Flake A W, Crombleholme T M, Johnson M P, Howell L J, Adzick N S
Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, and the Departments of Surgery and Obstetrics, University of Pennsylvania School of Medicine, USA.
Am J Obstet Gynecol. 2000 Nov;183(5):1059-66. doi: 10.1067/mob.2000.108871.
Our purpose was to determine whether prenatal tracheal occlusion improves survival in a selected population of fetuses affected by severe congenital diaphragmatic hernia.
Fetuses with isolated congenital diaphragmatic hernia were selected as candidates for fetal intervention by specific criteria designed to predict a 90% mortality rate with conventional postnatal treatment.
Fifteen fetuses underwent tracheal occlusion with 5 survivors (33%). Two fetuses were lost to early preterm labor. In 13 mothers, postoperative gestation ranged from 19 to 68 days, with a mean duration of pregnancy after tracheal occlusion of 38 days. The 5 survivors were hospitalized for an average of 76 days. Despite dramatic lung growth in some fetuses after tracheal occlusion, intensive management was required, and most deaths were caused by respiratory insufficiency.
Prenatal tracheal occlusion can result in impressive lung growth in a subset of fetuses with severe congenital diaphragmatic hernia. However, survival remains compromised by pulmonary functional abnormality and the consequences of prematurity.
我们的目的是确定产前气管阻塞是否能提高患有严重先天性膈疝的特定胎儿群体的存活率。
通过旨在预测传统产后治疗死亡率为90%的特定标准，选择孤立性先天性膈疝胎儿作为胎儿干预的候选对象。
15例胎儿接受了气管阻塞术，5例存活（33%）。2例胎儿因早产而失访。13例母亲术后妊娠时间为19至68天，气管阻塞术后平均妊娠持续时间为38天。5例存活者平均住院76天。尽管一些胎儿在气管阻塞术后肺有显著生长，但仍需要强化治疗，且大多数死亡是由呼吸功能不全导致的。
产前气管阻塞可使一部分患有严重先天性膈疝的胎儿肺显著生长。然而，存活率仍因肺功能异常和早产后果而受到影响。
