小儿外科课件

PediatricSurgery1ppt课件PediatricSurgery1ppt课件1PediatricSurgeryResponsibleforthetreatmentandpreventionofsurgicalconditionsinfetus28weeksofgestationtoadolescentatpuberty.Includingtherelatedbasicmedicaltheoriesandresearches.

AbnormalityTraumaInfectiousTumour2ppt课件PediatricSurgeryResponsiblef2精品资料精品资料3你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘……”“太阳当空照，花儿对我笑，小鸟说早早早……”小儿外科课件4精品资料精品资料5你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘……”“太阳当空照，花儿对我笑，小鸟说早早早……”小儿外科课件6HistoryofpediatricsurgeryEstablishmentofpediatricsurgeryAboard:endof1940s,China:beginningof1950sspecialtiesnowinclude：

generalsurgeryneonatesurgeryorthopedicsurologythoracic&cardiacsurgeryoncologyneurosurgery7ppt课件HistoryofpediatricsurgeryEs7小儿外科疑难重症临床中心

临床中心学科结构图

微创外科中心

血液肿瘤中心

肝病中心

心血管中心

遗尿中心

产瘫中心

神经外科8ppt课件小儿外科疑难重症临床中心临床中心学科结构图8CongenitalAbnormality(60%)Defectsintheabdominalwall(diaphragmatichernia,gastroschisis,omphalocele)Neurologicalsystem(brain,spinalcord,etc.)CardiovascularandpulmonaryabnormalityMalformationofdigestivesystemMalformationofurologicalandreproductivesystemLimbsandvertebraabnormality9ppt课件CongenitalAbnormality(60%)Def9CongenitalPosterolateralDiaphragmaticHernia(CDH)OneofmostsevereconditionsofneonateDefectindiaphragmduringearlyfetaldevelopmentleftsidemostcommonlyaffectedcontentofthehernia:smallbowelcolonspleenstomachliver,kidney,tailofpancreatic10ppt课件CongenitalPosterolateralDiap10

【Embryology】week8～9：divisionofcoelomiccavityintothepleuralandperitonealcavitybythediaphragm;atriangularareaintheposterolateralsitewasleftopen.week10～12：herniationoccurthroughthisopeningintothepleuralcavityatthereturnofmidgut11ppt课件【Embryology】11ppt课件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课件【pathophysiology】12ppt课12CDH-PulmonaryHypoplasiaEmbryonicPseudoglandularCanalicularSaccularAlveolar06162636PostnatalWeeksGestationCDHBranchingmorphogenesisArterioles,Bronchioles,AlveoliGasExchange13ppt课件CDH-PulmonaryHypoplasiaEmbr13diaphragmaticherniaClinicalmanifestations：

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

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

Inuterorepair

plateauHarrison,NEnglJMe,2003PrenatalTreatmentforCDH

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

18ppt课件TreatmentBeforedelivery:cort18omphalocele19ppt课件omphalocele19ppt课件19gastroschisis20ppt课件gastroschisis20ppt课件20I期还纳法21ppt课件I期还纳法21ppt课件21I期还纳法22ppt课件I期还纳法22ppt课件22CongenitalEsophagealAtresiawithTracheoesophagealFistulaIncidence:1/3000associatedanomaliescommonImpedimentofrecanalizationandinterruptionofseptationoftracheaandesophagus

23ppt课件CongenitalEsophagealAtresia23Congenitalesophagealatresia

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

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

Preoperativepreparationsupineandelevatedto30～40ºCatheterwasputattheblindendoftheesophagusforcontinuousdrainageoxygeninhalation,incubatori.v.fluidandbroad-spectrumantibioticssurgicalrepairPrognosis:98%~100%survivalrateforthelastdecade(aboard),allofthecasessurvivedsince2002(ourhospital).27ppt课件Preoperativepreparati27HypertrophicPyloricStenosis【pathophsiology】1、oliveshapedmass：length2～3.5cm，thickness0.4～0.6cm，paleincolorwithconsistencyofcartilage2、Muscularhypertrophyofallthelayersofthepylorus,mostsignificantinthecircularlayer,causingthestenosis28ppt课件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课件HypertrophicPyloricStenosis29【Diagnosis】1、Typicalvomitingandmassintheepigastrium2、Ultrasound:muscularthickness≥0.4cm，

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

tachypnea35ppt课件【Clinicalmanifestation】35ppt课35Commoncausesofneonateintestinalobstruction(Mechanicobstruction)

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

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

normallymeconiumwaspassedwithinthefirst24hrsoflifeandclearedin2-3days.

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

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

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

Malrotationisthetermusedtodefinethegroupofcongenitalanomaliesresultingfromaberrantintestinalrotationandfixation【Embryology】

Week6~8:Herniationofmidgutintotheumbilicalcordwitha180degreeofcounterclockwiserotationalongtheaxisofsuperiormesentericartery

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

CompressionofduodenumKinkedandforeshortenedproximaljejunumbyperitonealbandMidgutvolvulus47ppt课件MalrotationPathology：47ppt课件47【Clinicalmanifestations】

Emesis：bilious,intermittent，occurat3-5daysafterbirthorasymptomatic

Abdominaldistention:confinedinepigastrium,diffusetothefullabdomeninbowelnecrosis

Stool:normalmeconium,bloodystoolsuggestsvolvulusandnecrosis

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

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

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

AsymptomaticmalrotationmostrecommendsurgicaltreatmentsomebelieveoperationonlynecessaryinyoungchildrenHighintestinalobstruction

operatedonpromptly,butnotnecessarilyemergently

Voluluswithsignofbowelnecrosis

immediateoperation

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

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

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

1、spasmofaffectedsegmentnonormalperistalsis2、internalsphincterspasmnonormaldefecationreflex

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

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

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

simplicityofthemethodaccuracyinneonate80％

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

59ppt课件59ppt课件59

Histologicstainingofmucosa

IncreasedAChEcontentinthenervefibersofthelaminapropriaandmuscularismucosaeFull-thicknessRectalBiopsy

Complexityandcomplications,possibleeffectonfuturedefinitivesurgery

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

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

＃Donotusewater2、Colostomy：3、Surgicaloptions

SwensonDuhamalRehbeinSoave

Neonatalsurgery

Laparoscope's

Transanalpullthrough

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

Wingspreadclassification:accordingtotherelativepositionofretalendtotheelevaterani：

high:aboveelevateraniintermediate:withinelevateranilow:passthroughelevateraniFurtherclassificationaccordingtothefistula

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

Wingspreadclassificationof

AnorectalMalformations68ppt课件KeywordsCDHpathophysiologya68

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

AbnormalityTraumaInfectiousTumour71ppt课件PediatricSurgeryResponsiblef71精品资料精品资料72你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘……”“太阳当空照，花儿对我笑，小鸟说早早早……”小儿外科课件73精品资料精品资料74你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘……”“太阳当空照，花儿对我笑，小鸟说早早早……”小儿外科课件75HistoryofpediatricsurgeryEstablishmentofpediatricsurgeryAboard:endof1940s,China:beginningof1950sspecialtiesnowinclude：

generalsurgeryneonatesurgeryorthopedicsurologythoracic&cardiacsurgeryoncologyneurosurgery76ppt课件HistoryofpediatricsurgeryEs76小儿外科疑难重症临床中心

临床中心学科结构图

微创外科中心

血液肿瘤中心

肝病中心

心血管中心

遗尿中心

产瘫中心

神经外科77ppt课件小儿外科疑难重症临床中心临床中心学科结构图77CongenitalAbnormality(60%)Defectsintheabdominalwall(diaphragmatichernia,gastroschisis,omphalocele)Neurologicalsystem(brain,spinalcord,etc.)CardiovascularandpulmonaryabnormalityMalformationofdigestivesystemMalformationofurologicalandreproductivesystemLimbsandvertebraabnormality78ppt课件CongenitalAbnormality(60%)Def78CongenitalPosterolateralDiaphragmaticHernia(CDH)OneofmostsevereconditionsofneonateDefectindiaphragmduringearlyfetaldevelopmentleftsidemostcommonlyaffectedcontentofthehernia:smallbowelcolonspleenstomachliver,kidney,tailofpancreatic79ppt课件CongenitalPosterolateralDiap79

【Embryology】week8～9：divisionofcoelomiccavityintothepleuralandperitonealcavitybythediaphragm;atriangularareaintheposterolateralsitewasleftopen.week10～12：herniationoccurthroughthisopeningintothepleuralcavityatthereturnofmidgut80ppt课件【Embryology】11ppt课件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课件【pathophysiology】12ppt课81CDH-PulmonaryHypoplasiaEmbryonicPseudoglandularCanalicularSaccularAlveolar06162636PostnatalWeeksGestationCDHBranchingmorphogenesisArterioles,Bronchioles,AlveoliGasExchange82ppt课件CDH-PulmonaryHypoplasiaEmbr82diaphragmaticherniaClinicalmanifestations：

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

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

Inuterorepair

plateauHarrison,NEnglJMe,2003PrenatalTreatmentforCDH

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

87ppt课件TreatmentBeforedelivery:cort87omphalocele88ppt课件omphalocele19ppt课件88gastroschisis89ppt课件gastroschisis20ppt课件89I期还纳法90ppt课件I期还纳法21ppt课件90I期还纳法91ppt课件I期还纳法22ppt课件91CongenitalEsophagealAtresiawithTracheoesophagealFistulaIncidence:1/3000associatedanomaliescommonImpedimentofrecanalizationandinterruptionofseptationoftracheaandesophagus

92ppt课件CongenitalEsophagealAtresia92Congenitalesophagealatresia

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

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

Preoperativepreparationsupineandelevatedto30～40ºCatheterwasputattheblindendoftheesophagusforcontinuousdrainageoxygeninhalation,incubatori.v.fluidandbroad-spectrumantibioticssurgicalrepairPrognosis:98%~100%survivalrateforthelastdecade(aboard),allofthecasessurvivedsince2002(ourhospital).96ppt课件Preoperativepreparati96HypertrophicPyloricStenosis【pathophsiology】1、oliveshapedmass：length2～3.5cm，thickness0.4～0.6cm，paleincolorwithconsistencyofcartilage2、Muscularhypertrophyofallthelayersofthepylorus,mostsignificantinthecircularlayer,causingthestenosis97ppt课件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课件HypertrophicPyloricStenosis98【Diagnosis】1、Typicalvomitingandmassintheepigastrium2、Ultrasound:muscularthickness≥0.4cm，

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

tachypnea104ppt课件【Clinicalmanifestation】35ppt课104Commoncausesofneonateintestinalobstruction(Mechanicobstruction)

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