Wilson R Douglas
The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Curr Opin Obstet Gynecol. 2002 Apr;14(2):187-93. doi: 10.1097/00001703-200204000-00013.
The selection of fetuses that may benefit with in utero surgery is being developed. Noninvasive and invasive prenatal diagnosis techniques are utilized to try and gain as much knowledge about the fetus so that the appropriate counseling of parents can be undertaken. The most common invasive techniques are amniocentesis and chorionic villus sampling for fetal karyotyping and genetic diagnosis. Noninvasive techniques include ultrasound (2D and 3D), fetal echocardiography and magnetic resonance imaging. Additional techniques such as specific Doppler evaluation of vascular components, new techniques to look at fetal electrocardiograms and the use of computer tomography are also considered. The most common conditions for which in utero fetal surgery is also being considered are twin to twin transfusion syndrome, myelomeningocele, sacrococcygeal teratoma, cystic adenomatoid malformation of the lung with fetal hydrops and other monochorionic twin abnormalities (severe discordant birth defects or twin reversal arterial perfusion sequences). Ongoing evaluation of the sensitivity, specificity, positive and negative predicted values of these evaluation tools is required so that appropriate selection of fetuses for the surgery can be made.
针对可能从宫内手术中获益的胎儿的选择标准正在制定中。非侵入性和侵入性产前诊断技术被用于尝试获取尽可能多的关于胎儿的信息，以便能够为父母提供适当的咨询。最常见的侵入性技术是羊水穿刺术和绒毛取样术，用于胎儿核型分析和基因诊断。非侵入性技术包括超声（二维和三维）、胎儿超声心动图和磁共振成像。其他技术，如对血管成分的特定多普勒评估、观察胎儿心电图的新技术以及计算机断层扫描的应用也在考虑之中。目前也在考虑进行宫内胎儿手术的最常见病症包括双胎输血综合征、脊髓脊膜膨出、骶尾部畸胎瘤、伴有胎儿水肿的肺囊性腺瘤样畸形以及其他单绒毛膜双胎异常（严重不一致的出生缺陷或双胎反向动脉灌注序列）。需要持续评估这些评估工具的敏感性、特异性、阳性和阴性预测值，以便能够对适合手术的胎儿进行恰当选择。
