使用超微胎儿镜行宫内气管阻塞的两种新方法。
Two new approaches in intrauterine tracheal occlusion using an ultrathin fetoscope.
机构信息
Department of Obstetrics and Gynecology, University Medical Center, Mainz, Germany.
出版信息
Laryngoscope. 2010 Feb;120(2):394-8. doi: 10.1002/lary.20687.
OBJECTIVES/HYPOTHESIS: To introduce and establish a new approach in minimal invasive fetoscopic surgery in order to reduce access trauma and the iatrogenic preterm premature rupture of the membranes (PPROM) as a major complication of intrauterine treatment of congenital diaphragmatic hernia.
METHODS
In total, 27 pregnant sheep were operated on using fetoscopes with 1.2 and 1.0 mm optics. We used an elliptic sheath alone with a maximum diameter of 2.6/1.3 mm; in these cases the balloon was placed under ultrasound control. In comparison, we placed the balloon under fetoscopic control using the fetoscopic sheath and a 7F (2.3 mm) introducer. Therefore, the maximum access trauma was not bigger than the diameter of sheath of introducer.
RESULTS
With this technique we successfully operated on 22 sheep. The use of real time three-dimensional ultrasound control distinctly facilitates the operation procedure.
CONCLUSIONS
Our preliminary findings show that fetoscopic tracheal occlusion using ultrathin fetoscopes and reducing the access trauma on the level of 4.2 or even 2.65 mm(2) could be seen as a method of reducing the rate of PPROM.
目的/假设：介绍并建立一种新的微创胎儿镜手术方法，以减少入路创伤和医源性胎膜早破（PPROM），这是宫内治疗先天性膈疝的主要并发症。
方法
总共对 27 只怀孕绵羊进行了手术，使用了光学直径为 1.2 和 1.0 毫米的胎儿镜。我们仅使用最大直径为 2.6/1.3 毫米的椭圆形鞘管；在这些情况下，球囊在超声控制下放置。相比之下，我们使用胎儿镜鞘管和 7F（2.3 毫米）导入器在胎儿镜控制下放置球囊。因此，最大入路创伤不大于导入器鞘管的直径。
结果
使用该技术，我们成功地对 22 只绵羊进行了手术。实时三维超声控制的使用明显简化了手术过程。
结论
我们的初步研究结果表明，使用超薄胎儿镜进行胎儿镜气管阻塞，并将入路创伤减少到 4.2 甚至 2.65 毫米²，可以被视为降低胎膜早破率的一种方法。
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