联体畸形的诊断与治疗方法探讨

Diagnosis and treatment of conjoined twins a report of 2 cases

目的 探讨联体畸形的诊断和治疗方法 ,增进对该少见疾病的认识 ,提高疗效 ,以及生存率。方法 采用B超、CT及消化道钡餐等检查 ,判定内脏连接情况 ,手术分离 2对联体畸形婴儿。2对病例分别为剑脐联体畸形及胸腹联体畸形 ,均有肝脏连接 ,但胆囊及胆管各自独立 ,于生后第 2 8d、第 96d时分别实施分离手术 ,对于肝脏连接的处理 ,采用“局部血流阻断法” ,行共用肝离断术。结果 2对联体畸形经充分术前准备 ,均手术分离成功 ,术后患儿生长及发育正常。经采用局部血流阻断共用肝离断术方法 ,术中出血少 ,术后肝功能恢复顺利。结论 联体畸形较为罕见 ,充分的术前准备及合理的分离术式可提高患儿的双双存活率。局部血流阻断共用肝离断术 ,仅阻断了离断线局部的肝脏血流 ,对非操作区的肝脏血液供应毫无影响。

Objective To study the diagnosis and treatment of conjoined twins and improve the survival rate.Methods Two cases of conjoined twins of sternoxiphopagus and thoracoabdominalpagus underwent surgical separation at the age of 28d and 96d respectively. The conjoined state of viscera were detected using B-ultrasonography?computerized tomography(CT) scan and barium meal .The band of connecting tissue contained a bridge of liver with isolate cholecyst and bile duct. The liver were separated by blocking the local blood stream with less bleeding during operation.Results Two cases of conjoined twins were separated successfully and alive with normal liver function.Conclusions Conjoined twins are rare common. Complete preoperative preparation, effective surgical separation and blocking of the local blood stream of connecting liver bridge can increase the survival rate of twins of sternoxiphopagus and thoracoabdominalpagus.