Department of Obstetric Anaesthesia, University College Hospital, London, UK.
Department of Obstetrics and Fetal Medicine, University College Hospital, London, UK.
Anaesthesia. 2021 Apr;76 Suppl 4:63-68. doi: 10.1111/anae.15423.
Over the last three decades, advances in early diagnosis of fetal anomalies, imaging and surgical techniques have led to a huge expansion in fetal surgery. A small number of specialist centres perform fetal surgery, which involves high-risk anaesthesia for the mother and fetus. The anaesthetist plays an integral role within the large multispecialty and multidisciplinary team, involved in planning and delivering care for complex surgical procedures. This article reviews three fetal surgical procedures, congenital diaphragmatic hernia, myelomeningocele repair and ex-utero intrapartum treatment for airway obstruction. The underlying fetal pathology, surgical management, anaesthetic considerations and risks for both the mother and fetus are described for each. Fundamental to this is the understanding that clear communication and collaboration between all team members is vital to ensure successful outcomes of patients, the mother and the fetus.
在过去的三十年中，胎儿畸形的早期诊断、影像学和手术技术的进步导致了胎儿手术的巨大扩展。少数专业中心开展胎儿手术，这涉及到母亲和胎儿的高风险麻醉。麻醉师在大型多专业和多学科团队中发挥着不可或缺的作用，参与复杂手术的规划和提供护理。本文回顾了三种胎儿手术，即先天性膈疝、脊髓脊膜膨出修复和子宫外产时气道阻塞治疗。描述了每种手术的潜在胎儿病理学、手术管理、麻醉注意事项以及对母亲和胎儿的风险。至关重要的是，要理解所有团队成员之间的清晰沟通和协作对于确保患者、母亲和胎儿的治疗成功至关重要。
