In the demonstration classroom of the Pediatric Surgery Department of the Imperial Women's and Children's Hospital, a simulated operation was being carried out nervously and orderly.
These are a pair of conjoined twins, with their chest and abdomen united. Although they have two hearts, they share a pericardium and the hearts are also connected together.
The separation surgery is quite difficult. The Women's and Children's Hospital has joined forces with the Children's Hospital of Philadelphia, which is the world's top pediatric surgery center. After a series of preparations, it has entered the perioperative period. As long as the simulated surgery is successful, the surgery can be carried out at any time.
The 3D printed model of computer-aided design looks exactly like a real person.
Intraoperative navigation and two sets of customized external auxiliary devices ensure that surgical simulation can be performed.
If the simulated surgery is successful, the twins can undergo separation surgery at an early age to effectively protect the regenerative ability of their young hearts.
This set of preliminary preparations is extremely expensive. The Women's and Children's Hospital strives to approach the world's advanced medical standards at almost any cost, especially the application of 3D simulation printing and intraoperative navigation systems.
Intraoperative navigation is a preoperative assessment mode that accurately corresponds to the patient's preoperative or intraoperative image data and the patient's anatomical structure on the operating bed, and is reconstructed by computer.
During the operation, the surgical instruments are tracked and the position of the surgical instruments is updated and displayed in real time on the patient's image in the form of a virtual probe, allowing the doctor to know at a glance the position of the surgical instruments relative to the patient's anatomy, making the surgery faster, more precise, and safer.
Its application is mainly intraoperative application and preoperative simulation surgery, etc.
Intraoperative navigation technology has existed for a long time, but because it is expensive and the computer-assisted functions are not perfect, the application of preoperative simulated surgery has not been fully spread in clinical practice.
Zheng Ren has known this for a long time, and it is the same as the experimental subjects in the system space. But the technology is immature and not as easy to use as a big pig’s trotters.
Now, doctors at the Women's and Children's Hospital are trying to perform heart separation operations on conjoined twins in a "system operating room" built with a lot of money.
The surgical model is a 3D printed human that looks exactly like the Siamese twins.
The operation was originally supposed to be performed by the medical team of the Children's Hospital of Philadelphia. However, during the preoperative simulation operation, the team of the Children's Hospital of Philadelphia found that the child had severe cardiac malformation and the success rate of the operation was less than 5%, so they directly refused.
Under the careful care of the Women's and Children's Hospital, the vital signs of the conjoined twins were able to withstand the surgery, but as time went by, the symptoms of heart failure became more and more serious, and there was no way to delay it.
The hospital talked many times with the parents of the children, and finally reached a consensus that the conjoined twins had symptoms of heart failure and had a chance of survival with surgery. Without surgery, they would not even have a chance of survival.
Then give it a try.
As planned, this was the last simulated surgery.
The images produced by the three-dimensional positioning of CT and MRI done yesterday were bitmap in nature, showing the situation inside the bodies of the conjoined twins in a three-dimensional manner.
When the conjoined twins first came to Daodidu Women's and Children's Hospital, an examination revealed that they shared a pericardium and that the two hearts were connected in the atria. The great vessels and atria at the base of the heart are completely separated and have no communication. The apex of the heart is connected near the diaphragm. There is a small tubular connection between the two hearts with a diameter of 3 mm. Most of the two hearts are membranous.
The liver has many connected parts, but this is not the point.
The most difficult operation for conjoined twins is to connect the brains, followed by the heart. The rest of the organs are not very important.
However, the reason that led the expert team at the Children's Hospital of Philadelphia to give up was that as the conjoined twins grew, they found that their hearts beat at different frequencies, and the operation could not proceed at all.
Several simulated surgeries were attempted and no one could fix the problem.
Therefore, the Children's Hospital of Philadelphia announced that it would give up the operation.
Vice President Chen of the Women's and Children's Hospital is sitting in, ready to try a few more times. If the operation was abandoned at this time, the child would die within a month, and all previous efforts would be in vain.
Only they themselves know how much effort the Women's and Children's Hospital has put into this pair of conjoined twins.
Not to mention the top-notch 3D printed simulated children, not to mention the introduction of the surgical navigation system, countless small details are immersed in the efforts of the medical staff.
Feeding carefully is the first step.
In order to enhance the physique of conjoined twins and create conditions for surgery.
The two conjoined infants were 10 days old when admitted to the hospital, with a total weight of 3.93 kg. They were classified as II° malnourished.
After admission, the high-quality newborn formula feeding was increased from 3 mL each time, once every 3 hours, to 60 to 90 mL once every 3 hours. And during the feeding process, pay attention to the inclination of the bottle and the size of the milk hole, and be careful to prevent choking and vomiting. Even suffocation occurs.
During this period, intravenous nutrition - children's compound amino acid, fat emulsion, multivitamins, trace elements, and isotype plasma, human albumin, calcium, etc. were given intravenously.
Every detail was not missed, and the preoperative weight of the two babies had increased to 7.8 kg.
this,
Just part of it.
In addition to feeding, basic care must be strengthened to control infection and establish protective isolation in single rooms.
The air sterilizer in the ward automatically disinfects at regular intervals every day, and attention is paid to ventilation to keep the air fresh. The room temperature is 20°C-24°C, and the relative humidity is 50%-60%.
When the child was admitted to the hospital, he suffered from severe diaper rash and pustular rash in the armpits, groin, lower limbs, and around the anus and genitals. After being admitted to the hospital, he used 0.05% Xinjier water every day to bathe, and then used Baiduobanghong. Apply butt ointment to the affected area 3-4 times a day.
And this is only part of the foundation.
Because the area where conjoined twins are connected is relatively large, there may be a large area of skin deficiency after separation. In order to ensure that the incision skin is sufficient during the operation and to avoid skin grafting as much as possible, the body bridge must be lengthened and widened.
The body bridge is the "bridge" part shared by conjoined twins.
On admission, the initial length of the umbilicus of the conjoined twins was 16 cm. The body bridge is 4 cm wide and 37 cm long in circumference. Because the body bridge tension is high, the chest and abdominal walls need to be relaxed to expand the thoracoabdominal cavity.
The director of pediatrics will personally apply pressure on the connecting parts of the conjoined twins three times a day for 15 minutes each time.
The old director is almost 60 years old. Watching her put four fingers of one hand together flatly under the body bridge every day, with her thumb on top, and press rhythmically from light to heavy, Vice President Chen feels very hard.
When pressing, the reaction and complexion of the conjoined body should also be observed. After pressing, a rice bag with a length of 16 cm, a diameter of 2 cm, and a weight of 150 g is pressed on top of the body bridge.
A cotton bag of the same shape is used to cushion the lower part. During night sleep, the side-lying stretching method is used, that is, a small pillow is placed between the two children, so that the two children can be stretched as far apart as possible when they are lying on their sides, so as to achieve a body bridge during the operation. Prepare to be satisfied.
With joint efforts, the circumference of the conjoined twins' body bridge now reaches 54.
But everything was ready, but the operation could not be completed.