Coleman Beverly G, Adzick N Scott, Crombleholme Timothy M, Johnson Mark P, Howell Lori, Horii Steven C, Langer Jill E, Nisenbaum Harvey L, DeBari Suzanne, Iyoob Christopher
Department of Radiology, The University of Pennsylvania Medical Center, Philadelphia 19104, USA.
J Ultrasound Med. 2002 Nov;21(11):1257-88. doi: 10.7863/jum.2002.21.11.1257.
To review our experience with the use of sonography in evaluating potential candidates for in utero fetal therapy performed at The Center for Fetal Diagnosis and Treatment at The Children's Hospital of Philadelphia.
This review article was designed to discuss open hysterotomy for the 4 fetal surgical procedures that have been performed at our institution. The procedures included surgical repair of myelomeningocele, resection of sacrococcygeal teratoma in fetuses with nonimmune hydrops, resection of an enlarging congenital cystic adenomatoid malformation that is not amenable to thoracoamniotic shunting, and tracheal clip occlusion for severe left congenital diaphragmatic hernia.
For each surgical procedure, the use of sonography in the prenatal diagnosis of the congenital anomaly was detailed, as were indications for surgery and surgical procedures, postoperative monitoring and finally delivery, postnatal treatment, and long-term follow-up. Three of the procedures have been reasonably successful with rather dramatic results in some cases such that these techniques are still being performed. The 1 exception was open hysterotomy for the tracheal clip procedure for congenital diaphragmatic hernia, which has been abandoned.
Fetal therapy is a rapidly evolving specialty, which is being practiced at several centers in this country. Sonography is an integral part of this specialty practice and has been used extensively in the diagnosis of some congenital anomalies that have debilitating or lethal consequences for the fetus. Technologic improvements in both sonography and magnetic resonance imaging have assisted tremendously in the many advances herein reported in the diagnosis and treatment of the above-described 4 congenital anomalies.
回顾我们在费城儿童医院胎儿诊断与治疗中心使用超声评估宫内胎儿治疗潜在候选者的经验。
这篇综述文章旨在讨论我们机构已开展的4种胎儿外科手术的开放性子宫切开术。这些手术包括脊髓脊膜膨出的手术修复、非免疫性水肿胎儿骶尾部畸胎瘤的切除、无法进行胸腔羊膜分流术的增大性先天性囊性腺瘤样畸形的切除，以及严重左侧先天性膈疝的气管夹闭术。
对于每种外科手术，详细介绍了超声在先天性异常产前诊断中的应用，以及手术指征、手术过程、术后监测及最终分娩、产后治疗和长期随访情况。其中3种手术取得了一定成功，在某些情况下效果显著，因此这些技术仍在开展。唯一的例外是先天性膈疝气管夹闭术的开放性子宫切开术，该手术已被放弃。
胎儿治疗是一个快速发展的专业领域，在我国多个中心开展。超声是该专业实践不可或缺的一部分，已广泛用于诊断一些对胎儿有衰弱或致命后果的先天性异常。超声和磁共振成像技术的改进极大地推动了本文报道的上述4种先天性异常在诊断和治疗方面的诸多进展。
