一例胸腹联体婴儿肝脏分离手术的体会  

Liver separation in a case of thoracoventropagus

作　　者：宋步需[1] 田延锋[1] 李芳[1] 刘擘[1] 张峰[1] 裴永彬[1] 张学明[1] 赵增仁[1] 

机构地区：[1]河北医科大学第一医院普外科,石家庄050031

出　　处：《中华普外科手术学杂志（电子版）》2008年第3期48-50,共3页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

摘　　要：目的探讨胸腹联体婴儿肝脏分离术断肝的最佳方法及相关技术的配合。方法回顾性分析河北医科大学第一医院于2007年7月22日为一例胸腹联体婴儿A和B进行肝脏分离术的临床资料。术中首先确定A第二肝门及肝脏分离界线;先后采用阻断第一肝门、指压局部阻断肝血流和肝实质内处理诸管道相结合的方法进行肝脏分离,同时密切配合相关技术。结果历经1 h14 min,联体婴儿A和B共用肝分离成功,术中出血约120 ml。术后A恢复较顺利,至今仍存活。B于第25天因"粘连性肠梗阻"行第二次手术,因并发严重"肺部感染"死亡,共存活78 d。尸体解剖:腹腔无感染灶,肝脏断面愈合良好。结论指压局部阻断肝血流和肝实质内处理诸管道相结合的方法,是联体婴儿共用肝分离的最佳方法之一,同时注意相关技术有机配合。肝门阻断不宜首选。Objective To explore the best methods or combination of techniques for separating the liver in a thoracoventropagus. Methods We analyzed retrospectively the clinical data of surgical separation of a thoracoventropagus at the First Hospital of Hcbei Medical University on July 22, 2007. The hepatic hilum of infant A was determined as well as the limit of liver separation. By blocking the first hepatic hilum, part of the liver was pressed with fingers to block the bleeding while dealing with the pipeline inside the liver parenchyma to separate the liver. Meanwhile, techniques were used in close cooperation. Results After 1 hour and 14 minutes, the common liver was successfully separated after bleeding for 120 ml. Infant A survived and recovered smoothly. On the contrary, infant B had second operation 25 days later because of the adhesive ileus. She died of severe pulmonary infection after the second operation. She lived for a total of 78 days. Autopsy revealed no infection in the abdominal cavity and liver section was healing well. Conclusions It is one of the best ways for common liver separation for thoracoventropagus by pressing part of the liver with fingers to block the bleeding while dealing with the pipeline inside the liver parenchyma. The combined use of techniques is important in this process. It is not suitable to block the porta hepatic at first.

关 键 词：双生 联体 肝 外科手术 止血 

分 类 号：R726.5[医药卫生—儿科]