胸腹联体儿分离术后的早期监护

目的 探讨胸腹联体双胎婴儿分离术后早期监护特点。方法 1例胸腹联体婴儿在96d时接受分离手术，术后进行监护室，进行特别护理。分析呼吸道支持和管理，肝脏功能观察与保护，创缘的观察与处理，营养支持与喂养等特点。结果 经过严密观察，及时对症处理，两婴均无严重并发症，顺利转出监护室，并痊愈出院。结论 胸腹联体双胎婴儿极为罕见，分离术后加强早期监护是保障手术成功的重要环节。     

胸腹联体婴儿成功分离的护理组织管理

联体双胎为一罕见的先天畸形,系单卵双胎于妊娠早期未能完全分离或分离不成功所致,其患病率为1/50 000～100 000,大多数胚胎时或出生后即死亡.能成功进行分离手术,且术后两婴儿均存活的相当罕见[1-2].我院2004年2月和2007年7月,在充分准备下,为两例胸腹联体婴儿实施了分离手术并获成功,术后患儿恢复较好,现将两例胸腹联体婴儿手术分离的围手术期护理组织管理体会介绍如下.胸腹联体婴儿 分离术 护理 组织管理     

1例胸腹联体双胎分离术的全程护理

目的通过胸腹联体双胎婴儿的术前护理、术中配合护理、术后护理,提供联体女婴分离术的全程护理措施。方法通过1年的护理观察、喂养,根据手术预案列之相应的护理配合预案,术后专人监护,加强循环、呼吸及肝脏功能的监测,创面的保护,实施合理的喂养与营养支持。结果经过术前的精心喂养,术中、术后精密的护理预案的制定与落实,两婴均顺利出院。结论胸腹联体双胎婴儿极为罕见,术前合理喂养、正确评估,术中良好配合,术后精心护理,落实各项预案,是手术成功的关键。     

1例胸腹联体双胎分离术的全程护理

目的 通过胸腹联体双胎婴儿的术前护理、术中配合护理、术后护理,提供联体女婴分离术的全程护理措施.方法 通过1年的护理观察、喂养,根据手术预案列之相应的护理配合预案,术后专人监护,加强循环、呼吸及肝脏功能的监测,创面的保护,实施合理的喂养与营养支持.结果 经过术前的精心喂养,术中、术后精密的护理预案的制定与落实,两婴均顺利出院.结论 胸腹联体双胎婴儿极为罕见,术前合理喂养、正确评估,术中良好配合,术后精心护理,落实各项预案,是手术成功的关键.     

1 例骶尾部联体患儿分离手术的护理

<正>联体婴儿是一种罕见的、并在重建方面具有挑战性的先天性畸形之一。联体儿系单卵双胎于妊娠早期未能完全分离或分离不成功所致[1]。绝大多数联体婴儿为胸腹连体,臀部连体的病例较少见。存活被分离的联体儿大多是女孩,女孩与男孩的比例为3∶1[2]。至今全世界约有600对的联体婴儿生存。我院于2015年6月9日为1例骶尾部、臀部直肠联体婴儿成功的进行了手术分离,其中术中护理对术后恢复起到极其重     

1例胸腹联体儿分离术后的康复护理

联体双胎为一种罕见的先天畸形,其发生率为1／5万～1／10万,适合手术分离的病例极少。能成功进行胸腹联体分离手术,术后俩婴儿均存活的相当罕见。我院于2007年2月8日为1例胸腹联体儿成功进行分离手术,于2007年4月9日出院。后因走路步态异常1年余,联体双胎之大者于2010年5月7日在全身麻醉下行胸廓畸形矫正术,     

超声检查在胸腹联体婴儿分离围手术期的应用

目的通过对胸腹联体婴儿的超声检查,探讨其在胸腹联体婴儿分离围手术期的应用价值。方法术前通过常规超声对联体双胎婴儿进行检查,结合CT、MRI作出诊断,术中通过超声监测指导手术,并通过多学科协作完成手术,术后进行超声复查。结果第1例联体婴儿经超声等检查后实施分体术,其中一婴实施两次先心病手术获成功,病变与术前诊断一致,目前两婴健康存活。第2例在术前超声等影像检查及术中超声指导下分体成功,其中一婴于术后78d继发感染死亡,另一婴生存良好。结论超声在联体婴儿分离围手术期发挥着非常重要的作用,是一不可替代的检查手段。     

1例坐骨联体儿分离术后的早期重症监护

新生儿中联体儿发病率是3/10万,女性大于男性2倍多,死亡率91.5%.能接受手术的较少,能成功进行分离且术后婴儿存活的更罕见[1].其中坐骨联体尤其罕见,仅占所有联体婴儿的6%[2].国内坐骨联体儿分离手术,未见双双存活案例.我院2009年10月19日收治1例坐骨联体女婴,并于2009年11月17日进行联体双胎分离术,术后送综合ICU进行监护.经过积极治疗与护理,患儿病情稳定,于11月22日转普通儿外科继续治疗,现已痊愈出院.我们将两患儿术后早期重症监护体会进行总结,现报道如下.     

1例胸腹联体婴儿分离术的围手术期监护

联体双胎系单卵双胎于妊娠早期未能完全分离或分离不成功所致.联体婴儿是一种罕见而复杂的先天畸形,新生儿中联体儿发病率是0.001%～0.002%,女性大于男性2倍多,死亡率达91.5%[1].手术分离难度大,需多科室合作完成.我院于2010年7月收治了1对胸腹联体女婴,手术分离成功,现报道如下.     

胸腹联体儿肝脏分离术后肝功能的观察与护理

报告了胸腹联体、肝脏融合联体女婴行肝脏分离术后肝功能的观察与护理。联体儿于生后12d实施小部分胸骨、心包分离及肝脏融合分离术。术后经密切监护生命体征,观察皮肤黄染、尿便颜色,控制感染发生,及时合理喂养,促进胆红素代谢,做好基础护理等。联体婴儿的切口愈合良好,肝功能维持在正常范围,术后18d痊愈出院。     

First trimester diagnosis of dicephalic parapagus conjoined twins via transvaginal ultrasonography

Conjoined twins are rare, and most cases are thoracopagus. Parapagus conjoined twins (one body with two heads) are extremely rare. We report a case of dicephalic parapagus twins that was diagnosed in the first trimester at 10 weeks via transvaginal ultrasonography.     

医学影像学在诊断先天性联体畸形中的价值

目的：探讨医学影像学在诊断先天性联体畸形中的价值，以便做好分离术前准备。材料与方法：收集我院两例联体婴儿的消化道造影、CT、MRI、核医学等影像学资料，分析各自特异性表现。结果：联体婴儿1肝脏相连，心包有轻度的粘连，相连的肝脏没有大血管交通，其代谢、功能正常，各自具有完整独立的胆道系统、消化系统、泌尿系统。联体婴儿2心脏、肝脏相连,其它部位没有相连。结论：联体婴儿的影像学资料比较全面地反映了相连脏器的相连程度及其血管沟通和代谢、功能情况，能够较准确地指导分离手术方案的制定,医学影像检查的综合应用是联体畸形分离术成功的重要保障。     

Assessment and management of conjoined twins

Although a rare anomaly, conjoined twins provide a unique challenge to the health care professional. At times, the ethical issues present difficult dilemmas for parents and hospital staff. An awareness of the moral dilemmas that tax the emotions of the most experienced hospital staff is the first step toward providing the appropriate support to these families. Nurses must have an understanding of the classification of conjoined twins and the preoperative and postoperative management. Additionally, awareness of the special needs of the family prior to discharge both before and after surgical separation allows for meeting comprehensive care needs. Although the process toward the separation of these twins can be complex, the overall outcome is rewarding.     

胸腹联体双胎合并一胎心脏畸形临床精准诊治

目的：介绍1对胸腹联体儿合并一胎心脏畸形的特殊治疗体会。方法：选择复旦大学附属妇产科医院产前诊断并出生、在复旦大学附属儿科医院接收治疗的1对胸腹联体双胎，其中一胎合并心脏畸形，总结相关诊疗经过，分析特殊临床表现及治疗的个体化方案。结果：足月剖宫产，两患儿临床表现尿量差异大、体重增加稍缓慢，且先心患儿在出生后1月开始出现哭吵后青紫，于出生后38天行分离术;分离术后9天，先心患儿再次行B-T分流术。分离术后2周，无先心患儿顺利出院。先心患儿B-T分流术后20天亦顺利出院。结论：胸腹联体虽是最常见联体类型，但合并心脏畸形增加手术风险，需结合心脏疾病程度与临床表现，调整治疗方案及实施。联体儿需个体化诊疗提高救治成功率。     

Neurointerventional participation in craniopagus separation

Craniopagus-type conjoined twins (joined at the head) are exceedingly rare. Separation of craniopagus conjoined twins is a challenging task mainly owing to complex vascular anatomy and limited experience with this disorder. Modern neuroimaging techniques including digital subtraction angiography can be used to preoperatively assess the cerebral vascular system. These techniques can also provide the raw data to fabricate three-dimensional true-scale models. We report a case in which endovascular techniques have been used in the separation of craniopagus conjoined twins. To our knowledge there are no reports of successful incorporation of neurointerventional methods in the disconnection of shared venous channels.     

Prenatal evaluation of cephalopagus conjoined twins by means of three-dimensional ultrasound at 13 weeks of pregnancy.

Cephalopagus twinning, an extremely rare type of conjoined twins, is characterized by the anterior union of the upper half of the body, with two faces each situated on the opposite side of a conjoined head. The prognosis for cephalopagus twins is extremely poor because surgical separation is not an option. Thus early prenatal diagnosis of cephalopagus twins is important to provide an opportunity for pregnancy termination if desired. However, in many instances, cephalopagus twins are misdiagnosed as a singleton pregnancy because of the extreme degree of fusion which makes accurate demonstration of the abnormalities very difficult. This report presents a case of cephalopagus twins which was confirmed at 13 weeks of gestation using three-dimensional ultrasound.     

联体双胎分离术前影像学综合评价

目的对联体双胎(Conjoined Twins,CT)分离术前的影像学资料进行综合评价,确定手术的可行性及其方案。方法对两对(四婴)联体双胎在分离术前的影像学资料进行综合分析。结果两对联体双胎中肝脏均为联体融合畸形,其中一对为心脏融合畸形,另外一对为两个心脏,共用一个心包。X线、CT、MRI、超声学检查诊断比较准确、全面地显示了患儿联体畸形的解剖部位、联结面积程度和相关的解剖学关系。结论影像学诊断能比较全面的显示相连脏器的程度、血管沟通情况,有助于术前手术设计。联体双胎术前影像学检查有较高价值,是联体双胎分离手术的关键环节之一。     

Separation of conjoined twins: experiences of perioperative nurses and their recommendations

BACKGROUND: Within an 8-month period, an unprecedented and historical first in Queensland, Australia, the perioperative nurses were members of teams involved in the surgical separation of two sets of conjoined twins. Little is known about the (dis)stress that some of these perioperative nurses experienced nor how best to support them during such experiences. AIM: The aim of this paper is to report on the qualitative study that explored the experiences of those perioperative nurses involved in the surgical separation of cojoined twins and from their stories propose recommendations to support perioperative nurses who are confronted with such workplace experiences. METHODS: Using a narrative methodology, nine perioperative nurses shared their stories of being involved in the surgical separation of conjoined twins in Australia. Narrative and thematic analyses were conducted and recommendations to support perioperative nurses through workplace (dis)stress were identified. Participants validated the findings and recommendations. FINDINGS: The analyses revealed the themes of professionalism, teamwork, 'them vs. us' and emotional loads. DISCUSSION: The sensationalism around the rarity of conjoined twins brought an intensive intrusiveness from the world media. As a result, secrecy within the hospital about the conjoined twin cases created divisions between those perioperative nurses on the teams and those not. The processes and outcomes of the two surgical cases were in contrast to each other. For some perioperative nurses this caused distress. It is essential that professional support is offered in a way in which the perioperative nurse can take it up without fear of negative judgement.     

First-trimester diagnosis of conjoined twins aided by spatiotemporal image correlation

A case of conjoined twins after frozen embryo transfer at early blastocyst stage is described. The diagnosis was made early at 7 weeks by vaginal sonography and later confirmed by spatiotemporal image correlation with power Doppler. The value of spatiotemporal image correlation with Doppler in facilitating an early diagnosis of conjoined twinning is discussed.