Objective:To discuss the clinical efficacy of low-temperature radiofrequency ablation assisted by endoscopy combined with resection and drainage of cervical abscess for the treatment of congenital pyriform sinus fistula （CPSF） in the acute inflammatory period of children. Methods:Clinical data of 30 patients with CPSF in the acute inflammatory period who received low-temperature radiofrequency ablation assisted by endoscopy under laryngoscope, combined with resection and drainage of cervical abscess, from January 2018 to December 2023 were reviewed. After the operation, patients were followed up closely at different stages. All patients underwent color Doppler ultrasound and electronic laryngoscopy, and the results were analyzed. Results:All 30 children successfully completed the surgery without pharyngeal fistula, dysphagia, perifistula, or distal fistula infection, and the incision in the neck healed well. The follow-up survey ranged from 6 months to 2 years, and no recurrences were observed. Conclusion:Low-temperature radiofrequency ablation assisted by endoscopy combined with resection and drainage of cervical abscess is a promising method for treating CPSF in the acute inflammatory period. It is less traumatic, simple, safe, has a significant curative effect, and a low recurrence rate. This approach can be used as a supplementary operation for CPSF in children and provides a new way for clinical treatment.
Humans ; Pyriform Sinus/abnormalities* ; Abscess/surgery* ; Drainage ; Fistula/congenital* ; Female ; Male ; Child ; Radiofrequency Ablation ; Treatment Outcome ; Postoperative Period ; Endoscopy ; Laryngoscopy ; Inflammation ; Child, Preschool

Objective:To study the preoperative predictors for lower extremity intermuscular venous thrombosis (IMVT) in patients with thoracolumbar fracture.Methods:A retrospective study was conducted to analyze the 421 spinal fracture patients who had been admitted to Department of Spinal Surgery, The Fourth Hospital of Wuhan from November 2023 to October 2024. The cohort included 110 males and 311 females, aged from 16 to 89 years. They were stratified into a thrombosis group (26 cases) and a control group (395 cases) based on the presence or absence of lower extremity IMVT. Univariate analysis was performed of the following variables: gender, age, body mass index, multisegmental spinal fractures, fracture location, Caprini thrombosis risk score, visual analogue scale (VAS) pain score, D-dimer level, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), fibrinogen, coagulation factor activity assay, fibrinogen level, estimated fibrinolytic ratio, clotting time, 30-minute fibrinolytic ratio, coagulation comprehensive index, clot mechanical strength, platelet function, and fibrin generation rate. The variables with a significance level of P<0.05 in the univariate analysis were further analyzed using multivariate logistic regression to identify the independent risk factors for lower extremity IMVT. The predictive efficacy of these factors was evaluated using receiver operating characteristic (ROC) curve analysis. Results:Comparisons between the 2 groups showed that age, multisegmental spinal fractures, Caprini thrombotic risk score, and D-dimer level were variables with P<0.05. Binary logistic regression analysis of the above variables showed that a high Caprini thrombotic risk score, a high D-dimer level, and multisegmental spinal fractures were independent risk factors for preoperative lower extremity IMVT ( P<0.05). The ROC plot suggested an optimal cutoff point: a Caprini thrombotic risk score of 5 and a D-dimer level of 2.57 mg/L. Combination of Caprini thrombotic risk score, D-dimer level, and multisegmental spinal fractures demonstrated a sensitivity of 88.5%, a specificity of 71.9%, and an area under the curve (AUC) of 0.881 for diagnosis of lower extremity IMVT. Conclusions:The Caprini thrombosis risk score and presence of multisegmental spinal fractures are critical indicators for the preoperative risk of lower extremity IMVT in patients with thoracolumbar fracture. For individuals with a low Caprini thrombosis risk score, a D-dimer test is necessary in combination to determine the necessity of color Doppler ultrasound examination.

Objective:To study the preoperative predictors for lower extremity intermuscular venous thrombosis (IMVT) in patients with thoracolumbar fracture.Methods:A retrospective study was conducted to analyze the 421 spinal fracture patients who had been admitted to Department of Spinal Surgery, The Fourth Hospital of Wuhan from November 2023 to October 2024. The cohort included 110 males and 311 females, aged from 16 to 89 years. They were stratified into a thrombosis group (26 cases) and a control group (395 cases) based on the presence or absence of lower extremity IMVT. Univariate analysis was performed of the following variables: gender, age, body mass index, multisegmental spinal fractures, fracture location, Caprini thrombosis risk score, visual analogue scale (VAS) pain score, D-dimer level, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), international normalized ratio (INR), fibrinogen, coagulation factor activity assay, fibrinogen level, estimated fibrinolytic ratio, clotting time, 30-minute fibrinolytic ratio, coagulation comprehensive index, clot mechanical strength, platelet function, and fibrin generation rate. The variables with a significance level of P<0.05 in the univariate analysis were further analyzed using multivariate logistic regression to identify the independent risk factors for lower extremity IMVT. The predictive efficacy of these factors was evaluated using receiver operating characteristic (ROC) curve analysis. Results:Comparisons between the 2 groups showed that age, multisegmental spinal fractures, Caprini thrombotic risk score, and D-dimer level were variables with P<0.05. Binary logistic regression analysis of the above variables showed that a high Caprini thrombotic risk score, a high D-dimer level, and multisegmental spinal fractures were independent risk factors for preoperative lower extremity IMVT ( P<0.05). The ROC plot suggested an optimal cutoff point: a Caprini thrombotic risk score of 5 and a D-dimer level of 2.57 mg/L. Combination of Caprini thrombotic risk score, D-dimer level, and multisegmental spinal fractures demonstrated a sensitivity of 88.5%, a specificity of 71.9%, and an area under the curve (AUC) of 0.881 for diagnosis of lower extremity IMVT. Conclusions:The Caprini thrombosis risk score and presence of multisegmental spinal fractures are critical indicators for the preoperative risk of lower extremity IMVT in patients with thoracolumbar fracture. For individuals with a low Caprini thrombosis risk score, a D-dimer test is necessary in combination to determine the necessity of color Doppler ultrasound examination.

Objective:This study aims to summarize the surgical efficacy of macroglossia reduction combined with radiofrequency ablation of Beckwith-Wiedemann Syndrome (BWS).Methods:A retrospective analysis was conducted on the clinical data of patients with macroglossia who received treatment at the Department of Otolaryngology-Head and Neck Surgery, Xiamen Children’s Hospital between May 2019 and July 2022. All patients with macroglossia underwent either one-stage or staged anterior tongue V-shaped incision massive resection, followed by needle tip low-temperature plasma radiofrequency ablation on the lateral and base of the tongue. The postoperative complications in pediatric patients were monitored, including the incision shape of the tongue body, restoration of tongue body structure and function. MRI scans of the tongue were performed at 3 and 12 months post-operation to evaluate tissue healing, changes in tongue volume, and whether there was successful retraction of the enlarged tongue into the oral cavity for evaluating treatment efficacy (cured or not cured).Results:The study included 70 cases, comprising 31 male and 39 female patients, with an average age of 15.4 months (ranging from 5 months to 4 years old). Among them, 68 cases underwent macroglossia reduction combined with radiofrequency ablation at the same time, and 2 cases underwent macroglossia reduction surgery first in other hospitals, and tongue body radiofrequency ablation was performed one year after the surgery. All children were followed up foran average follow-up time of 18 months (6 to 36 months). There were no serious complications such as massive hemorrhage and tongue hematoma. After the operation, 14 cases of superficial rupture of tongue tip wound were gradually improved after 5-7 days of no oral eating, and recovered after 4-12 weeks of liquid diet. Thirteen cases had suture reactions in the tongue back, which were self-resolving within 2 to 3 weeks with no special treatment. All patients showed significant reduction in tongue size after the surgery, which could be completely inserted into the oral cavity, and the treatment effect was satisfactory.Conclusion:Macroglossia reduction combined with radiofrequency ablation is a feasible and effective method for the treatment of BWS with macroglossia and is recommended for application.

Objective:This study aims to summarize the surgical efficacy of macroglossia reduction combined with radiofrequency ablation of Beckwith-Wiedemann Syndrome (BWS).Methods:A retrospective analysis was conducted on the clinical data of patients with macroglossia who received treatment at the Department of Otolaryngology-Head and Neck Surgery, Xiamen Children’s Hospital between May 2019 and July 2022. All patients with macroglossia underwent either one-stage or staged anterior tongue V-shaped incision massive resection, followed by needle tip low-temperature plasma radiofrequency ablation on the lateral and base of the tongue. The postoperative complications in pediatric patients were monitored, including the incision shape of the tongue body, restoration of tongue body structure and function. MRI scans of the tongue were performed at 3 and 12 months post-operation to evaluate tissue healing, changes in tongue volume, and whether there was successful retraction of the enlarged tongue into the oral cavity for evaluating treatment efficacy (cured or not cured).Results:The study included 70 cases, comprising 31 male and 39 female patients, with an average age of 15.4 months (ranging from 5 months to 4 years old). Among them, 68 cases underwent macroglossia reduction combined with radiofrequency ablation at the same time, and 2 cases underwent macroglossia reduction surgery first in other hospitals, and tongue body radiofrequency ablation was performed one year after the surgery. All children were followed up foran average follow-up time of 18 months (6 to 36 months). There were no serious complications such as massive hemorrhage and tongue hematoma. After the operation, 14 cases of superficial rupture of tongue tip wound were gradually improved after 5-7 days of no oral eating, and recovered after 4-12 weeks of liquid diet. Thirteen cases had suture reactions in the tongue back, which were self-resolving within 2 to 3 weeks with no special treatment. All patients showed significant reduction in tongue size after the surgery, which could be completely inserted into the oral cavity, and the treatment effect was satisfactory.Conclusion:Macroglossia reduction combined with radiofrequency ablation is a feasible and effective method for the treatment of BWS with macroglossia and is recommended for application.

Objective:To investigate the clinical application of continuous renal replacement therapy (CRRT) in infants with acute kidney injury (AKI) after liver transplantation.Methods:A retrospective study was conducted on infants with AKI after liver transplantation in Tianjin First Center Hospital from January 1, 2019 to June 1, 2021. Infants with AKI within 1 year after liver transplantation were divided into CRRT group and non-CRRT group according to whether CRRT was performed. The preoperative and intraoperative condition, the postoperative complications were compared, the risk factors of CRRT for AKI infants, the clinical characteristics of CRRT were analyzed, and the prognosis between CRRT group and non-CRRT group were compared.Results:① A total of 512 cases of pediatric liver transplantation were performed. A total of 189 cases (36.9%) developed AKI within 1 year after surgery, including 18 cases in CRRT group and 171 cases in non-CRRT group. ② There was no significant difference in preoperative conditions between the two groups. The duration of liver transplantation (hours: 8.8±1.5 vs. 7.5±1.3) and intraoperative blood loss [mL: 370 (220-800) vs. 310 (200-400)] in CRRT group were significantly higher than those in non-CRRT group. CRRT group had significantly higher incidence of postoperative complication [unplanned operation: 8 cases (44.4%) vs. 14 cases (8.2%), primary nonfunction: 1 case (5.6%) vs. 0 case (0%), retransplantation: 3 cases (16.7%) vs. 0 case (0%), hepatic artery thrombosis: 3 cases (16.7%) vs. 4 cases (2.3%), intestinal fistula: 2 cases (11.1%) vs. 2 cases (1.2%)] than non-CRRT group (all P < 0.05). ③ The average start time of CRRT was 10 (1-240) days. The per capita frequency of CRRT treatment was 3.3 (1.0-14.0) times. The average duration of each CRRT treatment was 10.1 (6.0-19.3) hours, the average reduction rate of serum creatinine (SCr) was 25.6% (13.5%-45.0%) after CRRT. ④ In CRRT group, 5 patients died, the 1-year and 2-year survival rates were both 72.22%. In non-CRRT group, 6 patients died, the 1-year and 2-year survival rates were 97.1% and 96.5%, respectively. There were significant differences in 1-year and 2-year survival rates between the two groups (both P < 0.01). Conclusions:The incidence of AKI after pediatric liver transplantation was high, and most infants treated with CRRT were associated with serious surgical complications. CRRT was a powerful means to remove inflammatory factors and maintain the stability of circulation and internal environment, which could improve the multi-organ dysfunction effectively.

Objective:To systematically evaluate the efficacy and safety of neoadjuvant chemoradiotherapy (NCRT) plus surgery versus neoadjuvant chemotherapy (NCT) plus surgery in the treatment of advanced esophageal squamous cell carcinoma.Methods:Clinical controlled trials of comparing the treatment of NCRT plus surgery with NCT plus surgery for esophageal squamous cell carcinoma were electronically searched from the databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang and VIP from the inception of databases to January, 2019. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And then, a meta-analysis was performed by using RevMan 5.3 software.Results:A total of 8 clinical control studies were included, including 995 patients with esophageal squamous cell carcinoma. Meta-analysis results showed that compared with the NCT group, the R 0 resection rate was significantly higher ( OR=2.14, 95% CI: 1.03-4.45, P=0.040) and the pathological complete response (pCR) rate was significantly higher ( OR=4.19, 95% CI: 1.71-10.28, P=0.002) in the NCRT group. The incidence of postoperative complications ( OR=1.37, 95% CI: 0.76-2.48, P=0.300) and the risk of perioperative death ( OR=1.28, 95% CI: 0.58-2.83, P=0.54) were not significantly different between two groups. The long-term survival of patients with esophageal squamous cell carcinoma in the NCRT group was significantly better compared with that in the NCT group ( HR=0.77, 95% CI: 0.64-0.92, P=0.005). Conclusions:Compared with NCT plus surgery for advanced esophageal squamous cell carcinoma, NCRT plus surgery has higher R 0 resection rate and pCR rate, does not significantly increase the risk of perioperative complications or perioperative death, and significantly improves the long-term survival of esophageal squamous cell carcinoma patients.

OBJECTIVE To discuss the clinical efficacy of low-temperature radiofrequency ablaion for the treatment of neonatal tongue base cyst.METHODS Clinical data of 7 patients under the cystectomy with congenital tongue base cyst from July 2014 to Jan 2017 were reviewed.Diagnoses were confirmed by the medical history,electronic laryngoscopy and imaging examinations.RESULTS The tongue base cyst were totally removed in 7 patients and no 1 received invasive procedure.Follow-up survey ranged from 3 months to 2 years and only 1 case recurred in 6 months.CONCLUSION Low-temperature radiofrequency ablaion is a promising method for the neonatal tongue base cyst with less trauma and haemorrhage.Electronic laryngoscopy as a noninvasive,convenient,accurate examination method can be widely used in the diagnosis of neonatal upper airway obstruction diseases and postoperative follow-up of neonatal throat surgery.

OBJECTIVE To investigate the efficacy of coblation for early glottic cancer. METHODS Twenty-two patients with early glottic carcinoma (Tis-T2) without lymph node metastasis accepted resection of laryngeal cancer lesions using transoral endoscopic coblation,without pre-operative or post-operative radiotherapy and chemotherapy. All the patients were followed up for 30 to 70 months. RESULTS No severe complications such as dyspnea and bleeding occurred in these cases.Only mild postoperative pain happened to the patients.All patients could swallow and speak after operation. No recurrence occurred in 21 cases till now. One case, with poorly differentiated squarnous cell lesion in the anterior commissure invading subglottic area, recurred 4 months after operation. Salvage partial laryngectomy was performed and no recurrence was found after salvage operation. CONCLUSION The result suggests that transoral endoscopic coblation is a good method for early glottic cancer. It is worth popularizing.

OBJECTIVE: To study the clinical valuation of different operation methods in treatment primary trigeminal neuralgia by retrosigmoidal approach. METHOD: The clinical data of 165 cases with primary trigeminal neuralgia were studied, all head MRI(B-FFE) examination was made before surgery. According to patients' face sensation and cerebellopontine angle conditions, different operation methods were choose. RESULT: Among of 165 cases, 7 cases with face numbness and sensory loss symptom before surgery, were treated with partial rhizotomy of trigeminal sensory root and nerve combing and all cured, followed-up study 3.5 to 5.0 years and no relapse and face sequelae is same as before; 145 cases with blood vessel compression and no face sequelae were treated with microvascular decompression and nerve combing of trigeminal nerve sensory root, 144 cases were cured and 1 case relieve, 15 cases with herpes simplex were cured after 1-2 weeks, 4 cases with oral lips or tongue numbness were cured after 1-3 months. Followed-up study 3 to 5 years,3 cases relapse and after second same operation methods cured. Among of 13 cases without face sequelae, 5 cases with artery compression were not suit to microvascular decompression and 8 cases without blood vessel compression. All these cases were treated with surface coagulation and nerve combing of trigeminal nerve sensory root, 2 cases with herpes simplex were cured after one week. Followed-up studying of 3.2 to 5.0 years, one case relapse, All 13 cases were cured and no neuralgia relapse and no severe sequelae. Among the 165 cases, two cases died of hemorrhage cephalon in operation or postoperation. CONCLUSION It is a safe and effective way to choose different methods combine to treat primary trigeminal neuralgia according to patients' face sensation and cerebellopontine angle conditions, but the risk of operation should not be ignored.
Aged ; Aged, 80 and over ; Craniotomy ; methods ; Decompression, Surgical ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Treatment Outcome ; Trigeminal Neuralgia ; surgery