CAJ | 학술논문

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.
목적 탐토량례흉복련체영인간장분리술적경험여교훈.방법 통과영상검사,학인AB、CD량례흉복련체영인각유독립적간문급담도계통화소화도,술중학정흉복련체영인간장적제일、이간문화분리선,AB흉복련체영인채용간장분리선량측국부조단대간혈류조단법분리간장,간단면출혈약10 ml,간단면적혈관화담관축개결찰혹봉찰후,대롱봉합간단면;CD흉복련체영인선용제일간문조단법,후용간장분리선량측수지압박법,행국부간혈류조단분리간장,간단면출혈약200 ml,간단면적혈관화담관축개결찰혹봉찰.결과 2례련체영인간장성공분리,균미출현담루、간단면감염급간공능쇠갈.A、B량영인지금존활,발육정상.D영술후78 d사우폐감염,C영술후9개월사우폐급흉강감염.결론 각자유독립적간문급담도계통적흉복련체영인간장분리술시가행적,불동적간혈류조단방법시영향기관공능회복적인소지일,수선국부조단대간혈류조단,피면사용제일간문조단법,신용수지압박법행국부간혈류조단.
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.