Adzick N S, Harrison M R, Glick P L, Anderson J, Villa R L, Flake A W, Laberge J M
J Pediatr Surg. 1986 Jun;21(6):477-80. doi: 10.1016/s0022-3468(86)80215-9.
Maternal safety and future reproduction potential are paramount considerations in fetal surgery. In a series of 102 fetal surgical procedures on time-dated pregnant monkeys, we examined the maternal complications, the potential for future pregnancy, and the effects of uterine staples used for hysterotomy and uterine closure. There were significant maternal complications associated with the development of the present techniques for fetal surgery including 3 maternal deaths, 5 uterine ruptures, and 5 cases of wound infection of dehiscence. All were preventable with knowledge gained from this experience. Compared with a control unoperated breeding colony, fetal surgery did not interfere with subsequent reproductive capacity in animals that had uterine closure with absorbable sutures. However, metal staple hysterotomy resulted in a markedly decreased fertility rate probably related to exposure of the endometrial cavity to a permanent foreign body. Although serious maternal complications occurred in this series, many are avoidable as we improve both our obstetric management and our anesthetic and surgical techniques. Prenatal intervention carries considerable maternal risk and should not be attempted clinically under any but the most rigorous conditions.
在胎儿手术中，母体安全和未来生殖潜力是首要考虑因素。在对按孕周计时的怀孕猴子进行的一系列102例胎儿外科手术中，我们检查了母体并发症、未来怀孕的可能性以及用于子宫切开术和子宫闭合的子宫吻合钉的影响。当前胎儿手术技术的发展伴随着显著的母体并发症，包括3例母体死亡、5例子宫破裂和5例伤口感染或裂开。基于这次经验所获得的知识，所有这些都是可以预防的。与未手术的对照繁殖群体相比，对于采用可吸收缝线进行子宫闭合的动物，胎儿手术并未干扰其后续生殖能力。然而，金属吻合钉子宫切开术导致生育率显著下降，这可能与子宫内膜腔暴露于永久性异物有关。尽管在这一系列手术中出现了严重的母体并发症，但随着我们改进产科管理以及麻醉和手术技术，许多并发症是可以避免的。产前干预会给母体带来相当大的风险，除非在最严格的条件下，否则临床上不应尝试。
