Luton D, de Lagausie P, Guibourdenche J, Peuchmaur M, Sibony O, Aigrain Y, Oury J F, Blot P
Département de Périnatalogie, Hôpital Robert-Debré, Paris, France.
Fetal Diagn Ther. 2000 Jul-Aug;15(4):224-8. doi: 10.1159/000021011.
Recent studies on the management of human fetal gastroschisis have produced two major findings: (1) there is an inflammatory response in the amniotic fluid of these fetuses, and (2) amniotic fluid exchange designed to disrupt the inflammatory loop seems to have a favorable impact on the immediate and late outcome of these early operated neonates. To test this hypothesis, we used serial amniotic fluid exchanges in a model of gastroschisis developed in the ewe.
Gastroschisis was created at midgestation in 21 lamb fetuses by an in utero technique. Saline was amnioinfused in some fetuses every 10 days to term. Fetuses were sacrificed on day 145 by cesarean section. Extra-abdominal bowels with fibrous peel were processed for histologic examination. Comparisons were done between fetuses without gastroschisis (controls), fetuses with gastroschisis and amnioinfusion, and fetuses with gastroschisis without amnioinfusion.
Of 21 fetuses operated, 8 died in utero or were stillborn; 5 were not amnioinfused, and 8 underwent amnioinfusion. Thickness of bowel muscularis (micrometer) was 92.6 +/- 20.2 for controls, 126.2 +/- 21 for the amnioinfused fetuses, and 182.8 +/- 58.3 for the nonamnioinfused fetuses (p = 0.001). The same significant results were obtained for thickness of serous fibrosis (p = 0.02) and plasma cell infiltration (p = 0.015).
We have created a model of gastroschisis suitable for experimentation in the fetal sheep. Our amnioinfusion data in this model indicate a clear improvement of the deleterious process. This finding correlates well with recent data on amnioinfusion as a therapeutic approach to human gastroschisis.
近期关于人类胎儿腹裂管理的研究产生了两个主要发现：（1）这些胎儿的羊水中存在炎症反应，（2）旨在破坏炎症循环的羊水置换似乎对这些早期接受手术的新生儿的近期和远期结局有积极影响。为了验证这一假设，我们在母羊建立的腹裂模型中进行了系列羊水置换。
通过子宫内技术在21只妊娠中期的羔羊胎儿中制造腹裂。部分胎儿每10天向羊膜腔内注入生理盐水直至足月。在第145天通过剖宫产将胎儿处死。对带有纤维包膜的腹外肠管进行组织学检查。对未患腹裂的胎儿（对照组）、患腹裂且接受羊水灌注的胎儿以及患腹裂但未接受羊水灌注的胎儿进行比较。
在接受手术的21只胎儿中，8只在子宫内死亡或死产；5只未接受羊水灌注，8只接受了羊水灌注。对照组肠肌层厚度（微米）为92.6±20.2，接受羊水灌注的胎儿为126.2±21，未接受羊水灌注的胎儿为182.8±58.3（p = 0.001）。在浆液性纤维化厚度（p = 0.02）和浆细胞浸润（p = 0.015）方面也得到了相同的显著结果。
我们建立了一个适合在胎羊中进行实验的腹裂模型。我们在该模型中的羊水灌注数据表明有害过程有明显改善。这一发现与近期关于羊水灌注作为人类腹裂治疗方法的数据高度相关。
