CAJ | 학술논문

目的探讨联体畸形婴儿的手术时机以及术中共用肝离断线的定位及其分离方法.方法以两者胆总管为两条纵形线,在两线中间设一条与两线平行的纵线作为共用肝的离断线,然后采用"局部血流阻断"法,对共用肝进行离断.结果 3对联体畸形婴儿中,剑脐联体畸形1对,胸腹联体畸形2对,每对婴儿均共用同一肝脏,但每人各有独立的胆囊及胆管.分别于出生后第28天、第96天、第89天实施分离手术,均获成功.局部血流阻断后,术中肝脏断面出血很少,术后肝功能恢复顺利.分离手术后6个患儿均痊愈出院.结论对两患儿胆总管各自独立发育完善的共用肝脏,以两者胆总管作为纵向坐标定位共用肝离断线,多数情况下能避免肝脏重要血管及胆管损伤.共用肝离断中,局部血流阻断法仅阻断了离断线局部的血流,对非操作区的肝脏血流干扰极小,有利于肝功能恢复,增加两患儿术后的成活率.
목적 탐토련체기형영인적수술시궤이급술중공용간리단선적정위급기분리방법.방법 이량자담총관위량조종형선,재량선중간설일조여량선평행적종선작위공용간적리단선,연후채용"국부혈류조단"법,대공용간진행리단.결과 3대련체기형영인중,검제련체기형1대,흉복련체기형2대,매대영인균공용동일간장,단매인각유독립적담낭급담관.분별우출생후제28천、제96천、제89천실시분리수술,균획성공.국부혈류조단후,술중간장단면출혈흔소,술후간공능회복순리.분리수술후6개환인균전유출원.결론 대량환인담총관각자독립발육완선적공용간장,이량자담총관작위종향좌표정위공용간리단선,다수정황하능피면간장중요혈관급담관손상.공용간리단중,국부혈류조단법부조단료리단선국부적혈류,대비조작구적간장혈류간우겁소,유리우간공능회복,증가량환인술후적성활솔.
Objective To approach the surgical timing for the conjoined twins, location of the separation line for the joined liver, and the separation method.Methods The common bile ducts of the conjoined twins were considered as two vertical lines, and a vertical line running parallel to the two lines was set as the separation line for the joined liver.Local blood flow blocking method was then used to separate the joined liver.Results Among all the three cases of the conjoined twins, one case was with sternoxiphopagus and the other two with thoracoabdominalpagus.All the three cases of con-joined twins shared the common livers, but each case had respectively separated gallbladders and bile ducts.They underwent the surgical separation at the age of 28 d and 96 d and 89 d successfully.Their liver sections bled rarely by blocking the local blood flow.The liver function recovered successfully af-ter the operation.All the 6 sick children recovered and were discharged from our hospital.Conclusion Porvided the conjoined twins shared the joined liver with respectively separated common bile ducts, in most cases, the injuries of the important liver vascular as well as bile ducts could be avoided when the separation line for the joined liver was selected with the common bile ducts of the conjoined twins as the longitudinal coordinate.The local blood flow blocking method only blocked the local blood flow, in-terfering to the liver blood flow in the non-operating areas rarely, which was instrumental in the recovery of the liver function and increase of the survival rate of the conjoined twins after the operation.