联体婴儿分离手术家属主观幸福感变化及手术伦理学评估

The study for the ethical and change of subjective well-being during separation surgery in family members of conjoined twins

目的探讨联体婴儿分离手术家属主观幸福感变化及与分离手术伦理学实践的关系。方法纳入我科经治3例连体婴儿,均为足月产对称胸腹联体双胎,于我院行联体婴儿分离术,伦理学评价由我院伦理委员会进行。记录患儿直系亲属手术前后及随访期间MUNSH评分变化。结果①3例联体婴儿均顺利接受联体婴儿分离术,其中例2中小双因严重心脏畸形术后48h因心衰、呼衰死亡;②3例联体婴儿分离术后发育正常,未见手术并发症;③术后患儿直系亲属MUNSH评分评分显著高于术前(P<0.05)。结论联体婴儿分离术是涉及生命权和健康权的社会伦理问题,因重视分离术术前伦理学评价。连体婴儿分离术的进行应尊重家属意见、社会背景、文化差异及手术风险等多因素进行评价。

Objective To investigate the change the subjective well-being in family members of conjoined twins and to discuss the ethical practice during separation operation.Methods There pairs of full-term symmetrical conjoined twins between chest and abdomen with separation operation in our hospital were enrolled in this study.Ethics evaluation conducted by the Ethics Committee of our hospital.The change of MUNSH score in family members of them during separation were recorded.Results ①3 patients were successfully received separation operation,among them,the small one in case two died at 48 hours after operation due to heart and respiratory failure;② All infants developed normally after separation without surgical complication;③ the MUNSH scores in family members of conjoined twins after separtion were significantly higher than before（P〈0.05）.Conclusion With the emphasis on ethical evaluation of preoperative separation,the separation operation of conjoined twins is a ethical issue involving the right to life and health.A variety of factors such as the view of family members,social backgrounds,cultural differences should be considered to Ethics evaluation.