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目的通过2例胸腹联体婴的成功手术分离,总结其诊治经验。方法回顾性分析2例胸腹联体婴的诊治过程。第1例为脐部联体婴,肝脏相连伴复杂性先天性心脏病(大动脉异位和单心室);第2例为剑脐联体婴,肝脏相连、共用心包伴复杂性先天性心脏病(单心室和单心房)。因2例患儿均出现病情变化,遂在出生后1个月即行分离手术。结果 2例联体婴手术分离均成功。术中均见肝脏借肝桥相连,患儿的心包完整或共用1个心包。Gore-Tex膜修补腹膜、膈肌或纵隔缺损。术后患儿出现不同程度伤口感染,经取出Gore-Tex膜、清创缝合或引流治疗后愈合。第1例两患儿于术后37 d出院,其中1例出院后半年死于肺炎;第2例两患儿分别于术后40 d和93 d治愈出院。结论 术前依靠影像学检查对胸腹联体婴全身及联体局部情况进行详细了解,重点了解心血管系统、肝胆系统和胸腹壁情况;充分的术前准备、精细的肝脏切割及合理的胸廓和腹壁重建是手术成功的关键。
Objective To summarize the experience of diagnosis and treatment through the successful operation of 2 cases of thoracoabdominal combined infants. Methods Retrospective analysis of 2 cases of chest and abdomen in the diagnosis and treatment of infants. The first case was a umbilical conjunct infant with liver associated with complicated congenital heart disease (aortic aorta and single ventricle); the second case was an umbilical cord of the umbilical cord, the liver was connected and the concomitant heart with complicated congenital heart disease (Single ventricle and single atrium). Because of 2 cases of changes in the condition of children, then one month after birth, line separation surgery. Results Two cases of conjoined infant surgery were successful. Intraoperative liver liver bridge are connected, children with pericardial complete or shared 1 pericardium. Gore-Tex membrane repair peritoneum, diaphragm or mediastinal defect. Postoperative children with varying degrees of wound infection, removal of Gore-Tex membrane, debridement or drainage after healing wound healing. In the first case, two children were discharged at 37 days after operation, of which 1 died of pneumonia six months after discharge. The second case was cured after 40 days and 93 days respectively. Conclusion Preoperative imaging depends on the chest and abdomen of the whole body and the joint body of the United States a detailed understanding of the local situation, focusing on understanding of the cardiovascular system, liver and gallbladder system and chest and abdominal wall conditions; adequate preoperative preparation, fine liver incision and reasonable thorax And abdominal reconstruction is the key to successful operation.