As I write this, I feel sad because I feel heartache at the thought of the children I see in the outpatient clinic. I couldn't bear to think about their future lives, maybe some of them were gone, and in order to reduce this tragedy, I decided to write their stories.
Case 1 : "Doctor, what should I do if my child has a kidney?" "Kidney? What kidneys? I was confused. The parent pulls the child's pants down, points to the perineum and says, "Show me. "How old is the child?" At a glance, I saw the child's scrotum dysplasia, and two words immediately popped into my head: cryptorchidism. Reach out and touch, sure enough, the right egg is at the mouth of the outer ring, the left one is not touched, let the parents carry the child to the examination table, and then carefully check, but did not touch. The child's parents looked nervous and said, "4 years and 3 months. I thought to myself, It's so big!
Cryptorchidism, pediatric surgery knows: after 6 months of cryptorchidism is difficult to decline on its own, so treatment can be started after 6 months of birth, and cryptorchidism surgery should be completed within 18 months, because the treatment time will affect sperm production, hormone secretion, and the risk of tumors in adulthood. And some histopathology pointed out: the cryptorchidism testis has obvious changes from the second year of life. It is mainly manifested as a disorder of germ cell development, and the number of interstitial cells is also reduced. And the pathological changes of cryptorchidism become more obvious with age.
And I thought about it, and I said, "Haven't you been to the hospital before?" The child's parents swallowed and said, "The child is still young..." I prescribed the child a cryptorchidism ultrasound, holding a little luck, hoping that I had a mistake. But when my parents handed me the ultrasound results and saw that the testicle size described on it corroborated with my examination, I couldn't bear it. Our department performed testicular descending fixation surgery on the child, and the intraoperative exploration found that the right testicle was dysplasia, and the testicular epididymis was separated, and the left testicle had shrunk into a nodular shape. The childish "aunt" of the child at the first meeting echoed in my ears, and I couldn't bear to think, if a boy has no fertility function, then he will be in the future...
Case 2 : In the outpatient clinic, the parent holds a tightly wrapped child with an anxious face and says, "Doctor, please help me see. "When I opened the swaddling, I saw a little black and yellow face, a swollen belly, and the vein lines on it." How old is the child? What color is pulled? "It's been seven months, and it's white. "Why did you come to the hospital now? The words blurted out unconsciously carried a reproachful tone.
Because the diagnosis of biliary atresia has taken shape in my brain, it is an extremely serious disease, difficult to diagnose and treat, and the prognosis is poor. And the best time for surgery is within 60 days after birth, within 60 days! Calculated in days! Because children over 90 days of disease, the liver will be irreversibly damaged, and rapidly progress to cirrhosis, the surgical effect is reduced, for children larger than 120 days, the surgical effect is even worse, almost only liver transplantation is the way to live. "The child is small, and we are far away..."
I arranged for the child to have a color ultrasound examination of the biliary system specialty, and the results were consistent with the diagnosis of biliary atresia, and told the family about the child's current condition and treatment plan, mainly liver transplantation. Before the condition was explained halfway, the child's mother cried, crying and scolding the child's father, "I told you to come to the big city early, come early, you have to say you have to wait, wait..."
Case 3 : The most vivid memory is of a Tibetan boy, because when the outpatient call was called, five or six people dressed in Tibetan ethnic costumes suddenly poured in, except for the child's mother. The child's parents did not know Chinese, and his uncle acted as an interpreter, saying that the child could not solve the poop. Analless? Intestinal atresia? Ileus? Megacolon? Tumor...... A range of possible illnesses crossed my mind, and I asked, "How old is the child?" "Two years and one month. As the child's clothes were untied, I saw a bulging belly. Ask the parents to put the child on the examination table, and during the consultation, they know that the child's constipation is a matter of recent months, and there is no history of surgery.
I'm going to do a digital rectal exam first. When the family member bent the child's leg to turn it sideways, I saw a piece of plaster attached to the child's sacral tail, "This is? The child's uncle asked the child's mother, and the translator said, "The skin was broken, and the medicine was applied. I didn't care, decided to do a finger examination first, about 6cm from the anus, the fingertips touched a hard mass, very large, from the back wall of the rectum and pressed against the rectum, difficult to enter the fingers, I took off the gloves, in the child's crying with the breath massage abdomen, the child's lower abdomen can also palpate a hard mass. I dangled the plaster in front of my eyes, and I gently uncovered it, and my skin broke and infected. At this time, it is almost certain that the child has a sacrococcygeal teratoma, Altman type three, accounting for about 9% of the total number of sacrococcygeal teratomas.
How could it be so serious to come to the hospital, I thought it was incredible, so I pointed to the tumor rupture and asked, "There is a protruding piece here, didn't I go to the hospital?" The child's uncle asked the child's mother while translating, "I went to our hospital a few months ago, and said that the child was small, so I should observe first... The skin was broken, and the medicine was prescribed, and I said I would look at it later..."
I gave my child CT and tumor marker tests, and the family has left the room. As I washed my hands, I recalled: teratomas, about 80% benign, 20% malignant, the incidence of malignant teratomas is not only related to classification, but also related to age and sex at diagnosis, the incidence of malignant changes in infants greater than 6 months is significantly higher than in newborns, and malignant changes in boys seem to be more common. And this child, this child...
If I haven't encountered a similar case, I can't help but feel sad. In life, not every pair of parents is so lucky, The children born are perfect, and there are many newborns who are like apples bitten by God, Come into the world with one, two or more physical defects, such as congenital gastrointestinal atresia, congenital heart disease, congenital hydronephrosis, congenital polydactyly, etc., Some diseases that even if you are not a pediatric surgeon, you can see at a glance that you need immediate treatment, such as esophageal atresia, such as hypertrophic pyloric stenosis, such as..., Some congenital diseases need to be observed first, and then treated until the age is adapted, such as some soft tissue tumors, such as occult penis, such as polydactyly/toe deformity...
In view of the particularity of children's diseases, which diseases need to be operated on when is closely related to the degree of awareness of the disease and the local medical conditions, and in order to reduce some regrets that may result, the author consulted relevant literature guidelines to summarize the appropriate time for surgery for common congenital malformations in children.
Gastrointestinal atresia, atresia, biliary atresia, teratomas, various malignant tumors - surgery after diagnosis;
Various malignant congenital heart diseases – early surgery;
cleft lip – March-6 months;
cleft palate – 2-4 years old;
tongue tie too short – < 1 year old;
Inguinal hernia – our hospital ≥ June, as soon as possible after diagnosis abroad;
umbilical hernia – > 2 years old;
hydrocele – > 2 years of age;
cryptorchidism – June-18 months;
torticollis – > 1 year old;
spina bifida – June >;
Hip dislocation – traction brace fixation at < 2 years of age, surgery at > age 2;
hypospadias – 2-6 years old;
Polydactyly (toe) - about 1 year old;
Microtia – 6-8 years of age or adulthood.
Disclaimer: If there is any deficiency fallacy, please correct it!