ObjectiveTo explore the clinical efficacy and share the experience of Da Vinci robot assisted choledochal cyst resection in children. MethodThe data of children including preoperative, intraoperative, and postoperative details who underwent Da Vinci robot assisted choledochal cyst resection in the Department of Pediatric Surgery, West China Hospital of Sichuan University from April 2018 to June 2022 were collected and analyzed. ResultsA total of 200 patients were collected in this study, 54 of whom were males and 146 were females. The male to female was 1∶2.70. The age was (46±33) months and the body weight was (15.77±7.10) kg. The main symptoms were abdominal pain (136 cases, 68.0%), jaundice (62 cases, 31.0%), abdominal distension (20 cases, 10.0%), and abdominal mass (23 cases, 11.5%). The diameter of cyst was (3.46±2.01) cm. There were 153 cases of type Ⅰa, 35 cases of type Ⅰc, 1 case of type Ⅱ, and 11 cases of type Ⅳ. The operation time was (179.9±10.3) min, the intraoperative fluid infusion was (397.4±26.4) mL, the intraoperative blood loss was (21.5±10.9) mL, the liquid intake time was (3.01±0.35) d, the solid intake time was (3.80±0.27) d, and the postoperative hospitalization time was (7.44±0.94) d. The intraoperative blood transfusion was performed in 4 cases (2.0%). There were 7 cases (3.5%) of postoperative complications, including 2 cases of biliary leakage, 2 cases of incomplete intestinal obstruction, and 1 case of anastomotic bleeding, which were improved by conservative treatment. Anastomotic stenosis occurred in 1 case, and the Roux-en-Y anastomosis was performed again. Biliary loop torsion obstruction occured in 1 case, which received reoperation restoring the biliary loop and closing the mesangial fissure. ConclusionsFrom the results of this study, Da Vinci robotic surgical system can obviously reduce the difficulty of choledochal cyst resection in children. It has the advantages of safe, beautiful incision, clear exposure, rapid recovery, and less complications.
ObjectiveTo summarize the treatment and experience of percutaneous transhepatic portal vein recanalization by endovascular approach for treatment of cavernous transformation of the portal vein (CTPV) in a child. MethodThe clinical data of a child with idiopathic CTPV who underwent percutaneous transhepatic portal vein recanalization by endovascular approach were retrospectively analyzed. ResultsWe described a novel percutaneous transhepatic portal vein recanalization approach that had successfully treated a child with idiopathic CTPV following a multidisciplinary team evaluation. The operation time was 1.5 h and blood loss was approximately 1 mL. The child recovered uneventfully at 9-month follow-up, without any clinical evidence of CTPV complications. ConclusionIn light of our successful management, we can envision that the portal vein recanalization is an important therapeutic supplement for treating CTPV and will result in a paradigm change.
ObjectiveTo systematically review the detection rate of cognitive impairment in Chinese patients with type 2 diabetes mellitus (T2DM).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were searched to collect studies on the detection rate of cognitive impairment in Chinese patients with T2DM from inception to January 20th, 2021. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was then performed using Stata 12.0 software.ResultsA total of 27 studies involving 7 920 cases were included. Meta-analysis results showed that the total detection rate of cognitive impairment in Chinese patients with T2DM was 43.2% (95%CI 36.9% to 49.6%). The results of subgroup analysis showed that in T2DM patients, the detection rate of cognitive impairment in males was 42.4% (95%CI 34.4% to 50.4%), and that in females was 48.2% (95%CI 40.9% to 55.6%). The detection rate of cognitive impairment was 25.4% (95%CI 14.7% to 36.0%) in patients under the age of 60 years, and 47.0% (95%CI 30.0% to 64.0%) in patients aged 60 years or above. The detection rate of cognitive impairment among those with primary school education level or below was 67.1% (95%CI 48.9% to 85.3%). The detection rate of cognitive impairment was 37.1% (95%CI 27.3% to 46.8%) among those with education level of junior high school or above. The detection rate of cognitive impairment in patients with disease duration less than 10 years was 28.4% (95%CI 16.0% to 40.9%) and that in patients with disease duration more than 10 years was 50.6% (95%CI 33.2% to 68.0%). The detection rate of cognitive impairment in married individuals was 45.6% (95%CI 35.8% to 55.4%) and that in singles was 68.1% (95%CI 57.5% to 78.7%). The detection rate of cognitive impairment in smokers was 38.9% (95%CI 30.7% to 47.2%) and in non-smokers was 40.9% (95%CI 32.1% to 49.6%). The detection rate of cognitive impairment in drinkers was 35.6% (95%CI 27.3% to 44.0%) and that in non-drinkers was 41.8% (95%CI 32.2% to 51.4%).ConclusionsThe detection rate of cognitive impairment in Chinese patients with T2DM is high. Due to the quantity and quality of included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo summarize the clinical experience of retropancreatic tunnel established by superior mesenteric vein-approach in a child with cavernous transformation of the portal vein (CTPV) during Rex bypass. MethodThe retropancreatic tunnel was created by the superior mesenteric vein-approach during Rex bypass in a child with CTPV who was admitted to our hospital in September, 2023. Clinical data were retrospectively analyzed. ResultsFor the 4-year-old male child who was diagnosed with CTPV, after the establishment of the retropancreatic tunnel by superior mesenteric vein-approach, the portal vein was quickly identified, thus simplifying the portal dissection. The operation time of Rex bypass was about 8 hours, and intraoperative blood loss was about 60 mL. After a 3-month follow-up, the child recovered well with patent bypass vessels. ConclusionThe surgical strategy proposed by our team can simplify the Rex bypass, resulting in more rapid and safe access to the vascular anastomosis site.