小儿外科教学教材.ppt

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1、小儿外科HistoryofpediatricsurgeryEstablishmentofpediatricsurgeryAboard:endof1940s,China:beginningof1950sspecialtiesnowinclude：generalsurgeryneonatesurgeryorthopedicsurologythoracic&cardiacsurgeryoncologyneurosurgery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

2、外科CongenitalAbnormality(60%)Defectsintheabdominalwall(diaphragmatichernia,gastroschisis,omphalocele)Neurologicalsystem(brain,spinalcord,etc.)CardiovascularandpulmonaryabnormalityMalformationofdigestivesystemMalformationofurologicalandreproductivesystemLimbsandver

3、tebraabnormalityCongenitalPosterolateralDiaphragmaticHernia(CDH)OneofmostsevereconditionsofneonateDefectindiaphragmduringearlyfetaldevelopmentleftsidemostcommonlyaffectedcontentofthehernia:smallbowelcolonspleenstomachliver,kidney,tailofpancreatic【Embryology】week8

4、～9：divisionofcoelomiccavityintothepleuralandperitonealcavitybythediaphragm;atriangularareaintheposterolateralsitewasleftopen.week10～12：herniationoccurthroughthisopeningintothepleuralcavityatthereturnofmidgut【pathophysiology】1、HypoplasiaofthelungPulmonaryweight↓(i

5、psilateral+contralateral)↓Alveolinumber↓Hypertrophyofthemediaofpulmonaryarteriole↑Resistanceofthevessels↑2、PulmonaryhypertensionAbdominalvisceraintothethoraciccavity→Compressionofthelung,PaO2↓PaCO2↑→Acidosis,hypoxemia（PH<7.30）→Pulmonaryvesselsspasm→Vesselresistan

6、ce↑,righttoleftshuntingthroughpatentductusarteriesandforamenovale↑→Aggravateacidosisandhypoxemiainthebodycirculation(fetalcirculationsyndrome)CDH-PulmonaryHypoplasiaEmbryonicPseudoglandularCanalicularSaccularAlveolar06162636PostnatalWeeksGestationCDHBranchingmorp

7、hogenesisArterioles,Bronchioles,AlveoliGasExchangediaphragmaticherniaClinicalmanifestations：1，Severerespiratorydistress，cyanosis,vomit2，Breathsounds:diminishedonthesideofhernia3，Heartsounds:deviatedtothecontralateralchest4，Scaphoidabdomen【diagnosis】Prenataldiagno

8、sisUltrasound:abdominalorganvisibleinthefetalchestdiagnosisafterbirthX-rayfilm:Typicalair-filledstomachandbowelsinthechest,whichcontinuesintotheabdominalcavity