胸腹联体婴儿肝脏分离术二例诊治分析  

Liver separation procedures in two conjoined twins

作　　者：陈进军[1] 秦琦瑜[1] 陈虎[1] 石鑫[1] 王威[1] 赵增仁[1] 

机构地区：[1]河北医科大学第一医院肝胆外科,石家庄050031

出　　处：《中华普通外科杂志》2010年第9期720-724,共5页Chinese Journal of General Surgery

摘　　要：目的 探讨两例胸腹联体婴儿肝脏分离术的经验与教训.方法 通过影像检查,确认AB、CD两例胸腹联体婴儿各有独立的肝门及胆道系统和消化道,术中确定胸腹联体婴儿肝脏的第一、二肝门和分离线,AB胸腹联体婴儿采用肝脏分离线两侧局部阻断带肝血流阻断法分离肝脏,肝断面出血约10 ml,肝断面的血管和胆管逐个结扎或缝扎后,对拢缝合肝断面 CD胸腹联体婴儿先用第一肝门阻断法,后用肝脏分离线两侧手指压迫法,行局部肝血流阻断分离肝脏,肝断面出血约200 ml,肝断面的血管和胆管逐个结扎或缝扎.结果 2例联体婴儿肝脏成功分离,均未出现胆漏、肝断面感染及肝功能衰竭.A、B两婴儿至今存活,发育正常.D婴术后78 d死于肺感染,C婴术后9个月死于肺及胸腔感染.结论 各自有独立的肝门及胆道系统的胸腹联体婴儿肝脏分离术是可行的,不同的肝血流阻断方法是影响器官功能恢复的因素之一,首选局部阻断带肝血流阻断,避免使用第一肝门阻断法,慎用手指压迫法行局部肝血流阻断.Objective To sum up experience and lessons learnt from liver separation in two thoracoventropagus twins. Method By preoperative imaging it was verified that the two twins of thoracoventropagus named as AB and CD respectively having independent portal hepatic system and the digestive tract.Intraoperatively a separation line was delineated between the porta hepatis,the second porta hepatis.Liver parenchyma of the AB conjoined twin was separated under local blood control with both sides of the seperation line.Intraoperative bleeding was about 10ml,liver rough surface was suctured together,after ligation or suturing of blood vessels and bile ducts.The livers of CD conjoined twin were separated with blocking the first hepatic hilum firstly,and partial hepatic vascular exclusion secondly by part of the liver pressed with finger.There was intraoperative bleeding of about 200 ml. Results The two cases of conjoined twins were separated successfully,and there was no bile leakage,liver failure and infection.A and B are alive and well.D died of lung infection 78 days later.C died of lung and cavitas thoracis infection 9 months later. Conclusion Liver separation is feasible in a thoracoventropagus with independent porta hepatis system.Partial blocking of hepatic vasculature occlusion,in stead of portal triad clamping is preferred.During the separation of hepatic parenchyma finger press for the control of local hepatic blood flow is not always reliable.

关 键 词：双生 联体 外科手术 肝 肝血流阻断 

分 类 号：R686[医药卫生—骨科学]