Masahata Kazunori, Soh Hideki, Tachibana Kazuya, Sasahara Jun, Hirose Masayuki, Yamanishi Tadashi, Ibuka Souji, Okuyama Hiroomi, Usui Noriaki
Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Murodoucho 840, Izumi, Osaka, 594-1101, Japan.
Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan.
Pediatr Surg Int. 2019 Aug;35(8):835-843. doi: 10.1007/s00383-019-04494-1. Epub 2019 Jun 4.
The aim of this study was to evaluate the indications and the clinical outcomes of the fetuses managed with ex utero intrapartum treatment (EXIT) procedures.
We retrospectively reviewed the medical records of all fetuses who underwent EXIT procedures between 2003 and 2018.
EXIT procedures were performed in nine cases. The prenatal diagnosis of the neonates was congenital high airway obstruction syndrome in four cases, the neck masse in five cases. Although the airway management under the EXIT procedure was successful in eight cases, the airway management failed in one case. During the EXIT procedures, the airway was managed by endotracheal intubation in two cases, whereas six cases underwent tracheostomy. Six cases with fetal airway obstruction survived to discharge, whereas three cases died due to airway management failure or complications of the underlying disease. A case with a cervical teratoma underwent tumor resection the day after birth due to rapid enlargement of the neck mass. Long-term survival was achieved in five cases.
We concluded that the EXIT procedure was effective and could be performed safely in the airway management of fetuses with suspected airway obstruction. The treatment strategy for the neck masses should be planned before birth.
本研究旨在评估经子宫外产时处理（EXIT）手术治疗胎儿的适应症及临床结局。
我们回顾性分析了2003年至2018年间所有接受EXIT手术的胎儿的病历。
共进行了9例EXIT手术。新生儿的产前诊断为4例先天性高位气道梗阻综合征，5例颈部肿块。尽管EXIT手术中的气道管理在8例中成功，但1例失败。在EXIT手术期间，2例通过气管插管进行气道管理，而6例行气管切开术。6例胎儿气道梗阻病例存活出院，3例因气道管理失败或基础疾病并发症死亡。1例颈部畸胎瘤病例因颈部肿块迅速增大，于出生后第二天接受肿瘤切除术。5例实现长期存活。
我们得出结论，EXIT手术有效，可安全用于疑似气道梗阻胎儿的气道管理。颈部肿块的治疗策略应在出生前制定。
