Asai Yasunori, Kato Hisayuki, Horibe Kanetaka, Hiei Yusuke, Tateya Ichiro
Department of Otolaryngology-Head and Neck Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan.
Fujita Med J. 2023 Aug;9(3):259-263. doi: 10.20407/fmj.2021-030. Epub 2023 May 9.
In this study, we report a case of tracheotomy using the ex utero intrapartum treatment (EXIT) procedure in a fetus that was pointed out as having bilateral giant cervical cysts at prenatal diagnosis and whose postnatal airway occlusion was predicted. The subject was a female aged 35. She was diagnosed with polyhydramnios at 28 weeks of pregnancy. The fetus was found to have a giant cervical cyst before she was referred to the department of obstetrics and gynecology of our hospital. On the second day of 37 weeks of pregnancy, oral tracheal intubation was attempted on the fetus using the EXIT procedure after the caesarean operation, but intubation was difficult resulting in a tracheotomy. The oxygenation of the fetus during the operation was maintained well without any postoperative complication. Postnatal fetal airway occlusion is a critical incident which may lead to the death of a fetus. It was assumed, however, that the airway management under the same procedure was completed by the preoperative detailed simulation with the staff of the departments of anesthesiology, obstetrics and gynecology and pediatrics as well as the operating room personnel.
在本研究中，我们报告了一例在产前诊断为双侧巨大宫颈囊肿且预测产后气道阻塞的胎儿，采用产时宫外治疗（EXIT）手术进行气管切开术的病例。该患者为一名35岁女性。她在怀孕28周时被诊断为羊水过多。在转诊至我院妇产科之前，发现胎儿有巨大宫颈囊肿。怀孕37周的第二天，剖宫产术后使用EXIT手术对胎儿尝试进行经口气管插管，但插管困难，最终进行了气管切开术。手术过程中胎儿的氧合维持良好，术后无任何并发症。产后胎儿气道阻塞是一个可能导致胎儿死亡的关键事件。然而，据推测，通过麻醉科、妇产科、儿科工作人员以及手术室人员进行的术前详细模拟，在相同手术程序下完成了气道管理。
