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目的通过2例胸腹联体婴儿分离手术探讨联体婴儿的外科治疗方法。方法于2004年7月和2005年4月收治2例胸腹联体婴儿,第1例因脐疝皮肤破裂、肠管外露伴破裂急诊行分离手术,胸腹创面用局部皮瓣修复,继发创面用人工皮覆盖。第2例于出生后2个月先行胸腹壁皮肤扩张术,扩张完成1个月后行分离手术,用异体心包重建心包腔,多孔聚乙烯支架重建胸骨缺损,聚丙烯单丝网片重建腹壁,用胸腹扩张旋转皮瓣关闭胸腹创面。结果第1对婴儿分别于分离后2h和39h 死于呼吸衰竭和呼吸、循环衰竭。第2对婴儿均成活治愈出院。结论胸腹联体分离术应先行皮肤扩张以利于创面愈合,胸壁重建以多孔聚乙烯支架为好,腹壁重建可用聚丙烯网。分离手术最好在婴儿出生3个月后进行。
Objective To discuss the surgical treatment of conjoined infants through 2 cases of thoraco-abdominal surgery. Methods Two cases of thoracoabdominal conjoined infants were treated in July 2004 and April 2005. The first case was divided by umbilical hernia skin rupture and intestinal exudation with rupture emergency operation. The thoracic and abdominal wounds were repaired by local skin flap. The secondary wounds Cover with artificial skin. In the second case, the thoracic and abdominal wall skin expansion was performed 2 months after birth. One month after the expansion was performed, the percutaneous perforation was performed. Allogeneic pericardial reconstruction of the pericardial cavity and porous polyethylene scaffolds was used to reconstruct the sternal defect. The polypropylene monofilament mesh was used to reconstruct the abdominal wall, Thoracoabdominal dilatation flap to close the chest and abdomen wounds. Results The first infants died of respiratory failure, respiratory failure and circulatory failure at 2h and 39h respectively. The second infant survived and was discharged. Conclusion Thoracoabdominal conjunctive surgery should lead to skin expansion in advance to facilitate wound healing. Porous polyethylene scaffolds should be used for the reconstruction of the thoracic wall and polypropylene mesh for the reconstruction of the abdominal wall. Separation surgery is best done 3 months after birth.