Saura L, Castañón M, Prat J, Albert A, Caceres F, Moreno J, Gratacós E
Agrupació Sanitària Hospital, Sant Joan de Déu-Clínic, Universitat de Barcelona, Passeig Sant Joan de Déu 2, Esplugues, Barcelona, Spain.
Eur J Pediatr Surg. 2007 Dec;17(6):404-7. doi: 10.1055/s-2007-989275.
We report our experience in the postnatal management of congenital diaphragmatic hernia (CDH) after fetal endoluminal balloon tracheal occlusion (FETO).
Out of 19 CDH fetuses diagnosed since December 2005, 13 had a lung-to-head ratio (LHR) < 1.1 (0.86 +/- 0.11) and underwent FETO at a mean gestational age (GA) of 27.9 weeks. The balloon was removed in 3 cases through puncture in EXIT (ex utero intrapartum treatment); there were 3 trans-utero punctures, 3 fetoscopies and 3 balloons deflated spontaneously. One patient died from bleeding during the FETO procedure. Six patients were not subjected to FETO: 3 had a LHR > or = 1.4 and 3 did not come to consultation prenatally.
Twelve babies were born after FETO at 34.9 +/- 1.7 weeks GA; 3 died before surgery from refractory hypoxia. Six needed high frequency oscillatory ventilation (HFOV), and inhaled nitric oxide (NO), one progressing to extracorporeal membrane oxygenation (ECMO), and 3 needed conventional ventilation. CDH was repaired in 9: 2 with direct sutures and 7 with prosthetic patches. Extubation was at median of 5 days (range: 2 - 40), discharge was at 30.4 +/- 16.4 days. Early complications were 1 reherniation and 2 intestinal occlusions. Two patients died after CDH repair: the ECMO case at 15 days, and an infant discharged on oxygen at home, at age 4 months. Of the non-FETO patients, four needed HFOV and NO. CDH repair was performed in 5: 3 had direct repair and 2 had prosthetic patches. Extubation was at 13.4 +/- 12.9 days and discharge was at 43.8 +/- 26.5 days. One patient died before surgery from severe cardiac malformation. Early complications were 1 reherniation and 1 hiatus hernia. Late complication was 1 reherniation at 5 months of life. There was no postoperative mortality. One patient needs oxygen at home.
CDH patients with a poor prognosis undergoing FETO had postnatal outcomes similar to non-prenatally studied cases and good prognosis cases.
我们报告了胎儿腔内球囊气管阻塞术（FETO）后先天性膈疝（CDH）的产后管理经验。
自2005年12月以来诊断出的19例CDH胎儿中，13例肺头比（LHR）<1.1（0.86±0.11），平均孕周（GA）27.9周时接受了FETO。3例通过EXIT（子宫外产时治疗）穿刺取出球囊；有3例经子宫穿刺、3例胎儿镜检查及3例球囊自行瘪掉。1例患者在FETO手术期间死于出血。6例患者未接受FETO：3例LHR≥1.4，3例未进行产前咨询。
12例婴儿在FETO后于GA 34.9±1.7周出生；3例术前死于难治性缺氧。6例需要高频振荡通气（HFOV）及吸入一氧化氮（NO），1例进展为体外膜肺氧合（ECMO），3例需要传统通气。9例进行了CDH修补：2例直接缝合，7例使用人工补片。拔管中位时间为5天（范围：2 - 40天），出院时间为30.4±16.4天。早期并发症为1例复发疝和2例肠梗阻。2例患者CDH修补术后死亡：ECMO病例于15天死亡，1例在家中吸氧出院的婴儿于4个月时死亡。在未接受FETO的患者中，4例需要HFOV和NO。5例进行了CDH修补：3例直接修补，2例使用人工补片。拔管时间为13.4±12.9天，出院时间为43.8±26.5天。1例患者术前死于严重心脏畸形。早期并发症为1例复发疝和1例食管裂孔疝。晚期并发症为1例5个月大时复发疝。无术后死亡病例。1例患者在家中需要吸氧。
预后不良的CDH患者接受FETO后的产后结局与未进行产前研究的病例及预后良好的病例相似。
Zotero 插件