Stanford University School of Medicine and Lucile Packard Children's Hospital, Division of Neonatal and Developmental Medicine, Palo Alto, CA, USA; Division of Pediatric Surgery, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
The Richard Wood Jr. Center for Fetal Diagnosis and Treatment and Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Semin Fetal Neonatal Med. 2022 Dec;27(6):101406. doi: 10.1016/j.siny.2022.101406. Epub 2022 Nov 17.
Recently, two randomized controlled, prospective trials, the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trials, reported the outcomes on fetal endoluminal tracheal occlusion (FETO) for isolated left congenital diaphragmatic hernia (CDH). FETO significantly improved outcomes for severe hypoplasia. The effect in moderate cases, where the balloon was inserted later in pregnancy, did not reach significance. In a pooled analysis investigating the effect of the heterogeneity of the treatment effect by the time point of occlusion and severity, the difference may be explained by a difference in the duration of occlusion. Nevertheless, FETO carries a significant risk of preterm birth. The primary objective of this review is to provide an overview of the rationale for fetal intervention in CDH and the results of the randomized trials. The secondary objective is to discuss the technical aspects of FETO. Finally, recent developments of potential alternative fetal approaches will be highlighted.
最近，两项随机对照、前瞻性试验——气管阻塞加速肺生长（TOTAL）试验报告了胎儿腔内气管阻塞（FETO）治疗孤立性左侧先天性膈疝（CDH）的结果。FETO 显著改善了严重发育不良的预后。对于在妊娠后期插入球囊的中度病例，效果未达到显著水平。在一项探讨通过阻塞时间点和严重程度来分析治疗效果异质性的汇总分析中，差异可能可以用阻塞持续时间的不同来解释。然而，FETO 确实存在早产的显著风险。本综述的主要目的是概述胎儿干预 CDH 的基本原理以及随机试验的结果。次要目的是讨论 FETO 的技术方面。最后，将强调潜在替代胎儿方法的最新进展。
