超声监测严重先天性膈疝胎儿气管阻塞后的肺部反应。

Sonographic pulmonary response after tracheal occlusion in fetuses with severe isolated congenital diaphragmatic hernia.

机构信息

Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Department of Obstetrics and Gynecology, Spectrum Health Butterworth Hospital-Michigan State University, Grand Rapids, Michigan, USA.

出版信息

J Clin Ultrasound. 2022 Feb;50(2):185-190. doi: 10.1002/jcu.23121. Epub 2022 Jan 12.

DOI:10.1002/jcu.23121

PMID:35019149

Abstract

PURPOSE

To report the longitudinal lung growth and prognosis of fetuses with severe left sided congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO) in a single institution.

METHODS

Fetal lung size (observed-to-expected lung area to head circumference [o/e-LHR]) was measured in seven consecutive fetuses with isolated severe left-sided CDH who underwent FETO. Fetal lung growth was used to prognosticate survival and need for ECMO.

RESULTS

Seven consecutive fetuses had a FETO procedure in the timeframe of this study. A total of 44 longitudinal ultrasound were performed to evaluate lung development. FETO was performed at GA 28.5 ± 0.5 weeks. Five (71.4%) infants survived to one-year follow-up and ECMO was needed in three patients (42.8%). Fetal lung response was observed in all fetuses; mean o/e-LHR increased from 22.5% ± 1.4 before FETO to 44.4% ± 9.8 before delivery. Infants who survived had a higher percentage of fetal lung growth (21.8%) than those who died (8.25%).

CONCLUSION

Our study supports the hypothesis that FETO promotes fetal lung growth in fetuses with severe left-sided CDH, and the fetal pulmonary response seems to be associated with improved outcomes after the procedure.

摘要

目的

报道在单家医疗机构中，采用胎儿镜气管阻塞术（FETO）治疗的严重左侧先天性膈疝（CDH）胎儿的纵向肺生长和预后情况。

方法

对 7 例连续接受 FETO 治疗的孤立性严重左侧 CDH 胎儿进行了连续测量，以评估胎儿肺大小（观察到的与预期的肺面积与头围比 [o/e-LHR]）。胎儿肺生长用于预测存活率和 ECMO 需求。

结果

在本研究时间段内，7 例连续胎儿接受了 FETO 手术。共进行了 44 次纵向超声检查以评估肺发育情况。FETO 于 GA 28.5±0.5 周进行。5 例（71.4%）婴儿存活至 1 年随访，3 例（42.8%）需要 ECMO。所有胎儿均观察到胎儿肺反应；o/e-LHR 平均值从 FETO 前的 22.5%±1.4%增加到分娩前的 44.4%±9.8%。存活的婴儿的胎儿肺生长百分比（21.8%）高于死亡的婴儿（8.25%）。