Guilbaud Lucie, Roux Nathalie, Friszer Stéphanie, Garabedian Charles, Dhombres Ferdinand, Bessières Bettina, Fallet-Bianco Catherine, Di Rocco Federico, Zerah Michel, Jouannic Jean-Marie
Service de Médecine Foetale, Hôpital Armand Trousseau, APHP, 26 avenue du Docteur Arnold Netter, 75012, Paris, France.
Université Pierre et Marie Curie, Paris 6, Paris, France.
Childs Nerv Syst. 2017 Jul;33(7):1177-1184. doi: 10.1007/s00381-017-3461-7. Epub 2017 May 26.
This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model.
Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4). Lambs were killed at term, and histological examinations were performed.
Fetoscopic patch coverage was achieved in all the lambs of group 4. All the fetuses of group 2 had a complete closure of the defect whereas only 38% in group 3 and 14% in group 4. Fetal loss rate seems to be lower in group 4 than in groups 2 and 3.
Fetoscopic coverage of MMC defect can be performed using a sealed patch through a two-port access, but the patch and glue correction may not be the ideal technique to repair fetal MMC.
本研究旨在评估在绵羊模型中，通过双端口入路使用密封惰性补片进行胎儿脊髓脊膜膨出（MMC）覆盖的可行性和有效性。
44只胎儿在第75天接受了MMC缺损的手术创建，并在第90天根据MMC修复技术分为四组。第1组未接受治疗。第2组采用开放手术缝合缺损。第3组和第4组使用戈尔®聚四氟乙烯补片并用手术粘合剂（生物胶®）固定进行缺损覆盖，第3组采用开放入路，第4组采用胎儿镜入路。羔羊足月时处死并进行组织学检查。
第4组所有羔羊均实现了胎儿镜下补片覆盖。第2组所有胎儿的缺损均完全闭合，而第3组为38%，第4组为14%。第4组的胎儿丢失率似乎低于第2组和第3组。
可以通过双端口入路使用密封补片进行胎儿镜下MMC缺损覆盖，但补片和胶水矫正可能不是修复胎儿MMC的理想技术。
