Lautmann K, Staboulidou I, Schippert C, Hillemanns P, Wüstemann M
Medizinische Hochschule Hannover, Frauenklinik, Hannover.
Z Geburtshilfe Neonatol. 2007 Dec;211(6):250-3. doi: 10.1055/s-2007-981408.
Posterior urethral valves are the main cause of fetal lower urinary tract obstruction (LUTO) with typical sonographic signs like urinary tract dilatation and reduction of amniotic fluid. LUTO is associated with a high rate of perinatal mortality and is the main cause of kidney failure in early childhood. In such cases vesico-amniotic shunting is a common but risky procedure of fetal surgery to prevent anhydramnion and lethal lung hypoplasia. This case report demonstrates that lung hypoplasia can be prevented by vesico-amniotic shunting of the fetal megacytis in the 23rd week of gestation in a fetus with lower urinary tract obstruction and anhydramnion. The prenatal measured concentration of cystatin C in the fetal urine correlated with the postnatal impaired kidney function. The indication and therapeutic benefit of vesico-amniotic shunting remain controversially discussed in the literature because until today there is no evidence for a reduction in perinatal or long-term morbidity due to early fetal kidney damage. The earlier ultrasound detection of LUTO during the first trimester of pregnancy proposes the possibility of earlier intervention and protection of nephrogenesis. First case studies about first trimester vesico-amniotic shunting have been published; the influence on the postnatal kidney function merits further well-structured investigation.
后尿道瓣膜是胎儿下尿路梗阻（LUTO）的主要原因，具有典型的超声征象，如尿路扩张和羊水减少。LUTO与围产期死亡率高相关，是幼儿期肾衰竭的主要原因。在这种情况下，膀胱羊膜分流术是一种常见但有风险的胎儿手术，用于预防羊水过少和致命性肺发育不全。本病例报告表明，对于一名患有下尿路梗阻和羊水过少的胎儿，在妊娠第23周通过膀胱羊膜分流术可预防其巨膀胱导致的肺发育不全。产前检测的胎儿尿液中胱抑素C浓度与产后肾功能受损相关。膀胱羊膜分流术的适应症和治疗益处仍在文献中存在争议，因为直到现在，尚无证据表明早期胎儿肾脏损伤能降低围产期或长期发病率。妊娠早期超声对LUTO的早期检测提示了早期干预和保护肾发生的可能性。关于妊娠早期膀胱羊膜分流术的首例病例研究已发表；其对产后肾功能的影响值得进一步进行结构严谨的研究。
