Objective To investigate the safety and effectiveness of laparoscopic orchiopexy assisted by needle grasper hydrodissection for cryptorchidism.Methods From September 2020 to September 2022,21 children with cryptorchidism on 25 sides underwent laparoscopic orchiopexy assisted by needle grasper hydrodissection in our department.The water injection function of needle grasper was applied to inject normal saline into the retroperitoneal space to fully separate the retroperitoneum from the vas deferens and spermatic cord,establishing a liquid barrier to protect the vas deferens and spermatic cord.Then the retroperitoneum was bridge-likely cut off with the assistance of needle grasper.The vas deferens and spermatic cord were completely released in accordance with the principle of integrity and non-destructiveness,then the testes were successfully induced and fixed.Results During the operation,15 cases of inguinal cryptorchidism and 6 cases of intra-abdominal cryptorchidism were confirmed.There were 17 cases of unilateral cryptorchidism and 4 cases of bilateral cryptorchidism.All the 25 testes were successfully re-located into the dartos pouch of the scrotum under laparoscopic guidance.The operation time was 35-75 min(mean,45.1±14.3 min),and there were no surgical complications.During follow-ups for 12-24 months in 21 cases,the testicles were found located in the scrotum without retraction,atrophy,incision infection,incision hernia,or inguinal hernia.Conclusions Needle grasper hydrodissection assisted laparoscopic orchiopexy can effectively protect the vas deferens and spermatic cord.The operation is simple,safe,and effective.

Objective:To study the treatment efficacy and safety in using needle-grasper assisted single-port laparoscopic hepaticojejunostomy to treat choledochal cysts in children.Methods:The data of 41 patients with choledochal cysts treated at the Department of Pediatric Surgery, the First Affiliated Hospital of Xiamen University and the Second Hospital of Hebei Medical University from January 2018 to December 2021 were reviewed. There were 8 males and 33 females, aged (2.5±1.9) years. These patients were divided into the needle-grasper assisted single-port laparoscopic hepaticojejunostomy group (needle-grasper group, n=21) and the single-port laparoscopic hepaticojejunostomy group (control group, n=20). Operation time, intestinal function recovery time, gastric tube retention time, abdominal drain indwelling time, postoperative hospital stay, and perioperative complications were compared between the two groups. Results:All 21 children in the needle-grasper group underwent successful surgery without any need to convert to conventional laparoscopic or open surgery. The operation time (156.4±21.2) min was significantly shorter than the control group (218.3±28.6) min ( t=2.95, P=0.017). There were no significant differences in intestinal function recovery time, gastric tube retention time, abdominal drain indwelling time, postoperative hospital stay and perioperative complications between the two groups (all P>0.05). Parents were very satisfied with the cosmetic effect of the invisible scar after surgery. Conclusion:Needle-grasper assisted single-port laparoscopic hepaticojejunostomy was safe, reliable and the operation time was shorter than using a single-port to achieve minimally invasive and scarless surgery.

Objective:To mining differential expression genes (DEGs) and establish a regulatory network of dysregulated microRNAs (miRNAs) and messenger RNAs (mRNAs) in biliary atresia (BA) spectrum via bioinforma-tics analysis, and to explore the pathogenesis of BA.Methods:GSE46960 dataset was download from gene expression omnibus (GEO). DEGs between normal liver tissues and BA tissues were analyzed using the GEO2R analysis tool.The functional and pathway enrichment analyses of DEGs were performed utilizing the Database for Annotation, Visualization and Integrated Discovery (DAVID6.8). A protein-protein interaction (PPI) network was constructed using the PPI database (STRING11.0) and Cytoscape_v3.7.1 software, and thus key genes were analyzed.BA-related miRNAs were obtained using the human miRNA disease database (HMDD_V3.0) and target mRNAs were predicted by the miRNA target prediction database (miRDB). The intersection between the predicted target mRNAs and DEGs from the GSE46960 dataset was selected.The regulatory network of miRNA-mRNA was constructed using Cytoscape software.Results:A total of 565 DEGs, including 352 up-regulated ones and 213 down-regulated ones were identified.Among them, up-regulated DEGs were enriched in extracellular matrix(ECM)-receptor interaction, focal adhesion kinase (FAK), Amoebiasis, and the phosphoinositide 3 kinase/protein kinase B(PI3K/Akt) pathway.Down-regulated DEGs were enriched in metabolic signaling, biosynthesis of antibiotics and steroid biosynthesis pathway.From the PPI network, 10 key genes were screened out.A complex miRNA-mRNA regulatory network was constructed based on screened DEGs.Conclusions:Identified DEGs and miRNA-mRNA regulatory network constructed in this study may help clarify the molecular mechanisms of BA.This study provides a new direction to explore promising molecular targets for the diagnosis and treatment of BA.

Objective To explore the effect of single port laparoscopic traceless technology for child contralateral latent hernia.Methods Three hundred and twelve children cases of unilateral indirect inguinal hernia in Mianyang 404 Hospital from June 2013 to June 2016 were retrospectively analyzed.Among them,170 cases receivedsingle port laparoscopic traceless technology and 142 cases underwent common open surgery.The gender,age,recurrent rate,onset site of unilateral side,cases number of postoperative contralateral asynchrony hernia occurrence,cases number of contralateral vaginal process deformity found by laparoscopy and onset time of postoperative asynchrony hernia were compared between the two kinds of surgery.Results Among the 142 cases of common open surgery,male accounted for 97.8％ and female accounted for 2.2％,and the average age was (2.45±2.18) years old;the postoperative contralateral asynchrony hernia occurred in 5 cases (3.5％),in which 1 case (0.7％) was in the right side and 4 cases in the left side,the difference between them was statistically significant (x2 =5.30,P=0.01),the asynchrony hernia occurred in postoperative 8,14,18,20,24 months.Three cases (2.1 ％) had hernia relapse.The laparoscopic surgery had 170 cases,including 145 male cases (85.3％) and 25 female cases (14.7％),the average age was (2.44±2.15) years old.The intraoperation found 86 cases (50.6 ％) of latent hernia of contralateral vaginal process deformity,while the asynchrony inguinal indirect hernia was not found,1 case had the relapse in postoperative 18 months,the difference was statistically significant compared with the patients with open surgery (x2=10.12,P=0.01).Conclusion Single port laparoscopic surgery for treating child unilateral inguinal indirect hernia can accurately judge whether having contralateral latent hernia and simultaneously conducts the operation compared with the common open operation,its postoperative relapse rate and asynchrony hernia occurrence rate are significantly decreased.

Objective To compare the surgical and functional outcomes of single-site (transumbilical two-port) intracorporeal purse-suturing (IP) and single-port extracorporeal knotting (EK) for laparoscopic pediatric inguinal hernia (PIH) repair.Methods Between June 2008 and December 2014,358 PIH children underwent lapamscopic inguinal herniorrhaphy,including 126 treated by single-site intracorporeal purse string stitching using a needle-holder (IP group),and 232 by single-port extracorporeal knotting using an inner two-hook needle with preperitoneal hydrodissection (EK group).Results In all patients laparoscopic procedures were completed successfully without conversion.The operating time in IP group was significantly longer than that in EK group [unilateral:(20.4 ± 2.1) min vs.(9.4 ± 1.3) min,t=-5.23,P＜0.01;bilateral:(31.3 ±2.9) min vs.(15.2±1.7) min,t=-4.22,P＜0.01)].The hospital stay were similar between the two groups [(2.35 ±0.25) d vs.(2.38 ±0.18) d,t =-0.062,P ＞ 0.05].Five cases had intraoperative hematoma in the IP group while none in the EK group.One each suffered from recurrence in IP group and EK group.Three postoperative hydroceles were seen in IP group and one in EK group.Subcutaneous knot granulomas were seen in two in EK group.Conclusions Both IP and EK laparoscopic procedures are safe and feasible.With the assistance of preperitoneal hydrodissection technique,single-port laparoscopic EK herniorraphy is superior to single-site IP repair in easy performance and shorter operation time.

Objective:To evaluate the curative effect and safety of piperacillin/tazobactam in the treatment of children with con-genital gegacolon enteritis. Methods:122 cases of congenital intestinal enteritis were randomly divided into two groups. The 72 pa-tients in the treatment group were treated with piperacillin/tazobactam sodium, and the 50 patients in the control group were treated with cefoperazone/sulbactam. The course of treatment was 714 days. The differences in C-reactive proteins, bolld leukocytes count and neutrophilic granulocyte percentage before and after the treatment, and the average treatment time in both groups were compared, and the efficacy and bacterial clearance were evaluated. Results:Between the treatment group and the control group, the differences in C-reactive protein, blood leukocytes count and neutrophilic granulocyte precentage before and after the treatment had no statistical signifi-cance(P>0. 05). The effective rete of the treatment group was 86. 11%,and that of the control group was 88%(P>0. 05). The pos-itive detection rate of pathogenic bacteria was 75. 41%, in which Escherichia coli was the first pathogenic bacteria. The bacterial clear-ance in the treatment group was 85. 96%, which was higher than that (80%) in the control group(P>0. 05). Conclusion:The effi-cacy of piperacillin/tazobactam in the treatment of children with congenital megacolon enteritis is more obvious with promising safety.

Congenital diaphragmatic hernia(CDH) is characterized by a spectrum developmental defects in the diaphragm caused by embryogenesis disorders,and lead to incomplete fusion of elements which results in rise of the diaphragm.With the promotion of antenatal diagnosis,postoperation rehabilitation and neonatal intensive care unite,the mortality of CDH has been remarkably decreased.Nevertheless,the condition is uncommon enough that it has proven to be difficult to conduct prospective studies,leading to the lack of evidence of evidence-based medicine to explore the pathological mechanism and therapies.With the rise of endoscopic technique,the laparoscopy and thoracoscopy are also gradually carried out for the surgical management of CDH.Now,the minimally invasive surgery for CDH was reviewed.

Objective To explore the significance of the relative proteins in thrombin sensitive protein(TSP-1) and nuclear factor kappa B (NF-κB) signal pathways by detecting their expressions in different phases of hemangioma and the relations between them and microvessel density(MVD).Methods Forty cases with hemangioma were randomly selected and divided into proliferative group(n =21) and involutional group(n =19) according to Mulliken standard.The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK,NF-κBp65,p-IκBα,p-IKKβ,VEGF and CD34 in endothelial cells were detected by immunohistochemistry.The relevance between the proteins in TSP-1 and NF-κB signal pathways and MVD were compared and analyzed respectively.Results The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK in proliferative hemangioma were all lower than those in involutional hemangioma (F=32.582,47.575,11.645,18.824,13.140;P =0.000,0.000,0.002,0.000,0.001).Conversely,the expressions of NF-κBp65,p-IκBα,p-IKKβ,VEGF in proliferative hemangioma were higher than those in involutional hemangioma(F =7.807,6.323,5.988,4.216;P =0.009,0.018,0.021,0.049).Meanwhile,MVD were different between the two groups(F =7.256,P =0.012).The expressions of TSP-1,CD36,p59fyn and MVD showed a negative relationship(rs =-0.420,-0.519,-0.388;P =0.021,0.003,0.034).Conversely,the expressions of NF-κBp65,pvIκBα,VEGF and MVD showed a positive relationship(rs =0.666,0.611,0.515;P =0.000,0.000,0.004).The expression of TSP-1 and NF-κBp65 showed a negative relationship (rs =-0.413,P =0.023).Conclusions TSP-1 signal pathway and NF-κBp65 signal pathway may be interactive in evolution of infantile hemangioma,which has a potential role by effecting the progress of angiogenesis.

Objective To explore the significance of the relative proteins in thrombin sensitive protein(TSP-1) and nuclear factor kappa B (NF-κB) signal pathways by detecting their expressions in different phases of hemangioma and the relations between them and microvessel density(MVD).Methods Forty cases with hemangioma were randomly selected and divided into proliferative group(n =21) and involutional group(n =19) according to Mulliken standard.The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK,NF-κBp65,p-IκBα,p-IKKβ,VEGF and CD34 in endothelial cells were detected by immunohistochemistry.The relevance between the proteins in TSP-1 and NF-κB signal pathways and MVD were compared and analyzed respectively.Results The expressions of TSP-1,CD36,p59fyn,Caspase-3,p38MAPK in proliferative hemangioma were all lower than those in involutional hemangioma (F=32.582,47.575,11.645,18.824,13.140;P =0.000,0.000,0.002,0.000,0.001).Conversely,the expressions of NF-κBp65,p-IκBα,p-IKKβ,VEGF in proliferative hemangioma were higher than those in involutional hemangioma(F =7.807,6.323,5.988,4.216;P =0.009,0.018,0.021,0.049).Meanwhile,MVD were different between the two groups(F =7.256,P =0.012).The expressions of TSP-1,CD36,p59fyn and MVD showed a negative relationship(rs =-0.420,-0.519,-0.388;P =0.021,0.003,0.034).Conversely,the expressions of NF-κBp65,pvIκBα,VEGF and MVD showed a positive relationship(rs =0.666,0.611,0.515;P =0.000,0.000,0.004).The expression of TSP-1 and NF-κBp65 showed a negative relationship (rs =-0.413,P =0.023).Conclusions TSP-1 signal pathway and NF-κBp65 signal pathway may be interactive in evolution of infantile hemangioma,which has a potential role by effecting the progress of angiogenesis.

Biliary atresia is the most common obstructive cholangiopathy in infants.Its etiology and pathogenesis still remains unclear.Hypothetical mechanisms include genetic predisposition,viral infection,chronic inflammation or autoimmune-mediated bile duct injury,and congenital malformations of vessels or biliary tracts.The key pathogenesis is related to viral infection and immunoreaction.This review overviewed the research progress in the pathogenesis of biliary atresia in the past few years.