胎儿镜下脊髓脊膜膨出修补术
Fetoscopic Repair of Meningomyelocele.
作者信息
Belfort Michael A, Whitehead William E, Shamshirsaz Alireza A, Ruano Rodrigo, Cass Darrell L, Olutoye Oluyinka O
机构信息
Baylor College of Medicine, Departments of Obstetrics and Gynecology, Neurosurgery, and Surgery, Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.
出版信息
Obstet Gynecol. 2015 Oct;126(4):881-884. doi: 10.1097/AOG.0000000000000835.
BACKGROUND
Currently, maternal-fetal surgery for repair of myelomeningocele requires an upper-segment hysterotomy, which likely increases maternal postsurgical risks. If fetoscopic repair of myelomeningocele achieves similar or better fetal outcomes while decreasing maternal risks, it would be a better option.
CASE
A patient with a fetus with a L3-S1 meningomyelocele underwent a laparotomy and fetoscopic repair using a two-port, in-CO2 approach at 23 2/7 weeks of gestation. The neonate was delivered at 30 6/7 weeks of gestation by lower segment cesarean delivery and required no further surgery, has not needed a shunt (5 months), and has normal, age-appropriate neurologic function.
CONCLUSION
This innovative fetoscopic approach may offer an alternative to open fetal surgery and may prevent the need for hysterotomy and cesarean delivery in index and subsequent pregnancies.
背景
目前，用于修复脊髓脊膜膨出的母胎手术需要进行上段子宫切开术，这可能会增加产妇术后风险。如果胎儿镜下修复脊髓脊膜膨出能取得相似或更好的胎儿结局，同时降低产妇风险，那将是一个更好的选择。
病例
一名怀有L3 - S1脊髓脊膜膨出胎儿的患者，在妊娠23又2/7周时接受了剖腹手术及采用双端口二氧化碳入路的胎儿镜修复术。新生儿在妊娠30又6/7周时通过下段剖宫产分娩，无需进一步手术，（5个月时）未需要分流，且具有与其年龄相符的正常神经功能。
结论
这种创新的胎儿镜方法可能为开放性胎儿手术提供一种替代方案，并可能避免在本次及后续妊娠中进行子宫切开术和剖宫产。
Zotero 插件