Deprest J A, Luks F I, Peers K H, Vandenberghe K, Lerut T E, Brosens I A, Van Assche F A
Centre for Surgical Technologies, Faculty of Medicine, Katholieke Universiteit Leuven, Belgium.
Am J Obstet Gynecol. 1995 May;172(5):1422-6. doi: 10.1016/0002-9378(95)90472-7.
Our purpose was to evaluate the feasibility of intrauterine endoscopic fetal surgery in a fetal lamb model by creating a urinary tract obstruction.
Lower urinary tract obstruction was created by ligation of the urethra and urachus in 21 fetal lambs, eight at 95 to 105 days' gestation (term 145 days) and 13 at 70 to 75 days. The endoscopic approach consisted of a 0-degree 5 mm telescope, three 5 mm cannulas, uterine distention by amnioinfusion, and adapted instrumentation. Intrauterine fetal monitoring included temperature and pulse oximetry registration.
In 20 cases the urachus could be identified and ligated inside the umbilical cord. The urethra was ligated in the anterior abdominal wall (n = 7) or obstructed at the level of the penis (n = 13). Mean fetal heart rate was 147 +/- 35 beats/min, and fetal temperature at the end of intervention was 38.14 degrees +/- 2.1 degrees C. The overall postoperative survival rate was 76%.
Urinary tract obstruction can be created endoscopically in the fetal lamb. This operation can serve as a model for endoscopic fetal surgery.
我们的目的是通过制造尿路梗阻，在胎羊模型中评估宫内内镜胎儿手术的可行性。
通过结扎21只胎羊的尿道和脐尿管制造下尿路梗阻，其中8只处于妊娠95至105天（足月为145天），13只处于70至75天。内镜手术方法包括使用0度5毫米的望远镜、三个5毫米的套管、通过羊膜腔灌注使子宫膨胀以及适配的器械。宫内胎儿监测包括体温和脉搏血氧饱和度记录。
20例中可在脐带内识别并结扎脐尿管。尿道在前腹壁处结扎（n = 7）或在阴茎水平处梗阻（n = 13）。胎儿平均心率为147 ± 35次/分钟，干预结束时胎儿体温为38.14摄氏度 ± 2.1摄氏度。术后总体存活率为76%。
可在内镜下在胎羊中制造尿路梗阻。该手术可作为内镜胎儿手术的模型。
