Peranteau William H, Adzick N Scott
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Curr Opin Obstet Gynecol. 2016 Apr;28(2):111-8. doi: 10.1097/GCO.0000000000000253.
This review summarizes outcomes of fetal surgery for myelomeningocele (MMC) as they compare to postnatal MMC repair and provides insights into areas of investigation to improve fetal MMC repair.
Recent studies confirm the findings of the Management of Myelomeningocele Study and support the decreased need for postnatal ventricular shunts, improved hindbrain herniation, and improved neurofunctional outcome following open fetal repair compared to postnatal repair at the risk of increased maternal complications and preterm birth. Larger studies of minimally invasive fetal repair demonstrate that, although technically feasible, this approach is associated with longer operative times, increased membrane complications, an earlier gestational age at birth, persistent cerebrospinal fluid leakage, and incidences of persistent postnatal hindbrain herniation resulting in death or requiring surgical decompression.
Open prenatal MMC repair is a new standard of care option with improved postnatal outcomes in a highly specific patient population when performed at select multidisciplinary fetal surgery centers. More investigations are required to optimize minimally invasive approaches prior to reliable clinical application.
本综述总结了与出生后脊髓脊膜膨出（MMC）修复相比，胎儿手术治疗MMC的结果，并深入探讨了改进胎儿MMC修复的研究领域。
近期研究证实了脊髓脊膜膨出管理研究的结果，并支持与出生后修复相比，开放性胎儿修复术后出生后脑室分流需求减少、后脑疝改善以及神经功能结局改善，但产妇并发症和早产风险增加。对微创胎儿修复的更大规模研究表明，尽管在技术上可行，但这种方法与手术时间延长、膜并发症增加、出生时孕周更早、持续性脑脊液漏以及出生后持续性后脑疝导致死亡或需要手术减压的发生率有关。
在选定的多学科胎儿手术中心进行开放性产前MMC修复，对于特定的患者群体而言，是一种新的标准治疗选择，可改善出生后的结局。在可靠的临床应用之前，需要更多研究来优化微创方法。
