Yan Bin,Yu Jiakang,Zhong Wei,et al.Preoperative evaluation strategy and operative opportunity of 4 cases of thoracoabdominal conjoined infant[J].Journal of Clinical Pediatric Surgery,,18():304-309,314.[doi:10.3969/j.issn.1671-6353.2019.04.011]
Preoperative evaluation strategy and operative opportunity of 4 cases of thoracoabdominal conjoined infant
- Keywords:
- Twins; Conjoined/SU; Heart Defects; Congenital/DI
- CLC:
- R729;R619
- Abstract:
- Objective To summarize the experiences of treating thoracoabdominal conjoined infants and discuss the preoperative evaluations and treatment strategies of conjoined infants.Methods The clinical data of 4 hospitalized cases of thoracoabdominal conjoined infants from 2009 to 2016 were reviewed.The imaging evaluation strategy,influence of complicated malformation on operative opportunity,surgical separation techniques and diagnosis and treatment process of thoracoabdominal conjoined infants were analyzed.Results There were 2 male and 2 female conjoined babies.All of them were evaluated after admission.All four cases were all diagnosed as thoracoabdominal conjoined deformity.Liver connections in body bridges were independent of hepatic portal,bile duct and gallbladder.And gastrointestinal tract system and urinary tract were completely independent and showed no abnormalities.All of them were combined with severe congenital heart malformations.One case died after giving up treatment because of sharing a single four-chamber heart.Another 3 cases had pneumonia due to unstable circulation and fulfilled the indication of early separation.Treatment plan was formulated after multi-disciplinary (MDT) consultation.Abdominal wall defect was repaired after body bridge separation by pedicle flap transfer plus patching.The mean operative age was (35±6) days.Six patients were successfully separated and 4 children had poor wound healing after operation.One patient underwent cardiac deformity correction at 25 days after separation.The average hospitalization time was (79±9) days.One patient died of complications of cardiac malformation and another 5 children survived during a follow-up period of 6-9 years after discharge.Conclusion The survival rate of thoracoabdominal conjoined twins may be improved by comprehensive evaluations of thoracoabdominal conjoined infants,multidisciplinary cooperation,strict grasp of early and emergency surgical indications,establishment of fine body-bridge separation scheme and sequential treatment of concomitant malformations.
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Memo
收稿日期:2018-05-08。
基金项目:广东省科技计划项目（编号：2014A020212022）
通讯作者:钟微,Email:manr68@126.com