CAJ | 학술논문

目的探讨影像学检查在臀部联体儿术前评估中的价值,及其对分离手术方案和分离后患儿预后的意义.方法对我院最近成功分离的1例臀部联体患儿,结临床查体选择进行B超、X线、CT、MRI检查,分析其影像学特点,以明确联体儿连接部位、范围、内容,以及是否伴有身体内部其他器官的畸形.结果连接部前后径7.9 cm,上下径6.0 cm,位于腰骶部.双侧患儿腰3以下椎板裂,无骨性结构连接,但存在脊柱及骨盆的软骨连接.患儿下消化道及肛门独立,泌尿道独立.硬膜囊相连,但脊髓及马尾神经无相连及交叉支配.联体双患儿均存在动脉导管未闭,其中一侧患儿存在隐睾,未见其他畸形.术中所见证实影像学的结果.选择交叉V型皮瓣覆盖创面,直接缝合硬膜,联体儿成功分离,无术后感染及脑脊液漏,皮瓣愈合良好,无神经损伤,随访6个月,2例患儿发育及神经功能均正常.结论根据联体儿分型,结合查体选择和利用各种影像学检查,能较全面地反映连接部位的范围、内容,对手术的难度预测、手术方案制定、术后预后评估有重要意义.
목적 탐토영상학검사재둔부련체인술전평고중적개치,급기대분리수술방안화분리후환인예후적의의.방법 대아원최근성공분리적1례둔부련체환인,결림상사체선택진행B초、X선、CT、MRI검사,분석기영상학특점,이명학련체인련접부위、범위、내용,이급시부반유신체내부기타기관적기형.결과 련접부전후경7.9 cm,상하경6.0 cm,위우요저부.쌍측환인요3이하추판렬,무골성결구련접,단존재척주급골분적연골련접.환인하소화도급항문독립,비뇨도독립.경막낭상련,단척수급마미신경무상련급교차지배.련체쌍환인균존재동맥도관미폐,기중일측환인존재은고,미견기타기형.술중소견증실영상학적결과.선택교차V형피판복개창면,직접봉합경막,련체인성공분리,무술후감염급뇌척액루,피판유합량호,무신경손상,수방6개월,2례환인발육급신경공능균정상.결론 근거련체인분형,결합사체선택화이용각충영상학검사,능교전면지반영련접부위적범위、내용,대수술적난도예측、수술방안제정、술후예후평고유중요의의.
Objective To explore the value of imaging in the preoperative evaluation of pygopagus conjoined twins (PCT), and analyze the significance of imaging for separation surgery plan and prognosis. Methods Imaging data of a case with PCT, including ultrasound, X-ray, CT, MRI were collected from the case with PCTs treated in our hospital. The features of the images were analyzed for identification of the conjoined region, size, and structures and for judgement of other organ malformation and general body state. Results The conjoined region located at the lumbnsacral spine of which anteroposterior diameter was 7.9 cm, and 6.0 cm for cranial-caudal diameter. Spina bifida were found below L3 in bilateral twins. There were no bone structures but cartilage fusion in spine and pelvis. The neural structure such as spinal cord and canda equiua, lower GI tract and anus, and urinary tract were separated. The dural sac were fused. There were cryptorchidism in one twin, patent ductus arteriosns in both twins. The intraoperative finding matched with imaging results. Crossing V-shaped skin flap was used to cover the wound surface. The dura of conjoined twins were sutured. Successful separation of the PCT was achieved. There were no complications of infection, cerebrospinal fluid leakage and neurological deficit. The healing of the skin flap was good. With 6 months follow-up, the growth and neurological function were normal. Conclusions Imaging methods were selected according to the type of conjoined twins and the clinical symptoms and signs. The radiologic investigation can reveal the structure and size of conjunction area. Imaging investigation has important significance for the prediction of difficulty in surgery, selection of surgical procedures, and evaluation of prognosis.