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【分身有术】广西医科大学第一附属医院成功分离同"肝"共苦的连体婴儿
来源： 广西医科大一附院掌上医院 发布时间：2017-12-28
01 The conjoined twins were in good condition
“Just knowing it was twins, we were all happy and didn't expect to be connected." Mr. He, the father of the twins, said his wife had not been able to detect anything unusual during her pregnancy. On November 8th, he was shocked at the news that the twins were conjoined, feeling at a loss what to do.
Knowing that GMU had a successful separation surgery case for twins, the husband called the hospital for help at the birth of his babies at night.
The leaders of the hospital thought highly of the issue on receiving the unusual call. Dr. Zeng Zhiyu, the Vice-president of GMU and the president of the First Affiliated Hospital of GMU made the deployment timely, appointing Dr. He Songqing, vice-President of the hospital to coordinate the command, and the next day the hospital sent a group of experts consisting of pediatric surgery, neonatology, ultrasound and other disciplines to Pingnan for consultation. The conjoined baby was taken to the hospital after they made decisions on the transport of the twins.
Dr. Dong Chunqiang, Deputy Director of Pediatric Surgery and the attending doctor, said that an overall physical examination showed that the twins were symmetrically conjoined with the abdomens, even with abdominal wall and the liver. Departments like pediatric surgery, hepatic surgery and anesthesiology held a consultation, reaching the conclusion that the twins could be separated.
The newborn baby had a poor tolerance to anesthesia and surgeries. Since two boys had umbilical infection, they could not be operated until the birth of one month. Finally, the twins received the anti-infectious treatment in the hospital and the medical personnel took care of them day and night, curing the infection of navel cord for three and four times daily.
01连体婴儿日常互相“打脸”
“只知道是双胞胎，我们都很高兴，没想到是连在一起的。”孩子的父亲何先生说，妻子怀孕期间一直没查出异样。11月8日分娩，医生告诉他，两个孩子是连体婴，“当时懵了，不知道该怎么办”。
得知广西医科大学第一附属医院曾经成功分离过一对连体婴，何先生一家在孩子分娩当晚就给打了求助电话，希望得到帮助。
接到这个不寻常的求助电话后，广西医科大学第一附属医院高度重视，广西医科大学副校长、医院院长曾志羽作出部署，副院长何松青统筹指挥，第二天医院就派出一个由小儿外科、新生儿科、超声科等学科组成的专家组赶赴平南进行会诊，确定具备转运条件后，把连体婴接回了医院。
医院小儿外科副主任、手术主刀医生董淳强介绍，经过全面的检查，两个男婴是对称连体儿，面对面腹部相连，隔着相连的腹壁，里面的肝脏也连在一起。
经过小儿外科、肝胆外科、麻醉科、新生儿科、烧伤整形科、放射科、胃肠腺体外科、护理部、手术室等多部门组成的全院大会诊，判定这对肝脏相连的连体婴可以分离。
一般来说，刚刚出生的婴儿对麻醉和手术的耐受性差，而且这对连体婴的脐部有感染，不能立即开展手术，满月以后才考虑分离。于是，这对连体兄弟先在新生儿科进行抗感染等治疗。
医务人员必须不分昼夜每小时为他们擦身，每天对脐部感染进行3~4次的换药治疗。
02 Difficulty of the Surgery: The Liver Separation Must be Accurate
Dr. Dong said, the most difficult part of the operation was how to separate them and to make sure that they could survive. They must precisely judge, separate and make sure the blood vessels were in good condition. If not, one of the boys or even the twins could die because of the change of the liver volume or the surgical complication. It was reported that the survival rate of two infants was only 33% after the body separation. From 1997 to 2014, there was merely 34 successful cases at home and abroad.
On the morning of December 19th, the operation began. The careful arrangements contributed to the success of anesthesia. Firstly, a team of surgeons separated abdominal wall and liver before suturing the wounds. Lasting more than 4 hours, the surgery finally succeeded with the help of a dozen experts. Consequently, the two boys’ health condition and life expectation could be as normal as the ordinary people.
02手术难点：肝脏精准分离，一定要“物归其主”
小儿外科副主任董淳强说，手术最难的地方在于如何“物归其主”，并确保两个孩子存活。这一对连体婴两人各有一个完整的肝脏，只是中间融合在一起了。必须精准地判定相连肝脏各自的归属，并从中间精准地切分，保证血管的完整，不能切偏了，否则其中一个，甚至两个孩子可能会因肝脏体积改变，或血供偏差出现手术并发症危及生命，甚至死亡。
这些难关考验着多学科组成的专家团队。据报道，分离手术后，两个婴儿同时存活的概率只有33%。1997年至2014年，国内外的文献报道仅有34例连体婴儿分离成功。
12月19日上午，手术正式开始。
两套复杂的麻醉设备被提前搬到了手术间，因为要在同一间手术室里对兄弟俩同时进行麻醉，两个婴儿对向而卧，处于侧身状态，给插管等操作带来了极大难度，而且连体婴儿血液循环相连，无论先麻醉哪一个，都会对另一个带来影响。
经过周密的安排，麻醉成功。一个手术团队首先进行腹壁分离、肝脏分离等环节，然后由两组医生分别对两个孩子进行修复和最后的缝合。
历时4个多小时，在十多名专家的协作下，手术顺利完成。这对相连了41天的孪生兄弟终于“独立”了。
除了肝脏相连，两人的身体其他器官都与常人无异，因此今后的健康状况和预期寿命都与正常人一样。
03 To the Satisfaction of All: The Twins Could Discharge Soon
(Two boys were recovering so quickly that they were able to leave the hospital)
It was reported that Mr. He didn’t tell his wife the fact that the children were conjoined, taking his wife’s poor health into consideration. Until the operation was successful did he tell the truth to his wife scrupulously
Dr. He Songqing, vice-President of the First Affiliated Hospital of GMU, said that the chance of conceiving conjoined twins is about 0.001 to 0.002% while the survival rate is even lower, about 0.0005%. It is a rare phenomenon. There are many subjects involved in the operation of separation of conjoined infants, which is a great challenge to the technical skill, organization and coordination ability of each specialty in the hospital.
The medical community believes that the presence of conjoined twins is due to incomplete division of fertilized eggs. Most commonly, the chest is attached to the abdomen, followed by the conjoined buttocks and the ischium. At present, conjoined twins may be related to genetic and environmental factors.
The surgery is the second successful body separation of the First Affiliated Hospital of GMU after the first separation of conjoined twins of Guangxi in 2013, and two children are luckily survived. Guangxi has taken one step further in the treatment of difficult and rare diseases
03皆大欢喜：两兄弟近期可以出院了
目前，两个孩子恢复很快，目前已经达到出院条件。
据媒体报道， 孩子的父亲何先生考虑到妻子产后虚弱，孩子是连体婴的事情一直没敢告诉她，只说带孩子来南宁做检查。
直到确定能够通过手术分离，他才小心翼翼地跟妻子说出真相。现在两个孩子都保住了，皆大欢喜，他打算这两天就出院回家，让母子团聚。
医院副院长何松青说，怀上连体婴的概率为5万~10万分之一，怀上连体婴并活着生下来的概率就更低了，仅为20万分之一，属于非常罕见的现象。实施连体婴儿分离手术涉及的学科众多，对医院各专业的技术水平和组织、配合能力都是很大的挑战。
医学界认为，连体婴的出现，是由于受精卵分裂不完全造成的。最多见的是胸部和腹部相连，其次是臀部、坐骨部相连。目前认为连体婴可能与遗传、环境等因素有关。
这次的手术是继2013年广西首例连体婴成功分离之后，广西医科大学第一附属医院第二次成功分离连体婴，且两个患儿都成功成活，进一步提高了广西疑难病、罕见病方面的治疗水平。
04 Looking Back to Guangxi’s First Successful Conjoined Infants Body Separation
In June, 2013, Mr. and Mrs. Yin in Guiping had their twin girls. However, their twin’ livers were conjoined. The experts of the First Affiliated Hospital of GMU took the twins to the hospital to prepare for the operation. On August 8th, the conjoined infants were successfully separated after about a 6-hour operation. It’s the first successful case of separation operation in Guangxi.
04回顾广西首例成功分离连体婴儿
早在2013年6月，桂平市的尹先生夫妇迎来了自己的双胞胎女儿，可是两个女婴却是罕见的连体婴，肝脏相连。广西医科大学第一附属医院派出专家组将连体女婴接到医院，实施分离手术。8月8日，经过近6小时的手术，两个女婴被成功分离，成为广西首例成功分离的连体婴儿。