小兒外科課件

PediatricSurgery1ppt課件PediatricSurgery1ppt課件1PediatricSurgeryResponsibleforthetreatmentandpreventionofsurgicalconditionsinfetus28weeksofgestationtoadolescentatpuberty.Includingtherelatedbasicmedicaltheoriesandresearches.

AbnormalityTraumaInfectiousTumour2ppt課件PediatricSurgeryResponsiblef2精品資料精品資料3你怎么稱呼老師？如果老師最后沒有總結(jié)一節(jié)課的重點(diǎn)的難點(diǎn)，你是否會(huì)認(rèn)為老師的教學(xué)方法需要改進(jìn)？你所經(jīng)歷的課堂，是講座式還是討論式？教師的教鞭“不怕太陽(yáng)曬，也不怕那風(fēng)雨狂，只怕先生罵我笨，沒有學(xué)問無顏見爹娘……”“太陽(yáng)當(dāng)空照，花兒對(duì)我笑，小鳥說早早早……”小兒外科課件4精品資料精品資料5你怎么稱呼老師？如果老師最后沒有總結(jié)一節(jié)課的重點(diǎn)的難點(diǎn)，你是否會(huì)認(rèn)為老師的教學(xué)方法需要改進(jìn)？你所經(jīng)歷的課堂，是講座式還是討論式？教師的教鞭“不怕太陽(yáng)曬，也不怕那風(fēng)雨狂，只怕先生罵我笨，沒有學(xué)問無顏見爹娘……”“太陽(yáng)當(dāng)空照，花兒對(duì)我笑，小鳥說早早早……”小兒外科課件6HistoryofpediatricsurgeryEstablishmentofpediatricsurgeryAboard:endof1940s,China:beginningof1950sspecialtiesnowinclude：

generalsurgeryneonatesurgeryorthopedicsurologythoracic&cardiacsurgeryoncologyneurosurgery7ppt課件HistoryofpediatricsurgeryEs7小兒外科疑難重癥臨床中心

臨床中心學(xué)科結(jié)構(gòu)圖

微創(chuàng)外科中心

血液腫瘤中心

肝病中心

心血管中心

遺尿中心

產(chǎn)癱中心

神經(jīng)外科8ppt課件小兒外科疑難重癥臨床中心臨床中心學(xué)科結(jié)構(gòu)圖8CongenitalAbnormality(60%)Defectsintheabdominalwall(diaphragmatichernia,gastroschisis,omphalocele)Neurologicalsystem(brain,spinalcord,etc.)CardiovascularandpulmonaryabnormalityMalformationofdigestivesystemMalformationofurologicalandreproductivesystemLimbsandvertebraabnormality9ppt課件CongenitalAbnormality(60%)Def9CongenitalPosterolateralDiaphragmaticHernia(CDH)OneofmostsevereconditionsofneonateDefectindiaphragmduringearlyfetaldevelopmentleftsidemostcommonlyaffectedcontentofthehernia:smallbowelcolonspleenstomachliver,kidney,tailofpancreatic10ppt課件CongenitalPosterolateralDiap10

【Embryology】week8～9：divisionofcoelomiccavityintothepleuralandperitonealcavitybythediaphragm;atriangularareaintheposterolateralsitewasleftopen.week10～12：herniationoccurthroughthisopeningintothepleuralcavityatthereturnofmidgut11ppt課件【Embryology】11ppt課件11【pathophysiology】1、HypoplasiaofthelungPulmonaryweight↓(ipsilateral+contralateral)↓

Alveolinumber↓

Hypertrophyofthemediaofpulmonaryarteriole↑

Resistanceofthevessels↑2、PulmonaryhypertensionAbdominalvisceraintothethoraciccavity→Compressionofthelung,PaO2↓PaCO2↑→Acidosis,hypoxemia（PH<7.30）→Pulmonaryvesselsspasm→Vesselresistance↑,righttoleftshuntingthroughpatentductusarteriesandforamenovale↑→Aggravateacidosisandhypoxemiainthebodycirculation(fetalcirculationsyndrome)

12ppt課件【pathophysiology】12ppt課12CDH-PulmonaryHypoplasiaEmbryonicPseudoglandularCanalicularSaccularAlveolar06162636PostnatalWeeksGestationCDHBranchingmorphogenesisArterioles,Bronchioles,AlveoliGasExchange13ppt課件CDH-PulmonaryHypoplasiaEmbr13diaphragmaticherniaClinicalmanifestations：

1，Severerespiratorydistress，cyanosis,vomit2，Breathsounds:diminishedonthesideofhernia3，Heartsounds:deviatedtothecontralateralchest4，Scaphoidabdomen14ppt課件diaphragmaticherniaClinicalm14【diagnosis】PrenataldiagnosisUltrasound:abdominalorganvisibleinthefetalchest15ppt課件【diagnosis】15ppt課件15diagnosisafterbirthX-rayfilm:

Typicalair-filledstomachandbowelsinthechest,whichcontinuesintotheabdominalcavity.Diaphramcannotbeseenattheaffectedside.Absenceorscarcityofintestineintheabdominalcavity16ppt課件diagnosisafterbirth16ppt課件16FetoscopicTrachealOcclusionTrachealOcclusionClip

Inuterorepair

plateauHarrison,NEnglJMe,2003PrenatalTreatmentforCDH

17ppt課件FetoscopicTracheal17TreatmentBeforedelivery:cortisonecouldinducethematurationofpulmonarytissuePreoperativepreparation:（1）mechanicalventilationwithpureoxygen（2）nasogastrictubetodecompressstomachandintestine（3）semi-supineandinclinedtotheipsilateralside，keepwarm（4）i.v.fuild,correctionofacidosis(5）surgicalrepair

18ppt課件TreatmentBeforedelivery:cort18omphalocele19ppt課件omphalocele19ppt課件19gastroschisis20ppt課件gastroschisis20ppt課件20I期還納法21ppt課件I期還納法21ppt課件21I期還納法22ppt課件I期還納法22ppt課件22CongenitalEsophagealAtresiawithTracheoesophagealFistulaIncidence:1/3000associatedanomaliescommonImpedimentofrecanalizationandinterruptionofseptationoftracheaandesophagus

23ppt課件CongenitalEsophagealAtresia23Congenitalesophagealatresia

Ⅰ6％，Ⅱ2％，Ⅲ85％，Ⅳ1％。Ⅴ6％Classification24ppt課件Congenitalesophagealatresia

24【clinicalfindings】1、droolingsaliva,unabletoswallow2、coughandchokeandmaybecomecyanoticafterfeeding3、chemicalandaspirationpneumonia4、abdominaldistentionorscaphoidabdomen25ppt課件【clinicalfindings】25ppt課件25【diagnosis】1、prenataldiagnosis2、nasogastrictubecannotreachstomach.3、X-rayfilmshowthecoilingofthetubeintheuppermediastinum26ppt課件【diagnosis】26ppt課件26

Preoperativepreparationsupineandelevatedto30～40oCatheterwasputattheblindendoftheesophagusforcontinuousdrainageoxygeninhalation,incubatori.v.fluidandbroad-spectrumantibioticssurgicalrepairPrognosis:98%~100%survivalrateforthelastdecade(aboard),allofthecasessurvivedsince2002(ourhospital).27ppt課件Preoperativepreparati27HypertrophicPyloricStenosis【pathophsiology】1、oliveshapedmass：length2～3.5cm，thickness0.4～0.6cm，paleincolorwithconsistencyofcartilage2、Muscularhypertrophyofallthelayersofthepylorus,mostsignificantinthecircularlayer,causingthestenosis28ppt課件HypertrophicPyloricStenosis【28HypertrophicPyloricStenosis【symptoms】1、projectilevomiting:onset:2-3weeksafterbirthandprogressivewithtime;vomitus:non-biliousmilkandmilkcurds2、jaundice：deficiencyinliverenzymeandcompressionofthebiliarytract3、overallcondition:dehydration,weightlose,hypo-chloridemetabolicalkalosis,oliguria

4、abdominalexamination:distentionofepigastrium,visiblegastricwaves,presenceofapalpablepylorictumor(uniquephysicalsign)29ppt課件HypertrophicPyloricStenosis29【Diagnosis】1、Typicalvomitingandmassintheepigastrium2、Ultrasound:muscularthickness≥0.4cm，

SD=thickness×2/diameter≥50％3、GIforcaseswithdifficultyindiagnosis：①distentionofthestomach②stronggastricwaves③elongatedandnarrowpyloricchannel④delayinstomachemptying30ppt課件【Diagnosis】30ppt課件30【Treatment】Surgery————pyloromyotomy31ppt課件【Treatment】31ppt課件31IntestinalObstructionintheNeonate32ppt課件IntestinalObstructioninthe32【Etiology】1、Malrotationofmidgutaroundtheaxisofsuperiormesentericartery2、Intestinalrecanalizationanomaly3、Compromiseofintestinalbloodsupply4、Arrestofthemigrationofneuroblastderivedfromneuralcrestofepiderm5、Viscosityofmeconium:cysticfibrosis6、Maternalfactors:infection,diabetes,pharmaceuticals33ppt課件【Etiology】33ppt課件33【Pathophysiology】1、Lossoffluidfromemesis:dehydration,electrolytedisturbance,acid-baseimbalance2、Aspirationandabdominaldistention:chemicalandbacterialpneumonia,apnea3、Disseminationofenterobacterium:ischemia,necrosis,perforationandsepsis34ppt課件【Pathophysiology】34ppt課件34【Clinicalmanifestation】Charactersofneonateileus:BiliousvomitingAbdominaldistentionFailuretopassmeconiumGeneralcondition：drowsy、hypomyotonia、

tachypnea35ppt課件【Clinicalmanifestation】35ppt課35Commoncausesofneonateintestinalobstruction(Mechanicobstruction)

Extrinsic：intestinalatresiaandstenosis40％annularpancreasMalrotation10～15%intestinalduplicationmeconiumperitonitis（adhesion）internalhernia,incarceratedexternalherniaIntussuceptionIntrinsic：meconiumperitonitismilkcurdsobstrutionmeconiumplug36ppt課件Commoncausesofneonateintes36Functionalobstruction

Hirschsprung’sdisease25～30％NecrotizingenterocolitisLeftmicrocolonsyndromeInfectionMetabolic37ppt課件Functionalobstruction37ppt課件37IntestinalAtresiaandStenosis38ppt課件IntestinalAtresiaandStenosi38【Clinicalfindings】1、Vomitingonset:fromfirsttimeoffeedingtoafewdaysafterbirthvomitus:biliousorfeculent2、Abdominaldistentionhigh:confinedtoepigastriumlow:fullabdomendistention3、Failuretopassmeconium:

normallymeconiumwaspassedwithinthefirst24hrsoflifeandclearedin2-3days.

4、Generalcondition39ppt課件【Clinicalfindings】39ppt課件39【Diagnosis】1、Prenatalultrasound2、Clinicalfindings:

biliousvomiting24-48hrsafterbirthabdominaldistentionfailuretopassmeconium3、X-ray：duodenalatresia－－Doublebubblesignjejunalatresia－－triplebubblesignlowintestinalatresia－－multipleair-fluidlevel40ppt課件【Diagnosis】40ppt課件40Diagnosis(intestinalatresia)X-ray：supineforanteroposterior，erectedforlateral41ppt課件Diagnosis(intestinalatresia)41【Treatment】Theonlyoptionissurgery：

intestinalseptumexcisionIntestineresectionandanastomosis42ppt課件【Treatment】42ppt課件42CongenitalMalrotationofIntestine43ppt課件CongenitalMalrotationofInt43【Definition】

Malrotationisthetermusedtodefinethegroupofcongenitalanomaliesresultingfromaberrantintestinalrotationandfixation【Embryology】

Week6~8:Herniationofmidgutintotheumbilicalcordwitha180degreeofcounterclockwiserotationalongtheaxisofsuperiormesentericartery

Week10:Returntotheabdominalcavitywithafinal90degreeofrotationtocompletethe270-degreecounterclockwiserotation44ppt課件【Definition】44ppt課件44Schematicsofnormalmidgutrotation45ppt課件Schematicsofnormalmidgutro45【Pathology】NonrotationandIncompleterotation:abnormalpositioningoftheproximalsmallbowelandthececumDuodenumcompressedbyabnormalperitonealband(Ladd’sband):highincompleteextrinsicobstructionMidgutvolvulus:torsionofthenarrowmesentericpedicleproducesanacuteclosed-loopintestinalobstructionandvascularinsufficiency.Proximaljejunumfusedtotheascendingcolonbyanomalousperitonealattachments46ppt課件【Pathology】46ppt課件46MalrotationPathology：

CompressionofduodenumKinkedandforeshortenedproximaljejunumbyperitonealbandMidgutvolvulus47ppt課件MalrotationPathology：47ppt課件47【Clinicalmanifestations】

Emesis：bilious,intermittent，occurat3-5daysafterbirthorasymptomatic

Abdominaldistention:confinedinepigastrium,diffusetothefullabdomeninbowelnecrosis

Stool:normalmeconium,bloodystoolsuggestsvolvulusandnecrosis

Newborn:normalmeconium，intermittentvomitingafter3-5daysofbirth，noabdominaldistention,hardstool

Childrenandinfant：asymptomaticsincebirth,intermittentonsetorsuddenonsetofvolvulus48ppt課件【Clinicalmanifestations】48ppt48ClinicalmanifestationsSymptomsofvolvulus:bloodyvomitusandstool,abdominaltenderness49ppt課件ClinicalmanifestationsSympto49【X-rayfilm】1、PlainX-rayfilm:double-bubblesign

2、bariumenema:cecumintheupperorleftabdomen3、GI：incompleteduodenalobstruction;ligamentofTreitznottotheleftofthemidline;abnormalpositionoftheproximaljejunalloopstotherightofthemidline50ppt課件【X-rayfilm】50ppt課件50TreatmentPrinciples：

AsymptomaticmalrotationmostrecommendsurgicaltreatmentsomebelieveoperationonlynecessaryinyoungchildrenHighintestinalobstruction

operatedonpromptly,butnotnecessarilyemergently

Voluluswithsignofbowelnecrosis

immediateoperation

51ppt課件TreatmentPrinciples：51ppt課件51TreatmentLaddsoperationAllvolvulusisclockwisesothesmallbowelmustberotatedinacounterclockwisefashionExposeduodenumbydivisionoftheLadd’sbandsDissectionadditionalperitonealbandstoconvertthemesentericpedicletoawideplaneAlignmentofsmallboweltotherightandcolontotheleftoftheabdominalcavityAppendectomy52ppt課件TreatmentLaddsoperation52ppt52Hirschsprung’sDisease

Anatomy1、distendedsegment:proxiamlcolonenlargedwithmuscularhypertrophy2、stenosissegment：distalcolonspasm3、transitionalsegment：betweendistalandproximalsegments53ppt課件Hirschsprung’sDisease

Anato53Histology1、lackofganglioncellintheneuralplexusoftheaffectedsegmentofintestine2、hypertrophiednervetrunkstainpositiveforacetylcholinesterase3、Disarrayofadrenergicfibers54ppt課件Histology54ppt課件54【Pathophysiology】Arrestofcranialtocaudalmigrationofneuroblastsderivedfromneuralcrestprecursorsalongtheintestinaltractwithvagalnervefiberat6-12weeksofgestation,whichresultsinaganglionosisofthedistalbowel.

1、spasmofaffectedsegmentnonormalperistalsis2、internalsphincterspasmnonormaldefecationreflex

3、proximalboweldistendedwithhistologicevidenceofmuscularhypertrophy55ppt課件【Pathophysiology】55ppt課件55【clinicalfindings】Neonate：

1、emesis：biliousorfeculent2、abdominaldistention3、delayedpassageofmeconium4、rectalexamination：tightnessofinternalsphincter,rectalemptiness，withdrawbringsoutmeconiumandgas5、afterbowelirrigation,temporarysubsidingofthesymptomsChildrenandinfant：

1、Historyofneonateconstipation2、Malnutrition,anemia3、Chronicabdominaldistention56ppt課件【clinicalfindings】56ppt課件56【Diagnosis】BariumenemaDemonstrationofaspasmodicdistalintestinalsegmentwithdilatedproximalbowelFailuretoevacuatebariumfromcolonwithin24hours

simplicityofthemethodaccuracyinneonate80％

notsuitableforshortsegmenttype57ppt課件【Diagnosis】57ppt課件57AnorectalManometryAiddiagnosisthroughidentificationoftherectoanalinhibitoryreflexwhichisabsentinthevastmajorityofchildrenwithHirschsprung’sdiseaseDrawbacks:false-positiveinolderchildrenduetomaskingoftherelaxationresponsebycontractionoftheexternalsphincter58ppt課件AnorectalManometry58ppt課件58Rectalbiopsy(Definitivediagnosis)SuctionbiopsyBiopsytakenat1-2cmabovethedentatelinelookingforthepresenceorabsenceofganglioncellsandhypertrophiednervetrunkssimplicity,accuracy,absenceofcomplicationsFalse-negative(age,mucosaledema,tissuequality,experience)

59ppt課件59ppt課件59

Histologicstainingofmucosa

IncreasedAChEcontentinthenervefibersofthelaminapropriaandmuscularismucosaeFull-thicknessRectalBiopsy

Complexityandcomplications,possibleeffectonfuturedefinitivesurgery

60ppt課件Histologicstainingofmucos60【Complications】1、EnterocolitisMostfrequentlyencounteredandlife-threatening:fromconstipationtodiarrheaperitonitisandsepsisfeverandabdominaldistentiondigitalexam：massiveamountofodorantstool

2、PerforationCecumpeforationBowelnecrosisandperforation61ppt課件【Complications】61ppt課件61【Treatment】1、Colonirrigations:isotonicfluidonetotwotimesaday

＃Donotusewater2、Colostomy：3、Surgicaloptions

SwensonDuhamalRehbeinSoave

Neonatalsurgery

Laparoscope's

Transanalpullthrough

62ppt課件【Treatment】62ppt課件62AnorectalMalformations(ARMs)OneofthemostfrequentlyencountereddigestivetractabnormalityFrequencyisslightlyhigherinmalescomparedwithfemalesAssociatedanomaly:urogenital,anothergastrointestinalanomaly,cardiovascular,vertebraArrestofthecaudaldescentoftheurorectalseptumtowardthecloacalmembraneduringthefourthweekandendingbytheeighthweekofgestation.63ppt課件AnorectalMalformations(ARMs)63ARMclassification

Wingspreadclassification:accordingtotherelativepositionofretalendtotheelevaterani：

high:aboveelevateraniintermediate:withinelevateranilow:passthroughelevateraniFurtherclassificationaccordingtothefistula

64ppt課件ARMclassificationWingspread64PCline:pubococcygeallineIline:ischialline65ppt課件PCline:pubococcygealline65p65ARMdiagnosisInvert-gram12hoursafterbirth66ppt課件ARMdiagnosisInvert-gram12ho66ARMtreatmentAim：RebuiltananuswithwellfunctioninganalsphincteHighandintermediateimperforatedanuscolostomyatbirthdefinitivesurgeryat6-12monthsofageLowimperforatedanusTrans-perinealanoplastyafterbirthForfemalewithfistula，Dilatationoffistula,anoplastyat6-8months67ppt課件ARMtreatmentAim：Rebuiltanan67KeywordsCDHpathophysiologyandClinicalmanifestationsclinicalfindingsofCongenitalesophagealatresiasymptomsanddiagnosisofHypertrophicPyloricStenosis(pyloromyotomy)ClinicalmanifestationofneonateintestinalobstructionPathologyofCongenitalMalrotationofIntestineHistologyandclinicalfindingsofHirschsprung’sDisease

Wingspreadclassificationof

AnorectalMalformations68ppt課件KeywordsCDHpathophysiologya68

Thankyou！69ppt課件Thankyou！69ppt課件69PediatricSurgery70ppt課件PediatricSurgery1ppt課件70PediatricSurgeryResponsibleforthetreatmentandpreventionofsurgicalconditionsinfetus28weeksofgestationtoadolescentatpuberty.Includingtherelatedbasicmedicaltheoriesandresearches.

AbnormalityTraumaInfectiousTumour71ppt課件PediatricSurgeryResponsiblef71精品資料精品資料72你怎么稱呼老師？如果老師最后沒有總結(jié)一節(jié)課的重點(diǎn)的難點(diǎn)，你是否會(huì)認(rèn)為老師的教學(xué)方法需要改進(jìn)？你所經(jīng)歷的課堂，是講座式還是討論式？教師的教鞭“不怕太陽(yáng)曬，也不怕那風(fēng)雨狂，只怕先生罵我笨，沒有學(xué)問無顏見爹娘……”“太陽(yáng)當(dāng)空照，花兒對(duì)我笑，小鳥說早早早……”小兒外科課件73精品資料精品資料74你怎么稱呼老師？如果老師最后沒有總結(jié)一節(jié)課的重點(diǎn)的難點(diǎn)，你是否會(huì)認(rèn)為老師的教學(xué)方法需要改進(jìn)？你所經(jīng)歷的課堂，是講座式還是討論式？教師的教鞭“不怕太陽(yáng)曬，也不怕那風(fēng)雨狂，只怕先生罵我笨，沒有學(xué)問無顏見爹娘……”“太陽(yáng)當(dāng)空照，花兒對(duì)我笑，小鳥說早早早……”小兒外科課件75HistoryofpediatricsurgeryEstablishmentofpediatricsurgeryAboard:endof1940s,China:beginningof1950sspecialtiesnowinclude：

generalsurgeryneonatesurgeryorthopedicsurologythoracic&cardiacsurgeryoncologyneurosurgery76ppt課件HistoryofpediatricsurgeryEs76小兒外科疑難重癥臨床中心

臨床中心學(xué)科結(jié)構(gòu)圖

微創(chuàng)外科中心

血液腫瘤中心

肝病中心

心血管中心

遺尿中心

產(chǎn)癱中心

神經(jīng)外科77ppt課件小兒外科疑難重癥臨床中心臨床中心學(xué)科結(jié)構(gòu)圖77CongenitalAbnormality(60%)Defectsintheabdominalwall(diaphragmatichernia,gastroschisis,omphalocele)Neurologicalsystem(brain,spinalcord,etc.)CardiovascularandpulmonaryabnormalityMalformationofdigestivesystemMalformationofurologicalandreproductivesystemLimbsandvertebraabnormality78ppt課件CongenitalAbnormality(60%)Def78CongenitalPosterolateralDiaphragmaticHernia(CDH)OneofmostsevereconditionsofneonateDefectindiaphragmduringearlyfetaldevelopmentleftsidemostcommonlyaffectedcontentofthehernia:smallbowelcolonspleenstomachliver,kidney,tailofpancreatic79ppt課件CongenitalPosterolateralDiap79

【Embryology】week8～9：divisionofcoelomiccavityintothepleuralandperitonealcavitybythediaphragm;atriangularareaintheposterolateralsitewasleftopen.week10～12：herniationoccurthroughthisopeningintothepleuralcavityatthereturnofmidgut80ppt課件【Embryology】11ppt課件80【pathophysiology】1、HypoplasiaofthelungPulmonaryweight↓(ipsilateral+contralateral)↓

Alveolinumber↓

Hypertrophyofthemediaofpulmonaryarteriole↑

Resistanceofthevessels↑2、PulmonaryhypertensionAbdominalvisceraintothethoraciccavity→Compressionofthelung,PaO2↓PaCO2↑→Acidosis,hypoxemia（PH<7.30）→Pulmonaryvesselsspasm→Vesselresistance↑,righttoleftshuntingthroughpatentductusarteriesandforamenovale↑→Aggravateacidosisandhypoxemiainthebodycirculation(fetalcirculationsyndrome)

81ppt課件【pathophysiology】12ppt課81CDH-PulmonaryHypoplasiaEmbryonicPseudoglandularCanalicularSaccularAlveolar06162636PostnatalWeeksGestationCDHBranchingmorphogenesisArterioles,Bronchioles,AlveoliGasExchange82ppt課件CDH-PulmonaryHypoplasiaEmbr82diaphragmaticherniaClinicalmanifestations：

1，Severerespiratorydistress，cyanosis,vomit2，Breathsounds:diminishedonthesideofhernia3，Heartsounds:deviatedtothecontralateralchest4，Scaphoidabdomen83ppt課件diaphragmaticherniaClinicalm83【diagnosis】PrenataldiagnosisUltrasound:abdominalorganvisibleinthefetalchest84ppt課件【diagnosis】15ppt課件84diagnosisafterbirthX-rayfilm:

Typicalair-filledstomachandbowelsinthechest,whichcontinuesintotheabdominalcavity.Diaphramcannotbeseenattheaffectedside.Absenceorscarcityofintestineintheabdominalcavity85ppt課件diagnosisafterbirth16ppt課件85FetoscopicTrachealOcclusionTrachealOcclusionClip

Inuterorepair

plateauHarrison,NEnglJMe,2003PrenatalTreatmentforCDH

86ppt課件FetoscopicTracheal86TreatmentBeforedelivery:cortisonecouldinducethematurationofpulmonarytissuePreoperativepreparation:（1）mechanicalventilationwithpureoxygen（2）nasogastrictubetodecompressstomachandintestine（3）semi-supineandinclinedtotheipsilateralside，keepwarm（4）i.v.fuild,correctionofacidosis(5）surgicalrepair

87ppt課件TreatmentBeforedelivery:cort87omphalocele88ppt課件omphalocele19ppt課件88gastroschisis89ppt課件gastroschisis20ppt課件89I期還納法90ppt課件I期還納法21ppt課件90I期還納法91ppt課件I期還納法22ppt課件91CongenitalEsophagealAtresiawithTracheoesophagealFistulaIncidence:1/3000associatedanomaliescommonImpedimentofrecanalizationandinterruptionofseptationoftracheaandesophagus

92ppt課件CongenitalEsophagealAtresia92Congenitalesophagealatresia

Ⅰ6％，Ⅱ2％，Ⅲ85％，Ⅳ1％。Ⅴ6％Classification93ppt課件Congenitalesophagealatresia

93【clinicalfindings】1、droolingsaliva,unabletoswallow2、coughandchokeandmaybecomecyanoticafterfeeding3、chemicalandaspirationpneumonia4、abdominaldistentionorscaphoidabdomen94ppt課件【clinicalfindings】25ppt課件94【diagnosis】1、prenataldiagnosis2、nasogastrictubecannotreachstomach.3、X-rayfilmshowthecoilingofthetubeintheuppermediastinum95ppt課件【diagnosis】26ppt課件95

Preoperativepreparationsupineandelevatedto30～40oCatheterwasputattheblindendoftheesophagusforcontinuousdrainageoxygeninhalation,incubatori.v.fluidandbroad-spectrumantibioticssurgicalrepairPrognosis:98%~100%survivalrateforthelastdecade(aboard),allofthecasessurvivedsince2002(ourhospital).96ppt課件Preoperativepreparati96HypertrophicPyloricStenosis【pathophsiology】1、oliveshapedmass：length2～3.5cm，thickness0.4～0.6cm，paleincolorwithconsistencyofcartilage2、Muscularhypertrophyofallthelayersofthepylorus,mostsignificantinthecircularlayer,causingthestenosis97ppt課件HypertrophicPyloricStenosis【97HypertrophicPyloricStenosis【symptoms】1、projectilevomiting:onset:2-3weeksafterbirthandprogressivewithtime;vomitus:non-biliousmilkandmilkcurds2、jaundice：deficiencyinliverenzymeandcompressionofthebiliarytract3、overallcondition:dehydration,weightlose,hypo-chloridemetabolicalkalosis,oliguria

4、abdominalexamination:distentionofepigastrium,visiblegastricwaves,presenceofapalpablepylorictumor(uniquephysicalsign)98ppt課件HypertrophicPyloricStenosis98【Diagnosis】1、Typicalvomitingandmassintheepigastrium2、Ultrasound:muscularthickness≥0.4cm，

SD=thickness×2/diameter≥50％3、GIforcaseswithdifficultyindiagnosis：①distentionofthestomach②stronggastricwaves③elongatedandnarrowpyloricchannel④delayinstomachemptying99ppt課件【Diagnosis】30ppt課件99【Treatment】Surgery————pyloromyotomy100ppt課件【Treatment】31ppt課件100IntestinalObstructionintheNeonate101ppt課件IntestinalObstructioninthe101【Etiology】1、Malrotationofmidgutaroundtheaxisofsuperiormesentericartery2、Intestinalrecanalizationanomaly3、Compromiseofintestinalbloodsupply4、Arrestofthemigrationofneuroblastderivedfromneuralcrestofepiderm5、Viscosityofmeconium:cysticfibrosis6、Maternalfactors:infection,diabetes,pharmaceuticals102ppt課件【Etiology】33ppt課件102【Pathophysiology】1、Lossoffluidfromemesis:dehydration,electrolytedisturbance,acid-baseimbalance2、Aspirationandabdominaldistention:chemicalandbacterialpneumonia,apnea3、Disseminationofenterobacterium:ischemia,necrosis,perforationandsepsis103ppt課件【Pathophysiology】34ppt課件103【Clinicalmanifestation】Charactersofneonateileus:BiliousvomitingAbdominaldistentionFailuretopassmeconiumGeneralcondition：drowsy、hypomyotonia、

tachypnea104ppt課件【Clinicalmanifestation】35ppt課104Commoncausesofneonateintestinalobstruction(Mechanicobstruction)

Extrinsic：intestinalatresiaandstenosis40％annularpancreasMalrotation10～15%intestinalduplicationmeconiumperitonitis（adhesion）internalhernia,incarceratedexternalherniaIntussuceptionIntrinsic：meconiumperitonitismilk