differences on OS and PFS (all P＜0.05).On multivariate analysis,TLG was a risk factor for PFS (HR=5.591,P＜0.001),and MTV was a risk factor for OS (HR=4.369,P＜0.001).MTV was correlated with TNM-staging (r=0.449,P =0.012).Conclusion In patients with stage Ⅱ or Ⅲ NSCLC,MTV is a independent significant prognostic factor for OS,and TLG is able to predict the progression.

Biliary atresia(BA) is a progressive inflammatory disease which is characterized by inflammation,fibrosis and obliteration of the extrahepatic biliary duct.It is unique and special for neonates.The morphological research of liver and biliary tract has been the hot point for its critical role in overcoming BA.In this review,some meaningful morphological studies as well as clinical progress were summarized for rediscovering BA.

Objective To compare the relative dose of small fields measured by clinically common detectors and those obtained from Monte Carlo simulation in order to obtain the accurate measurement method, and to modify the inappropriate detectors.Methods The percentage depth-dose distribution curve and profile (flatness and symmetry) curves were collected at 2 cm×2 cm, 3 cm×3 cm, and 4 cm×4 cm under 6-MV X-ray of Trilogy linear accelerator by CC13, PFD, SFD, and blue phantom.The results were compared with the stimulation results from Monte Carlo method (the current gold standard).The correction factors for the detectors with large error were calculated to provide reference data for clinical practice.Results The results measured by SFD detector were most close to the results from Monte Carlo simulation.The measurement errors of CC13 and PFD detectors were large.The correction factor in the penumbra for CC13 and PFD detector was 0.664-1.499.Conclusions SFD detector is better than CC13 and PFD detector in the measurement of small fields, but CC13 and PFD detector can provide reference data for clinical practice after the corresponding correction.

OBJECTIVETo summarize the reason and treatment of redo surgery in Hirschsprung disease for postoperative distension and constipation.

METHODSFrom January to December 2014, 35 patients with constipation and distention after pull-through done elsewhere were referred to our institution. The reasons procedures and outcomes of redo surgery were a retrospectively analyzed.

RESULTSThe indication of reoperation in 21 cases was pathological problems, including residual aganglionosis, retained transition zone bowel, and in 13 cases was anatomical problems, including retained dilated segment, obstructive Soave cuff. One case had both pathological and anatomical problems. Among them, 5 cases belonged to total colonic aganglionosis. All the cases received conservative treatment for about 6 months before reoperation. Five cases had enterostomy before redo pull through surgery. Thirty cases underwent Soave surgery with or without laparoscopy or laparotomy. Twenty-six cases underwent transabdominal Soave surgery, 3 cases transanal Soave surgery, 1 case transanal Soave surgery with laparoscopy. Other surgery included Ikeda surgery, excision of diaphragm or scar, and anoplasty. Postoperative complications were found in 3 patients. One had rectovesical fistula and was cured after operation. Two cases had anastomotic leakage and then underwent diverting ileostomy. Thirty-three cases had a mean follow-up of 59 months. During the follow-up, 32 cases had no distension and constipation. Two cases presented occasional dirty pants, 2 cases frequent soiling, 1 case daily soiling.

CONCLUSIONSReasons of distension and constipation in Hirschsprung's disease after surgery are pathological and anatomical problems. Operation procedure is chosen based on reasons. Transabdominal Soave surgery is safe and effective.

Anastomotic Leak ; Cicatrix ; Constipation ; Digestive System Surgical Procedures ; Hirschsprung Disease ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Postoperative Complications ; Postoperative Period ; Reoperation ; Retrospective Studies

Objective To summarize our therapeutic experiences on patients with pediatric spontaneous biliary duct perforation.Methods We retrospectively analyzed the clinical data of patients diagnosed as spontaneous biliary duct perforation who were admitted into the Department of Pediatric General Surgery,the Beijing Children Hospital from January 2008 to December 2014,and summarized the therapeutic experiences.Results There were 7 boys and 18 girls,with a average age of 2.4 years (range 11 months to 10 years).Twenty-one patients (84.0％) were diagnosed by ultrasonography.Two patients were treated with conservative therapy and were discharged home.The remaining 23 patients were treated with emergent surgery.Of these patients,9 were treated with cholecystostomy and abdominal drainage (the cholecystostomy group),and the remaining 14 were treated with choledochal drainage and abdominal drainage (the choledochal drainage group).The mean hospitalization stay for the cholecystostomy group was 25.2 days,and 3 patients developed comphcations (33.3％).The mean hospitalization stay for thecholedochal drainage group was 16.1 day,and 2 patients developed complications (14.2％).Twenty-four patients were diagnosed to suffer from congenital choledochal cysts or pancreaticobiliary maljunction by imaging studies during or after surgery.Elective choledochal cystectomy with hepaticojejunostomy were performed on 23 stable patients who developed no severe complications.Conclusions Pediatric spontaneous bile duct perforation is closely related with congenital choledochal cysts,and the pathological basis in diagnosis is pancreaticobiliary maljunction.Bile duct elastic fiber hypogenesis and specific blood supply are important to the onset of perforation.Abdominal ultrasonography plays an important role in the diagnosis.Patients with peritoneal irritation and non-localized perforation should be operated in time,and choledochal drainage with abdominal drainage is a good treatment choice.All patients diagnosed as congenital choledochal cysts or pancreaticobiliary maljunction should undergo elective choledochal cystectomy with hepaticojejunostomy.

The anatomical abnormalities associated with pancreatitis mainly include pancreas anomalies, pancreaticobiliary maljunction and intestinal duplication.Pancreas anomalies are the most common congenital abnormalities in the triggers of pancreatitis, including pancreas divisum, annular pancreas and heterotopic pancreas prevail.In all these anomalies, the mechanism of pancreatitis is likely due to outlet obstruction.Awareness of these anomalies is necessary to arrange the proper strategy for the treatment of patients with pancreatitis.

Objective:To analyze the causes of unplanned reoperation in pediatric patients after elective digestive tract surgery and the prognosis.Methods:Medical records were reviewed from pediatric patients undergoing unplanned reoperation after elective digestive tract surgery at our department from Jan 2012 to Dec 2019. Primary diagnoses, procedures and levels of index surgeries, causes and procedures of unplanned reoperations, and patients' prognosis were analyzed.Results:There were 39 cases, and the primary diagnoses included biliary disease, anal and colorectal disease, and intestinal disease. There were 4 (10%) cases of level Ⅱ surgeries,and 35 (90%) cases of level Ⅲ&Ⅳ surgeries. The index surgical procedures included 19 (49%) biliary-intestinal procedures, 11 (28%) simple intestinal procedures, and 9 (23%) anal and colorectal procedures. The direct causes of unplanned reoperation included 10 (26%) anastomotic leakages, 8 (20%) adhesive intestinal obstructions, 5 (13%) postoperative intussusceptions, 5 (13%) incisional complications (infection, dehiscence and incisional hernia), 3 (8%) postoperative hemorrhages and 8 (20%) miscellaneous (iatrogenic injury and surgical misjudgment). Patients' prognosis included 24 (62%) full recoveries, 9 (23%) further operations, and 5 (13%) deaths, and 1 (3%) short bowel syndrome.Conclusions:Most pediatric unplanned reoperations after elective digestive tract surgery occur in complex surgical procedures. The most common causes of unplanned reoperation are anastomotic leakage, adhesive intestinal obstruction. Unplanned reoperations are often prone to adverse effects on prognosis.