胎儿气管闭塞后肺部反应的证据及模式：临床对照研究。
Evidence and patterns in lung response after fetal tracheal occlusion: clinical controlled study.
作者信息
Cannie Mieke M, Jani Jacques C, De Keyzer Frederik, Allegaert Karel, Dymarkowski Steven, Deprest Jan
机构信息
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium.
出版信息
Radiology. 2009 Aug;252(2):526-33. doi: 10.1148/radiol.2522081955. Epub 2009 Jun 9.
PURPOSE
To prospectively assess changes in lung volume in fetuses with isolated severe congenital diaphragmatic hernia (CDH) after fetoscopic endoluminal tracheal occlusion (FETO) compared with those in fetuses with CDH of variable severity who were expectantly managed.
MATERIALS AND METHODS
Informed consent was obtained for this ethics committee-approved study. Forty fetuses with severe CDH (lung-to-head ratio < 1 and intrathoracic liver) who underwent FETO and 18 fetuses with CDH of variable severity who were expectantly managed were longitudinally followed up by using magnetic resonance (MR) imaging volume measurements. Fetuses born prior to 32 weeks were excluded from the study. For those undergoing FETO, lung volume responsiveness was defined as the proportionate increase in observed-to-expected (O/E) ratio of total fetal lung volume (TFLV) at 2-5 weeks after FETO compared with the pre-FETO value. Changes in lung volume were compared by using the Mann-Whitney U test. Regression analysis was used to investigate the effect of pre-FETO O/E ratio of TFLV, gestational age at FETO and at delivery, lung volume responsiveness, occlusion period, side of CDH, and balloon removal prior to delivery on survival. Correlation between post-FETO lung volume responsiveness and gestational age at FETO was performed by using linear regression analysis.
RESULTS
A total of 260 MR imaging examinations were performed. For expectantly managed fetuses, O/E ratio of TFLV remained unchanged during gestation, whereas it significantly increased after FETO. Regression analysis demonstrated that pre-FETO O/E ratio of TFLV and lung volume responsiveness at 3.3 weeks after FETO provided significant independent prediction of postnatal survival. There was a significant negative association between lung volume responsiveness and gestational age at FETO.
CONCLUSION
In fetuses with CDH, pre-FETO O/E ratio of TFLV and lung volume at 3.3 weeks after FETO provide independent prediction of postnatal survival.
SUPPLEMENTAL MATERIAL
http://radiology.rsnajnls.org/cgi/content/full/2522081955/DC1.
目的
前瞻性评估孤立性严重先天性膈疝（CDH）胎儿在胎儿镜下腔内气管阻塞术（FETO）后肺容积的变化，并与接受期待治疗的不同严重程度CDH胎儿的肺容积变化进行比较。
材料与方法
本研究经伦理委员会批准，并获得了知情同意。对40例接受FETO的严重CDH胎儿（肺头比<1且胸腔内有肝脏）和18例接受期待治疗的不同严重程度CDH胎儿进行纵向随访，采用磁共振（MR）成像容积测量。孕周小于32周出生的胎儿被排除在研究之外。对于接受FETO的胎儿，肺容积反应性定义为FETO后2至5周观察到的与预期的（O/E）总胎儿肺容积（TFLV）比值相对于FETO前值的成比例增加。采用Mann-Whitney U检验比较肺容积变化。回归分析用于研究FETO前TFLV的O/E比值、FETO时及分娩时的孕周、肺容积反应性、阻塞期、CDH的侧别以及分娩前球囊移除对生存的影响。采用线性回归分析进行FETO后肺容积反应性与FETO时孕周之间的相关性分析。
结果
共进行了260次MR成像检查。对于接受期待治疗的胎儿，TFLV的O/E比值在孕期保持不变，而在FETO后显著增加。回归分析表明，FETO前TFLV的O/E比值和FETO后3.3周的肺容积反应性对出生后生存提供了显著的独立预测。肺容积反应性与FETO时的孕周之间存在显著的负相关。
结论
对于CDH胎儿，FETO前TFLV的O/E比值和FETO后3.3周的肺容积对出生后生存提供独立预测。
补充材料
http://radiology.rsnajnls.org/cgi/content/full/2522081955/DC1
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