小儿外科教学教材.pptVIP

小儿外科;History of pediatric surgery;小儿外科疑难重症临床中心;Congenital Abnormality(60%);Congenital Posterolateral Diaphragmatic Hernia (CDH); 【Embryology】 week8～9 ： division of coelomic cavity into the pleural and peritoneal cavity by the diaphragm; a triangular area in the posterolateral site was left open. week10～12 ：herniation occur through this opening into the pleural cavity at the return of midgut ; 【pathophysiology】 1、Hypoplasia of the lung Pulmonary weight ↓ (ipsilateral+contralateral)↓ Alveoli number↓ Hypertrophy of the media of pulmonary arteriole ↑ Resistance of the vessels↑ 2、Pulmonary hypertension Abdominal viscera into the thoracic cavity → Compression of the lung, PaO2↓PaCO2↑→ Acidosis, hypoxemia（PH7.30）→ Pulmonary vessels spasm → Vessel resistance↑, right to left shunting through patent ductus arteries and foramen ovale↑→ Aggravate acidosis and hypoxemia in the body circulation (fetal circulation syndrome) ;;diaphragmatic hernia;【 diagnosis 】 Prenatal diagnosis Ultrasound: abdominal organ visible in the fetal chest ;diagnosis after birth X-ray film: Typical air-filled stomach and bowels in the chest, which continues into the abdominal cavity. Diaphram can not be seen at the affected side. Absence or scarcity of intestine in the abdominal cavity;;Treatment;omphalocele;gastroschisis;I期还纳法;I期还纳法;Congenital Esophageal Atresia with Tracheoesophageal Fistula;Congenital esophageal atresia;【 clinical findings】 1、drooling saliva, unable to swallow 2、cough and choke and may become cyanotic after feeding 3、chemical and aspiration pneumonia 4、abdominal distention or scaphoid abdomen;【 diagnosis 】 1、prenatal diagnosis 2、nasogastric tube can not reach stomach. 3、 X-ray film show the coiling of the tube in the upper mediastinum ; Preoperative preparation;Hypertrophic Pyloric Stenosis;Hypertrophic Pyloric Stenosis; 【Diagnosis】 1、Typical vomiting and mass in the epigastrium 2、Ultrasound: muscula