Mesas Burgos Carmen, Conner Peter, Papatziamos Georgios, Tiblad Eleonor
Karolinska Universitetssjukhuset - Pediatric Surgery Stockholm, Sweden Karolinska Universitetssjukhuset - Pediatric Surgery Stockholm, Sweden.
Karolinska Universitetssjukhuset - Centrum för Fostermedicin Stockholm, Sweden Karolinska Universitetssjukhuset - Centrum för Fostermedicin Stockholm, Sweden.
Lakartidningen. 2017 Aug 29;114:EM6E.
Advances in fetal surgery Fetal surgery is a subspeciality that is evolving rapidly with focus on improving the natural history of congenital malformations and conditions that are either life threatening or cause severe disability. Fetal surgery for myelomeningocele has been shown to improve neurologic outcome, motor function and to reduce the need of ventriculo-peritoneal shunting after birth compared to postnatal care. However, it conveys an increased risk of preterm birth and maternal morbidity. The role of prenatal intervention with endoscopic tracheal occlusion in congenital diaphragmatic hernia is currently the focus of an ongoing multicenter randomized controlled trial. The trial is comparing the effect of fetal surgery as an alternative to standard postnatal management. The main, but not sole, indication for an Ex-utero intrapartum treatment (EXIT) is airway obstruction due to laryngeal atresia and tumors in the head and neck region. It is a complex procedure that should be performed only in experienced centers with a multidisciplinary team.
胎儿外科手术的进展 胎儿外科手术是一个发展迅速的亚专业领域，其重点在于改善先天性畸形以及危及生命或导致严重残疾的疾病的自然病程。与出生后治疗相比，胎儿脊髓脊膜膨出手术已被证明可改善神经功能、运动功能，并减少出生后进行脑室 - 腹腔分流术的需求。然而，它会增加早产和母体发病的风险。目前，先天性膈疝的产前内镜气管闭塞干预作用是一项正在进行的多中心随机对照试验的重点。该试验正在比较胎儿手术作为标准出生后管理替代方案的效果。宫外产时处理（EXIT）的主要但并非唯一指征是由于喉闭锁和头颈部肿瘤导致的气道阻塞。这是一个复杂的手术，应仅在有经验的多学科团队中心进行。
