Clinical Experience on Separation Surgery for Thoracoomphalopagus Conjoined Twins: Report of Two Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Jiakang , XIA Huimin , ZHONG Wei , CHEN Xinxin , WANG Yong , PAN Jing.

Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou 510120, Guangdong Province, China;

Corresponding author：

Keywords：

Conjoined twins; Thoracoomphalopagus; Joined liver; Separation surgery

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ObjectiveTo summarize the diagnosis and treatment of thoracoomphalopagus conjoined twins according to successful separation of two cases of conjoined twins. MethodsA retrospectives study was performed on two pairs of thoracoomphalopagus twins. One case was omphalopagus with complex congenital heart disease (transposition of the great arteries and single cardiac ventricle), and the other was sternoxiphopagus with single pericardium and complex congenital heart disease (single cardiac ventricle and cardiac atrium). All the two cases of conjoined twins shared the common livers. The separation surgery was performed at one month after birth. Results All the two cases of conjoined twins were successfully separated. These conjoined twins were connected by a liver bridge, and shared a pericardium or had a contact pericardium, respectively. The coloboma of peritoneum, diaphragm， and mediastinum were repaired by Gore-Tex patch. Each patient, to varying degrees, had a wound infection after surgery, and healed by taking out the Gore-Tex, debridement or drainage. The first two infants were discharged on 37 d after operation, but one died of pneumonia after 6 months. The two other infants were discharged on 40 d and 93 d after operation, respectively. ConclusionsDetailed information about the twins’ general and conjoined condition, especially on cardiovascular system and the joined liver, shall be understood by the imagination examinations before the operation. Adequate preoperative preparation, elaborate liver separation and rational reconstruction for thoracic and abdominal wall are the key to successful operation.

Citation： YU Jiakang,XIA Huimin,ZHONG Wei,CHEN Xinxin,WANG Yong,PAN Jing.. Clinical Experience on Separation Surgery for Thoracoomphalopagus Conjoined Twins: Report of Two Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(7): 741-744. doi: Copy

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17.	Ekenze SO, Ibeziako SN, Adimora GN, et al. Ruptured omphalocele in thoracoomphalopagus conjoined twins [J]. Int Surg, 2009, 94(3): 221223.
18.	Walton JM, Gillis DA, Giacomantonio JM, et al. Emergency separation of conjoined twins [J]. J Pediatr Surg, 1991, 26(11): 13371340.
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21.	孙家明, 阮庆兰, 孙宗全, 等. 胸腹联体婴儿分离术二例 [J]. 中华外科杂志, 2007, 45(9): 623625.
22.	Karpelowsky JS, Millar AJ. Porcine dermal collagen (Permacol) for chest and abdominal wall reconstruction in thoracoomphalopagus conjoined twin separation [J]. Pediatr Surg Int, 2010, 26(3): 315318.
23.	Fishman SJ, Puder M, Geva T, et al. Cardiac relocation and chest wall reconstruction after separation of thoracopagus conjoined twins with a single heart [J]. J Pediatr Surg, 2002, 37(3): 515517.
24.	Dasgupta R, Wales PW, Zuker RM, et al. The use of Surgisis for abdominal wall reconstruction in the separation of omphalopagus conjoined twins [J]. Pediatr Surg Int, 2007, 23(9): 923926.
25.	蒲庆华, 时德. 高分子材料疝修补的临床应用进展 [J]. 中国普外基础与临床杂志, 2000, 7(1): 5961.
26.	胡安军, 阮士荣. 联体婴儿胸腹部皮瓣互换修复联体部巨大缺损 [J]. 中华整形外科杂志, 2004, 20(2): 108109.

1. Votteler TP. Conjoined twins. //O’Neill JA, eds. Pediatric Surgery [M]. 5th edn. Chicago: MosbyYear Book, 1998: 771779.
2. Edmonds LD, Layde PM. Conjoined twins in the United states, 19701977 [J]. Teratology, 1982, 25(3): 301308.
3. Applebaum H. Conjoined twins. //Puri P, eds. Newborn surgery [M]. London: Arnold, 2003: 643648.
4. Spencer R. Theoretical and analytical embryology of conjoined twins: part II： adjustments to union [J]. Clin Anat, 2000, 13(2): 97120.
5. Spitz L, Kiely EM. Experience in the management of conjoined twins [J]. Br J Surg, 2002, 89(9): 11881192.
6. Al Rabeeah A. Conjoined twins—past, present, and future [J]. J Pediatr Surg, 2006, 41(5): 10001004.
7. Thompson JL, Zarroug AE, Matsumoto JM, et al. Anatomy of successfully separated thoracopagusomphalopagus conjoined twins [J]. Clin Anat, 2007, 20(7): 814818.
8. De Ugarte DA, Boechat MI, Shaw WW, et al. Parasitic omphalopagus complicated by omphalocele and congenital heart disease [J]. J Pediatr Surg, 2002, 37(9): 13571358.
9. Spencer R, Robichaux WH, Superneau DW, et al. Unusual cardiac malformations in conjoined twins: thoracopagus twins with conjoined pentalogy of Cantrell and an omphalopagus twin with atretic ventricles [J]. Pediatr Cardiol, 2002, 23(6): 631638.
10. Shi CR, Cai W, Jin HM, et al. Surgical management to conjoined twins in Shanghai area [J]. Pediatr Surg Int, 2006, 22(10): 791795.
11. Weber MA, Sebire NJ. Genetics and developmental pathology of twinning [J]. Semin Fetal Neonatal Med, 2010, 15(6): 313318.
12. MartínezFrías ML, Bermejo E, Mendioroz J, et al. Epidemiological and clinical analysis of a consecutive series of conjoined twins in Spain [J]. J Pediatr Surg, 2009, 44(4): 811820.
13. 王文献, 戴书华, 孙清荣, 等. 影像学综合评估联体婴儿分离术的意义 [J]. 中国医学影像学杂志, 2002, 10(3): 161163.
14. Martínez L, Fernández J, Pastor I, et al. The contribution of modern imaging to planning separation strategies in conjoined twins [J]. Eur J Pediatr Surg, 2003, 13(2): 120124.
15. 杨彤翰, 李靖, 黄小兵, 等. 联体畸形婴儿的手术时机与共用肝的分离方法 [J]. 中华肝胆外科杂志, 2010, 16(3): 161163.
16. Thompson JL, Zarroug AE, Matsumoto JM, et al. Anatomy of successfully separated thoracopagusomphalopagus conjoined twins [J]. Clin Anat, 2007, 20(7): 814818.
17. Ekenze SO, Ibeziako SN, Adimora GN, et al. Ruptured omphalocele in thoracoomphalopagus conjoined twins [J]. Int Surg, 2009, 94(3): 221223.
18. Walton JM, Gillis DA, Giacomantonio JM, et al. Emergency separation of conjoined twins [J]. J Pediatr Surg, 1991, 26(11): 13371340.
19. 王学浩, 陆森. 肝切除技术的现状 [J]. 中国普外基础与临床杂志, 2010, 17(6): 525527.
20. 文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008, 15(4): 299302.
21. 孙家明, 阮庆兰, 孙宗全, 等. 胸腹联体婴儿分离术二例 [J]. 中华外科杂志, 2007, 45(9): 623625.
22. Karpelowsky JS, Millar AJ. Porcine dermal collagen (Permacol) for chest and abdominal wall reconstruction in thoracoomphalopagus conjoined twin separation [J]. Pediatr Surg Int, 2010, 26(3): 315318.
23. Fishman SJ, Puder M, Geva T, et al. Cardiac relocation and chest wall reconstruction after separation of thoracopagus conjoined twins with a single heart [J]. J Pediatr Surg, 2002, 37(3): 515517.
24. Dasgupta R, Wales PW, Zuker RM, et al. The use of Surgisis for abdominal wall reconstruction in the separation of omphalopagus conjoined twins [J]. Pediatr Surg Int, 2007, 23(9): 923926.
25. 蒲庆华, 时德. 高分子材料疝修补的临床应用进展 [J]. 中国普外基础与临床杂志, 2000, 7(1): 5961.
26. 胡安军, 阮士荣. 联体婴儿胸腹部皮瓣互换修复联体部巨大缺损 [J]. 中华整形外科杂志, 2004, 20(2): 108109.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Experience on Separation Surgery for Thoracoomphalopagus Conjoined Twins: Report of Two Cases

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