胎镜内膜气管封闭与严重左侧先天性腹膜的胎儿的预期管理
Vivien Dütemeyer1, Thomas Schaible2, Dominique A Badr3
1Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium (Drs Dütemeyer, Badr, and Jani); Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (Drs Dütemeyer).
American journal of obstetrics & gynecology MFM
|December 9, 2023
概括
在经验丰富的中心,对严重的先天性隔膜的预期治疗显示出比胎儿内膜内膜气管封闭更高的生存率. 这种方法利用体外膜氧化,为受影响的胎儿提供了更好的结果.
科学领域:
- 围产儿医学 围产儿医学
- 胎儿外科手术 胎儿外科
- 儿科手术 儿科手术
背景情况:
- 生产腹膜 (CDH) 治疗是复杂的.
- 胎镜内膜气管封闭 (FETO) 显示出与预期护理相比的潜在好处.
- 标准化和专业知识显著影响CDH生存率.
研究的目的:
- 为了比较胎儿的存活率和发病率与严重的孤立左侧CDH.
- 为了评估胎儿透视的内发光道气管封闭与预期的管理.
- 分析高人数的欧洲中心的结果.
主要方法:
- 严重孤立左侧CDH的多中心回顾性研究.
- 期待管理 (德国) 和FETO (比利时,法国,意大利) 的比较.
- 严重CDH的定义:通过MRI观察/预期的胎儿肺总体积≤35%和胸内肝脏.
- 对管理策略影响的物流回归分析.
主要成果:
- 分析了147个预期管理与47个FETO案件.
- 预期组的肺体积较小,但存活率更高 (74.3%与出院时的44.7%相比,72.8%与2年后的42.5%相比).
- 预期的管理组在分娩时有更高的妊娠年龄和更频繁的ECMO使用 (55.8%对4.3%).
结论:
- 在经验丰富的中心与产后ECMO支持进行产前预产管理,改善了严重孤立左侧CDH的存活率.
- 胎镜内膜气管封闭与这一队列中较低的存活率有关.
- 中心的专业知识和管理策略对于CDH结果至关重要.
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