医生对脊柱裂胎儿产前手术的益处和负担的看法。

Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele.

作者信息

Antiel R M, Collura C A, Flake A W, Johnson M P, Rintoul N E, Lantos J D, Curlin F A, Tilburt J C, Brown S D, Feudtner C

机构信息

University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.

Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.

出版信息

J Perinatol. 2017 Sep;37(9):994-998. doi: 10.1038/jp.2017.75. Epub 2017 Jun 15.

DOI:10.1038/jp.2017.75

PMID:28617430

Abstract

OBJECTIVE

Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure.

STUDY DESIGN

Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs).

RESULTS

Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure.

CONCLUSION

Individual and specialty-specific values may influence recommendations about prenatal surgery.

摘要

目的

探讨儿科和产科亚专科医生如何看待产前脊柱裂（MMC）修复的益处和负担。

研究设计

对1200名新生儿科医生、小儿外科医生和母胎医学专家（MFM）进行邮件调查。

结果

在1176名符合条件的医生中，670名（57%）回复。大多数受访者不同意（68%，11%强烈反对）开放性胎儿手术给妇女及其家庭带来不可接受的负担这一观点。大多数人同意（65%，10%强烈同意）拒绝开放性母胎手术的益处对未来孩子不公平。对于一种假设的胎儿镜技术，其分流率相似（40%）但产妇发病率降低，大多数人（94%）会推荐产前胎儿镜检查而非开放性或产后MMC修复。当胎儿镜检查的假设分流率提高到60%时，医生们意见不一（49%选择胎儿镜检查，45%选择开放性手术）。关于负担和公平性的观点与推荐产后或胎儿镜检查而非开放性修复的可能性相关。