Gucciardo Leonardo, Deprest Jan A, Vaast Pascal, Favre Romain, Gallot Denis, Huissoud Cyril, Bretelle Florence, Agenor Joel, Benachi Alexandra, Jani Jacques, Done Elise, van Mieghem Tim, Ville Yves, Devlieger Roland
Bull Acad Natl Med. 2008 Nov;192(8):1589-607; discussion 1607-9.
Congenital diaphragmatic hernia (CDH) affects one in 2500 to 5000 births and can be detected in utero by means of ultrasound screening Associated structural problems aggravate the prognosis. The survival rate is 70% or more for cases managed in tertiary care centers. The commonest causes of neonatal death in this setting are pulmonary hypoplasia and pulmonary hypertension. Prenatal imaging findings can now accurately predict postnatal outcome, based mainly on ultrasound determination of the lung-to-head ratio and liver position. This information can be used to counsel patients. In severe cases, prenatal intervention can reverse pulmonary hypoplasia. We review current data on prenatal prediction of neonatal survival. We also discuss experimental and clinical data on the benefits of fetal tracheal occlusion. The TOTAL trial (Tracheal Occlusion To Accelerate Lung growth) is currently ongoing in Europe.
先天性膈疝（CDH）在2500至5000例出生中约有1例发生，可通过超声筛查在子宫内检测到。相关的结构问题会加重预后。在三级护理中心治疗的病例，存活率为70%或更高。在此情况下，新生儿死亡的最常见原因是肺发育不全和肺动脉高压。目前，产前影像学检查结果主要基于超声测定肺头比和肝脏位置，能够准确预测产后结局。这些信息可用于为患者提供咨询。在严重病例中，产前干预可逆转肺发育不全。我们回顾了目前关于新生儿生存产前预测的数据。我们还讨论了关于胎儿气管闭塞益处的实验和临床数据。欧洲目前正在进行TOTAL试验（气管闭塞促进肺生长）。
