Surgical Separation of Conjoined Twins : A Review of Japanese Series

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  • 結合双生児分離手術 : 本邦報告例34組の検討

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Purpose : Here, we review the reports of conjoined twins which have undergone surgical separation inJapan. Materials and Method : Thirty-four pairs of conjoined twins which have been reported in the literature up to December of 2002 were analyzed. Results : The types of conjoined twins were craniopagus (n=2), thoraco-omphalopagus (n=12), xipho-omphalopagus (n=9), omphalopagus (n=2). ischiopagus (n=5) and pygopagus (n=4) respectively. There were 27 pairs of female twins and 7 pairs of male twins. Fetal diagnosis was made only in 7 pairs (20%). Mean gestational age was 37 weeks, mean birth weight of twins was 4,616 g and mean maternal age was 28 years old. Twenty-two pairs were delivered by scheduled cesarean section, but twelve pairs were attempted by vaginal delivery. The delivery of half of the latter pairs was changed to emergency cesarean section due to their conjoined status. Surgical separation was tried at some time during thirteen months after birth. In 20 pairs. both twins were successfully separated. In 8 pairs, only one twin survived. And in 6 pairs. the separation ended in the death of both twins. Conjoined hearts, a single portal vein or major vessels, and fusion of spinal cord or brain were the main causes of failed separation. Conclusion : Thirty-four cases of surgical separation of conjoined twins were reported in Japan. The survival rate was 71%. The risk factors for separation were conjoined hearts, single major vessels, or fused spinal cord or brain.

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