Department of Obstetrics and Prenatal Medicine, German Center for Fetal Surgery and Minimally Invasive Therapy, University of Bonn, Sigmund Freud Strasse 25, 53105 Bonn, Germany.
Surg Endosc. 2010 Aug;24(8):2056-67. doi: 10.1007/s00464-010-0879-3. Epub 2010 Mar 17.
The availability of high-end endoscopic equipment, microcatheters, miniballoons, tiny laser fibers, and other devices has been instrumental in the development of minimally invasive fetoscopic interventions. These interventions are performed for a spectrum of fetal disease states that progress in severity over the course of gestation and have a huge impact on termination of pregnancy rates, fetal demise, perinatal mortality and morbidity, and long-term prognosis. This report aims to introduce interested readers to these new procedures.
Fetoscopic interventions such as laser coagulation of pathologic placental vascular connections in twin-to-twin-transfusion-syndrome, fetal biopsies, fetal tracheal balloon occlusion in diaphragmatic hernia, perforation of posterior urethral valves, tracheal decompression in fetal laryngeal atresia, and even coverage of spina bifida aperta can be performed by percutaneous minimally invasive fetoscopic techniques.
In contrast to prenatally untreated patients, the majority of patients who underwent fetoscopic interventions followed by state-of-the-art neonatal intensive care experienced improved survival rates and enhanced quality of life. Yet for some patients, significant morbidity from the underlying disease or fetal surgical complications, most often early preterm delivery, persist in postnatal life.
A growing spectrum of fetal disease states has become amenable to minimally invasive fetoscopic interventions. Sufficient training, an interdisciplinary approach, ethical board supervision, and continued scientific assessment of benefits and risks are important for the success and acceptance of these procedures. Further improvements in fetal selection, surgical techniques, and postnatal management accompanied by the development of specialized devices are desired.
高端内窥镜设备、微导管、迷你球囊、微小激光光纤和其他设备的可用性为微创胎儿镜介入的发展提供了帮助。这些介入是针对一系列胎儿疾病状态进行的，这些疾病在妊娠过程中会逐渐加重，对终止妊娠率、胎儿死亡、围产期死亡率和发病率以及长期预后有很大影响。本报告旨在向感兴趣的读者介绍这些新程序。
可以通过经皮微创胎儿镜技术进行胎儿镜介入，例如在双胎输血综合征中激光凝固病理性胎盘血管连接、胎儿活检、膈疝胎儿气管球囊阻塞、后尿道瓣膜穿孔、胎儿喉闭锁气管减压，甚至开放性脊柱裂的覆盖。
与未经产前治疗的患者相比，大多数接受胎儿镜介入治疗并接受最先进的新生儿重症监护的患者的生存率提高，生活质量得到改善。然而，对于一些患者，基础疾病或胎儿手术并发症的严重发病率，通常是早期早产，仍然存在于产后生活中。
越来越多的胎儿疾病状态已经可以通过微创胎儿镜介入来治疗。充分的培训、跨学科方法、伦理委员会监督以及对这些程序的益处和风险的持续科学评估对于这些程序的成功和接受至关重要。还需要进一步改进胎儿选择、手术技术和产后管理，并开发专门的设备。
