Fetal Treatment Center, Pediatric Surgery Department University of California, San Francisco, San Francisco, CA 94143-0570, USA.
J Pediatr Surg. 2010 Jan;45(1):65-9. doi: 10.1016/j.jpedsurg.2009.10.012.
Gastroschisis is associated with inflammatory changes in the exposed bowel which leads to intestinal dysmotility after postnatal repair. The insult is a combined effect of amniotic fluid exposure and mechanical constriction. We hypothesized that in utero anatomic repair is possible in a sheep model, and that it may halt the inflammatory damage caused by both mechanisms.
Gastroschisis was surgically created in mid-gestation (day 75) in 8 sheep fetuses. On gestational day 100, 2 fetuses underwent open fetal gastroschisis repair, where the eviscerated bowel was returned to the peritoneal cavity, and the abdominal wall was primarily closed. All fetuses were harvested at 135 days of gestation.
Six fetuses survived the initial operation, and both fetuses that underwent gastroschisis repair survived to term. At 100 and 135 days of gestation, the eviscerated bowel showed progressive signs of inflammation and peel development. The gross and microscopic inflammatory changes in the gastroschisis bowel at 100 days of gestation were completely resolved at term following in utero repair.
In utero anatomic repair of gastroschisis is possible in mid-gestation in the fetal lamb model, and it appears to ameliorate the inflammatory process.
先天性腹壁裂与暴露肠段的炎症变化有关，这会导致产后修复后肠道蠕动功能障碍。这种损伤是羊水暴露和机械性压迫的综合作用。我们假设在羊模型中可以进行宫内解剖修复，并且可能阻止这两种机制引起的炎症损伤。
在 8 只胎羊的妊娠中期（第 75 天）通过手术创建先天性腹壁裂。在妊娠第 100 天，2 只胎羊接受了开放性胎儿先天性腹壁裂修复，将脱出的肠管还纳入腹腔，并将腹壁进行一期缝合。所有胎羊均在妊娠第 135 天收获。
6 只胎羊存活下来，接受先天性腹壁裂修复的 2 只胎羊均存活至足月。在妊娠第 100 天和 135 天，脱出的肠管出现进行性炎症和剥脱发展的迹象。在宫内修复后，100 天妊娠时先天性腹壁裂肠管的大体和显微镜下炎症变化在足月时完全消退。
在胎儿羊模型中，妊娠中期的先天性腹壁裂宫内解剖修复是可行的，并且似乎可以改善炎症过程。
