开放性修复术与胎儿镜胎儿手术：哪种是宫内脊髓脊膜膨出矫正的最佳方法？系统评价与荟萃分析。
Open repair versus fetoscopic fetal surgery: Which is the best approach for intrauterine myelomeningocele correction? Systematic review and meta-analysis.
作者信息
de Oliveira Júnior Jairo Porfírio, Morais Bárbara Albuquerque, Fernandes Matheus Neves Faria, de Paula Mendes Teixeira Otávio Augusto, Lacerda Aloisio Oliveira, Ramos Milena Vieira, Watanabe Rodrigo Akira, Ribeiro Paulo Ronaldo Jubé
机构信息
Division of Neurosurgery, Department of Surgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.
Faculty of Medicine, University of Rio Verde, Goiás, Brazil.
出版信息
Childs Nerv Syst. 2025 Aug 8;41(1):256. doi: 10.1007/s00381-025-06915-0.
OBJECTIVE
The Management of Myelomeningocele Study in 2011 the prenatal approach has become the gold standard for the correction of myelomeningocele. Since then, advancements in minimally invasive techniques, including fetoscopic repair, have aimed to minimize maternal complications while maintaining fetal benefits.This systematic review and meta-analysis examines the maternal and neonatal outcomes of open versus fetoscopic myelomeningocele repair in utero.
METHODS
We systematically searched PubMed and LILACS databases for studies published between 2011 and 2024, following PRISMA guidelines. Data on maternal and fetal outcomes were extracted and analyzed. A total of 32 studies were included.
RESULTS
Regarding maternal and fetal complications in open and fetoscopic surgery, the rates were respectively: premature rupture of membranes (0.298 95% CI: 0.202-0.393 vs. 0.522 95% CI: 0.254-0.790), oligohydramnios (0.145 95% CI: 0.086-0.203; vs. 0.488 95% CI: 0.162-0.813), premature placental abruption (0.032 95% CI: 0.015-0.048 vs. 0.042 95% CI: 0.0-0.084), birth weight (2261.330 g 95% CI: 2125.819-2369.84; vs. 2251.531 g 95% CI: 1845.674-2657.389), prematurity < 37 weeks (0.789 95% CI: 0.729-0.849 vs. 0.636 95% CI: 0.208-1.064), neonatal sepsis (0.097 95% CI: 0.030-0.163 vs. 0.251 95% CI: 0.046-0.455), surgical time (133.7 min 95% CI: 92.070-175.394 vs. 220.4 min 95% CI: 194.264-246.607), neonatal surgical wound dehiscence (0.043 95% CI: 0.023-0.064 vs. 0.137 95% CI: 0.052-0.222), hydrocephalus (0.422 95% CI: 0.256-0.588 vs. 0.391 95% CI: 0.272-0.510), reversal of brainstem herniation (0.601 95% CI: 0.385-0.816 vs. 0.581 95% CI: 0.356-0.806), maintenance or improvement in motor function (0.809 95% CI: 0.692- 0.927 vs. 0.856 95% CI: 0.734-0.978). Only neonatal sepsis in the fetoscopic surgery group was not statistically significant (p < 0.05).
CONCLUSIONS
The open approach, traditionally associated with better fetal outcomes, showed better outcomes for maternal complications compared to fetoscopic surgery.
目的
2011年脊髓脊膜膨出管理研究中，产前治疗方法已成为脊髓脊膜膨出矫正的金标准。从那时起，包括胎儿镜修复在内的微创技术的进步旨在尽量减少母体并发症，同时保持对胎儿的益处。本系统评价和荟萃分析研究了开放性与胎儿镜下子宫内脊髓脊膜膨出修复的母体和新生儿结局。
方法
我们按照PRISMA指南，系统检索了PubMed和LILACS数据库中2011年至2024年发表的研究。提取并分析了有关母体和胎儿结局的数据。共纳入32项研究。
结果
关于开放性手术和胎儿镜手术中的母体和胎儿并发症，发生率分别为：胎膜早破（0.298 95%CI：0.202 - 0.393对0.522 95%CI：0.254 - 0.790）、羊水过少（0.145 95%CI：0.086 - 0.203；对0.488 95%CI：0.162 - 0.813）、胎盘早剥（0.032 95%CI：0.015 - 0.048对0.042 95%CI：0.0 - 0.084）、出生体重（2261.330g 95%CI：2125.819 - 2369.84；对2251.531g 95%CI：1 | 845.674 - 2657.389）、孕周<37周（0.789 95%CI：0.729 - 0.849对0.636 95%CI：0.208 - 1.064）、新生儿败血症（0.097 95%CI：0.030 - 0.163对0.251 95%CI：0.046 - 0.455）、手术时间（133.7分钟95%CI：92.070 - 175.394对220.4分钟95%CI：194.264 - 246.607）、新生儿手术伤口裂开（0.043 95%CI：0.023 - 0.064对0.137 95%CI：0.052 - 0.222）、脑积水（0.422 95%CI：0.256 - 0.588对0.391 95%CI：0.272 - 0.510）、脑干疝复位（0.601 95%CI：0.385 - 0.816对0.581 95%CI：0.356 - 0.806）、运动功能维持或改善（0.809 95%CI：0.692 - 0.927对0.8 | 56 95%CI：0.734 - 0.978）。只有胎儿镜手术组的新生儿败血症无统计学意义（p<0.05）。
结论
传统上与更好的胎儿结局相关的开放性手术方法，与胎儿镜手术相比，在母体并发症方面显示出更好的结局。
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