Fetal Medicine and Treatment Unit of University Hospital Gasthuisberg, Leuven, Belgium.
Ultrasound Obstet Gynecol. 2009 Sep;34(3):304-10. doi: 10.1002/uog.6450.
To examine operative and perinatal aspects of fetal endoscopic tracheal occlusion (FETO) in congenital diaphragmatic hernia (CDH).
This was a multicenter study of singleton pregnancies with CDH treated by FETO. The entry criteria for FETO were severe CDH on the basis of sonographic evidence of intrathoracic herniation of the liver and low lung area to head circumference ratio (LHR) defined as the observed to the expected normal mean for gestation (o/e LHR) equivalent to an LHR of 1 or less.
FETO was carried out in 210 cases, including 175 cases with left-sided, 34 right-sided and one with bilateral CDH. In 188 cases the CDH was isolated and in 22 there was an associated defect. FETO was performed at a median gestational age of 27.1 (range, 23.0-33.3) weeks. The first eight cases were done under general anesthesia, but subsequently either regional or local anesthesia was used. The median duration of FETO was 10 (range, 3-93) min. Successful placement of the balloon at the first procedure was achieved in 203 (96.7%) cases. Spontaneous preterm prelabor rupture of membranes (PPROM) occurred in 99 (47.1%) cases at 3-83 (median, 30) days after FETO and within 3 weeks of the procedure in 35 (16.7%) cases. Removal of the balloon was prenatal either by fetoscopy or ultrasound-guided puncture, intrapartum by ex-utero intrapartum treatment, or postnatal either by tracheoscopy or percutaneous puncture. Delivery was at 25.7-41.0 (median, 35.3) weeks and before 34 weeks in 65 (30.9%) cases. In 204 (97.1%) cases the babies were live born and 98 (48.0%) were discharged from the hospital alive. There were 10 deaths directly related to difficulties with removal of the balloon. Significant prediction of survival was provided by the o/e LHR and gestational age at delivery. On the basis of the relationship between survival and o/e LHR in expectantly managed fetuses with CDH, as reported in the antenatal CDH registry, we estimated that in fetuses with left CDH treated with FETO the survival rate increased from 24.1% to 49.1%, and in right CDH survival increased from 0% to 35.3% (P < 0.001).
FETO in severe CDH is associated with a high incidence of PPROM and preterm delivery but a substantial improvement in survival.
研究胎儿内镜气管阻塞（FETO）在先天性膈疝（CDH）中的手术和围生期情况。
这是一项多中心研究，纳入了接受 FETO 治疗的 CDH 单胎妊娠。FETO 的纳入标准为超声证据显示肝脏疝入胸腔和肺面积与头围比（LHR）严重降低，定义为观察到的与妊娠正常平均值（o/e LHR）相等，相当于 LHR 为 1 或更低。
共进行了 210 例 FETO，其中左侧 175 例，右侧 34 例，双侧 1 例。188 例为单纯 CDH，22 例合并其他畸形。FETO 中位孕龄为 27.1 周（范围 23.0-33.3）。前 8 例在全身麻醉下进行，随后使用区域麻醉或局部麻醉。FETO 中位持续时间为 10 分钟（范围 3-93 分钟）。203 例（96.7%）在首次操作中成功放置球囊。99 例（47.1%）在 FETO 后 3-83 天（中位 30 天）发生自发性胎膜早破（PPROM），35 例（16.7%）在操作后 3 周内发生。球囊的移除方式为产前经羊膜镜或超声引导下穿刺、产时经子宫外产时治疗（EXIT）、产后经气管镜或经皮穿刺。分娩时孕周为 25.7-41.0 周（中位 35.3 周），34 周前分娩的有 65 例（30.9%）。204 例（97.1%）新生儿存活，98 例（48.0%）存活出院。10 例死亡与球囊移除困难直接相关。o/e LHR 和分娩时的孕周对存活率有显著预测作用。基于产前 CDH 登记处报告的期待治疗 CDH 胎儿的存活率与 o/e LHR 的关系，我们估计左侧 CDH 胎儿 FETO 治疗后的存活率从 24.1%提高到 49.1%，右侧 CDH 从 0%提高到 35.3%（P<0.001）。
严重 CDH 患者行 FETO 治疗后，PPROM 和早产发生率较高，但存活率显著提高。
