Objective:To investigate the clinical application of ultrasound-guided percutaneous catheter drainage in the management of pediatric pancreatitis, delineate the indications, and assess the efficacy and safety of the procedure.Methods:A retrospective case analysis.Eighteen patients who underwent ultrasound-guided percutaneous drainage at Children′s Hospital of Chongqing Medical University from September 2018 to January 2023 were conducted.The cohort comprised 10 males and 8 females aged 1 year 4 months to 15 years and 9 months.The causes of disease were traumatic pancreatitis (9 cases), acute pancreatitis (8 cases), and recurrent pancreatitis (1 case).The disease duration ranged from 1 day to 5 months.The indications for the procedure included acute peripancreatic fluid collection with infection and peritonitis, pancreatic pseudocyst, progressive increase of acute peripancreatic fluid collection, or compression symptoms.Patients′ clinical data, including drainage site, drainage condition, puncture technique, puncture success rate and puncture complications, were collected and analyzed.Results:Nineteen drainage procedures were all successfully performed on the 18 children, and no puncture injury, drainage tube obstruction, drainage tube infection, and other complications were observed.Postoperative drainage volume on the first day ranged from 100 mL to 1 010 mL.Postoperative catheterization time spanned from 6 to 93 days, with a median of 29 days.One patient experienced drainage tube displacement after surgery, and one patient progressed to chronic pancreatitis.The remaining patients achieved clinical cure and had their drainage tubes removed.No serious short-term or long-term complications were noted postoperatively.Conclusions:Ultrasound-guided percutaneous drainage emerges as an effective therapeutic approach for children with acute pancreatitis, offering advantages such as favorable efficacy, straightforward operation, high safety, and minimal trauma.

Median arcuate ligament compression syndrome (MALS) presents with atypical clinical manifestations. MALS is rarely reported in pediatric patients but is recognized as an independent risk factor for postoperative hepatic artery thrombosis in liver transplant recipients. We report a case of a pediatric liver transplant recipient with hepatolenticular degeneration, cirrhosis, and acute liver failure. Despite undergoing artificial liver support therapy, the patient showed no significant improvement in liver function and subsequently underwent liver transplantation. Intraoperatively, weak arterial pulsation and the absence of a pulsatile waveform in the hepatic artery anastomosis raised suspicion of MALS. The condition was successfully managed by releasing and transecting the median arcuate ligament, along with ligation of the splenic and left gastric arteries. To optimize transplantation outcomes, meticulous preoperative imaging assessment, particularly focusing on characteristic findings in CT angiography, is essential. Additionally, individualized surgical planning and intraoperative adjustments based on ultrasound monitoring and arterial pulsation assessments are critical for ensuring successful transplantation.

Objective:To investigate the clinical application of ultrasound-guided percutaneous catheter drainage in the management of pediatric pancreatitis, delineate the indications, and assess the efficacy and safety of the procedure.Methods:A retrospective case analysis.Eighteen patients who underwent ultrasound-guided percutaneous drainage at Children′s Hospital of Chongqing Medical University from September 2018 to January 2023 were conducted.The cohort comprised 10 males and 8 females aged 1 year 4 months to 15 years and 9 months.The causes of disease were traumatic pancreatitis (9 cases), acute pancreatitis (8 cases), and recurrent pancreatitis (1 case).The disease duration ranged from 1 day to 5 months.The indications for the procedure included acute peripancreatic fluid collection with infection and peritonitis, pancreatic pseudocyst, progressive increase of acute peripancreatic fluid collection, or compression symptoms.Patients′ clinical data, including drainage site, drainage condition, puncture technique, puncture success rate and puncture complications, were collected and analyzed.Results:Nineteen drainage procedures were all successfully performed on the 18 children, and no puncture injury, drainage tube obstruction, drainage tube infection, and other complications were observed.Postoperative drainage volume on the first day ranged from 100 mL to 1 010 mL.Postoperative catheterization time spanned from 6 to 93 days, with a median of 29 days.One patient experienced drainage tube displacement after surgery, and one patient progressed to chronic pancreatitis.The remaining patients achieved clinical cure and had their drainage tubes removed.No serious short-term or long-term complications were noted postoperatively.Conclusions:Ultrasound-guided percutaneous drainage emerges as an effective therapeutic approach for children with acute pancreatitis, offering advantages such as favorable efficacy, straightforward operation, high safety, and minimal trauma.

Median arcuate ligament compression syndrome (MALS) presents with atypical clinical manifestations. MALS is rarely reported in pediatric patients but is recognized as an independent risk factor for postoperative hepatic artery thrombosis in liver transplant recipients. We report a case of a pediatric liver transplant recipient with hepatolenticular degeneration, cirrhosis, and acute liver failure. Despite undergoing artificial liver support therapy, the patient showed no significant improvement in liver function and subsequently underwent liver transplantation. Intraoperatively, weak arterial pulsation and the absence of a pulsatile waveform in the hepatic artery anastomosis raised suspicion of MALS. The condition was successfully managed by releasing and transecting the median arcuate ligament, along with ligation of the splenic and left gastric arteries. To optimize transplantation outcomes, meticulous preoperative imaging assessment, particularly focusing on characteristic findings in CT angiography, is essential. Additionally, individualized surgical planning and intraoperative adjustments based on ultrasound monitoring and arterial pulsation assessments are critical for ensuring successful transplantation.

Objective To summarize the clinical characteristics,treatment regimen and clinical outcomes of infantile hepatic hemangioma(IHH)with high-output heart failure(HHF).Methods A retrospective analysis was conducted on 3 IHH infants with concomitant HHF admitted to the Children's Hospital of Chongqing Medical University during October 2020 and October 2023.The characteristics,treatment plans and efficacy were analyzed in the 3 cases.CNKI,WANFANG DATA,Chinese Medical Association Journal Full-text Database,and PubMed databases were retrieved to search domestic and foreign literature concerning the diseases,and the enrolled cases were analyzed and reviewed.Results Among the 3 infants,they were 1 male and 2 females,and aged 1 d,19 d and 80 d,respectively.The main clinical symptoms were dyspnea and respiratory distress.All 3 patients rapidly progressed to respiratory failure,pulmonary hypertension and heart failure after admission.Diffuse IHH was diagnosed in 2 cases and focal IHH in 1 case.One case of diffuse IHH underwent percutaneous hepatic artery embolization,and the cardiopulmonary function recovered on the day of surgery,and the ventilator was removed.In the other 2 cases,propranolol combined with steroid medication was used,and the estimated right ventricular systolic pressure and E wave to A wave mitral flow ratio(E/A)were the most sensitive indicators in echocardiographic monitoring.There were 24 cases included in literature review,with 4 cases of treatment failure and death,3 cases of remission,and 17 cases of complete recovery.Conclusion Propranolol combined with steroid medication and percutaneous hepatic artery embolization are effective in treating IHH complicated with HHF.Right ventricular systolic pressure and E/A during drug therapy might be early sensitive marker for the early evaluation of potential therapeutic effects of drugs.

Objective:To analyze the efficacy of percutaneous variceal embolization (PTVE) in children with portal hypertension at high risk of esophageal variceal bleeding.Methods:Clinical data of 14 children undergoing PTVE in Children's Hospital Affiliated to Chongqing Medical University from October 2018 to May 2023 were retrospectively analyzed, including 9 males and 5 females, with a median age of 1 years and 11 months, ranging from 7 months to 12 years and 10 months. The causes of portal hypertension were portal vein spongiosis in 5 cases, portal vein anastomotic stenosis after liver transplantation in 7 cases and decompensated cirrhosis in 2 cases. PTVE was performed in all patients. The surgical approach, intraoperative portal vein pressure, complications, prognosis, and gastrointestinal bleeding were analyzed.Results:The portal vein pressure was (21.3±4.1) mmHg (1 mmHg=0.133 kPa), ranging from 15.8 to 28.6 mmHg. PTVE was successfully completed in all cases, with 11 cases by hepatic approach and 3 cases by splenic approach. All patients were embolized without puncture bleeding. Among the 5 cases with portal vein spongiosis, Meso-Rex was performed in 4 cases from 1 to 27 months after PTVE, and liver transplantation was performed in 1 case 11 months after PTVE for there was no indication of Meso-Rex. Balloon dilatation was performed during embolization in 7 patients with portal vein anastomotic stenosis after liver transplantation. Two cases of decompensated cirrhosis underwent liver transplantation at 3 months and 7 months after embolization, respectively. All children were followed up for 5 to 60 months, and no death occurred, two cases had gastrointestinal bleeding.Conclusion:PTVE could be an effective minimally invasive treatment for children with portal hypertension at high risk of esophageal and gastric varices bleeding, and the incidence of posttreatment gastrointestinal bleeding rate is low.

Objective:To explore the effects of different graft to recipient body weight ratio (GRWR) on the efficacy of living donor liver transplantation (LDLT) in infants with biliary atresia (BA).Methods:Clinical data of 175 BA infants, including 98 males and 77 females, age at transplantation was 5.40 (4.77, 6.33) months, who underwent LDLT at the Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from May 2018 to December 2022 were retrospectively analyzed. They were divided into the routine GRWR group (2%≤GRWR≤ 4%, n=121) and high GRWR group (GRWR>4%, n=54). The preoperative general condition, intraoperative condition and postoperative recovery of children in the two groups were compared. Survival analysis was performed by using Kaplan-Meier method, and log-rank test was used to compare survival differences. Results:A total of 16 (9.14%, 16/175) children underwent unplanned surgery after LDLT. There were statistically significant differences in weight at LDLT and graft weight between children in the routine GRWR and high GRWR groups (both P<0.05). There were no statistically significant difference between the two groups in terms of operative time, intraoperative bleeding, and postoperative complication rates (all P>0.05). There were no hepatic artery thrombosis or stenosis occurred in the children of both groups after LDLT. The cumulative survival rates of the children in the routine GRWR group were 97.5% and 95.5% at 1 and 3 years after LDLT, respectively, and 96.3% and 94.2% at 1 and 3 years after LDLT in the high GRWR group, and the difference in cumulative survival rates between the two groups was not statistically significant ( P=0.692). Conclusion:The use of liver grafts with GRWR >4% is also safe and effective for LDLT in infants with BA, which supposes that may not be necessary to reduce the transplanted liver volume in children LDLT with high GRWR.

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.

Objective: To investigate the recovery of splenomegaly and hypersplenism after liver transplantation in children and explore the necessity of splenomegaly management before and during liver transplantation. Method: The data of 22 children who were underwent liver transplantation with preoperative splenomegaly and hypersplenism who were not treated with splenomegaly before and during operation and with no recurrence of portal hypertension during postoperative follow-up in Department of Hepatobiliary Surgery, Children’s Hospital of Chongqing Medical University from December 2008 to January 2019 were collected. There were 13 male patients and 9 female patients with a median age of 6.5 months. The changes of erythrocyte, platelet, white blood cell and spleen length and thickness were analyzed by paired t-test before and at the 1st, 3rd and 6th months after surgery. Correlation analysis was performed on the change of spleen long diameter and thickness product and blood cell recovery. Results: There were 21 cases of red blood cell decreased before surgery, with a mean value of(3.1±0.5)×10¹²/L, and(3.7±0.7)×10¹²/L, (4.6±0.6)×10¹²/L and (4.3±0.5)×10¹²/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the preoperative and postoperative groups were statistically significant (P<0.05). There were 7 cases of thrombocytopenia before operation, with an average of (70.0±17.0)×10⁹/L, and (191.0±129.0)×10⁹/L, (156.0±79.0)×10⁹/L and (167.0±63.0)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the first, third, and sixth months after surgery were significant compared with that before surgery (P<0.05). Leukocyte count decreased in 5 cases with an average value of (3.30±0.56)×10⁹/L before surgery, (7.5±4.4)×10⁹/L, (7.4±1.4)×10⁹/L, (5.1± 2.5)×10⁹/L at the 1st, 3rd and 6th months after operation, respectively. The differences between the two groups were significant (P<0.05). The average value of preoperative spleen length times thickness was (35.7±12.9) cm² and at the 1st, 3rd, 6th month after surgery it was (26.2±8.1)cm², (25.2±13.4)cm², (27.2±7.4)cm², respectively. The differences between the first, third months after surgery were significant compared with that before surgery (P<0.05). The white blood cell and platelet counts of children before and after surgery were correlated with spleen size negatively (correlation coefficients were -0.902, -0.933, respectively), and the differences were statistically significant (P<0.05). Conclusions In the early stage of liver transplantation, the size of spleen retracts to varying degrees, and hypersplenism can be alleviated continuously. Therefore, it is unnecessary to treat splenomegaly and hypersplenism before and during liver transplantation.

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.