联体畸形婴儿的手术时机与共用肝的分离方法

目的 探讨联体畸形婴儿的手术时机以及术中共用肝离断线的定位及其分离方法.方法 以两者胆总管为两条纵形线,在两线中间设一条与两线平行的纵线作为共用肝的离断线,然后采用"局部血流阻断"法,对共用肝进行离断.结果 3对联体畸形婴儿中,剑脐联体畸形1对,胸腹联体畸形2对,每对婴儿均共用同一肝脏,但每人各有独立的胆囊及胆管.分别于出生后第28天、第96天、第89天实施分离手术,均获成功.局部血流阻断后,术中肝脏断面出血很少,术后肝功能恢复顺利.分离手术后6个患儿均痊愈出院.结论 对两患儿胆总管各自独立发育完善的共用肝脏,以两者胆总管作为纵向坐标定位共用肝离断线,多数情况下能避免肝脏重要血管及胆管损伤.共用肝离断中,局部血流阻断法仅阻断了离断线局部的血流,对非操作区的肝脏血流干扰极小,有利于肝功能恢复,增加两患儿术后的成活率.

Operation timing and methods of separation surgery for joined liver of conjoined twins: a report of three Cases

Objective To approach the surgical timing for the conjoined twins, location of the separation line for the joined liver, and the separation method.Methods The common bile ducts of the conjoined twins were considered as two vertical lines, and a vertical line running parallel to the two lines was set as the separation line for the joined liver.Local blood flow blocking method was then used to separate the joined liver.Results Among all the three cases of the conjoined twins, one case was with sternoxiphopagus and the other two with thoracoabdominalpagus.All the three cases of con-joined twins shared the common livers, but each case had respectively separated gallbladders and bile ducts.They underwent the surgical separation at the age of 28 d and 96 d and 89 d successfully.Their liver sections bled rarely by blocking the local blood flow.The liver function recovered successfully af-ter the operation.All the 6 sick children recovered and were discharged from our hospital.Conclusion Porvided the conjoined twins shared the joined liver with respectively separated common bile ducts, in most cases, the injuries of the important liver vascular as well as bile ducts could be avoided when the separation line for the joined liver was selected with the common bile ducts of the conjoined twins as the longitudinal coordinate.The local blood flow blocking method only blocked the local blood flow, in-terfering to the liver blood flow in the non-operating areas rarely, which was instrumental in the recovery of the liver function and increase of the survival rate of the conjoined twins after the operation.