From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto; and Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children.
Plast Reconstr Surg. 2022 Jul 1;150(1):133-144. doi: 10.1097/PRS.0000000000009267. Epub 2022 May 17.
Conjoined twinning is a rare medical phenomenon, and numerous challenges remain with respect to surgical separation and reconstruction. The purpose of this study is to present a detailed discussion of the authors' institutional experience with eight conjoined twin separations over the past three decades, focusing on challenges and lessons gleaned from these cases.
The records of all patients who underwent conjoined twin separation at The Hospital for Sick Children in Toronto, Ontario, Canada, from 1984 to 2018 were retrospectively reviewed.
Eight sets of conjoined twins were analyzed. Half of the sets [ n = 4 (50 percent)] were female. There were four sets (50 percent) of ischiopagus twins, three sets (37.5 percent) of omphalopagus twins, and one set (12.5 percent) of craniopagus twins. The median age at separation was 6.75 months. The mean durations of intensive care unit and hospital stay were 14.1 ± 12.9 days and 4.9 ± 4.8 months, respectively. Mean length of follow-up was 6.7 ± 4.4 years. Three deaths occurred in our series, with an overall survival rate of 81 percent. Two sets of twins experienced expander-related complications such as infection and bowel perforation. Three twins required reoperation because of flap necrosis or dehiscence after separation.
The authors' results highlight the unique nature of each operation and the great ingenuity required in managing the particular considerations of each case and also adhering to a systematic approach of evaluation and planning. A number of novel strategies were used at the authors' center and have now become commonplace. The lessons learned from such procedures may improve care for future generations of patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
联体双胎是一种罕见的医学现象，在手术分离和重建方面仍然存在许多挑战。本研究旨在详细讨论作者在过去三十年中对 8 例联体双胎分离的机构经验，重点讨论从这些病例中获得的挑战和经验教训。
回顾性分析了 1984 年至 2018 年在加拿大安大略省多伦多 SickKids 医院接受联体双胎分离的所有患者的记录。
分析了 8 组联体双胞胎。其中一半[ n = 4（50%）]为女性。有 4 组（50%）为坐骨联体双胞胎，3 组（37.5%）为脐联体双胞胎，1 组（12.5%）为颅联体双胞胎。分离时的中位年龄为 6.75 个月。重症监护病房和住院的平均时间分别为 14.1±12.9 天和 4.9±4.8 个月。平均随访时间为 6.7±4.4 年。本系列中有 3 例死亡，总生存率为 81%。有 2 组双胞胎出现了扩张器相关并发症，如感染和肠穿孔。由于分离后皮瓣坏死或裂开，有 3 对双胞胎需要再次手术。
作者的结果突出了每一次手术的独特性，以及在管理每个病例的特殊考虑因素和坚持系统评估和规划方法时所需要的极大创造力。作者所在中心使用了一些新的策略，现在已经很常见。从这些手术中吸取的经验教训可能会改善未来几代患者的护理。
临床问题/证据水平：治疗，V。
