Luks F I, Peers K H, Deprest J A, Lerut T E, Vandenberghe K
Division of Pediatric Surgery, Brown University School of Medicine, Providence, RI, USA.
J Pediatr Surg. 1996 Feb;31(2):310-4. doi: 10.1016/s0022-3468(96)90024-x.
Open fetal surgery predictably results in postoperative uterine contractions and often in premature labor, but its intraoperative effects on the uterus are not known. In 10 pregnant ewes (108 to 115 days' gestation), uterine artery flow, uterine venous oxygen saturation, arterial saturation, and uterine electromyography were recorded simultaneously (control). Six ewes underwent a stapled hysterotomy, and four underwent placement of three endoscopic surgery cannulas and amnioinfusion. Uterine contractions were present 52% of the time (range, 34% to 72%), and there was no significant difference between control, hysterotomy, and endoscopic access. Uterine artery blood flow and uteroplacental oxygen delivery at rest decreased (to 73% of control) after hysterotomy (P < .05), but not after endoscopy. Fetal + uteroplacental oxygen consumption did not differ significantly between the groups. In conclusion, (1) uteroplacental oxygen delivery after hysterotomy alone decreased to levels critical for adequate fetal oxygenation; (2) endoscopy did not alter uteroplacental oxygen delivery; and (3) during open fetal surgery, further oxygen demand/delivery mismatch is likely, by traction on uterine and umbilical vessels and fetal stress.
开放性胎儿手术可预见地会导致术后子宫收缩，并常常引发早产，但其术中对子宫的影响尚不清楚。在10只妊娠母羊（妊娠108至115天）中，同时记录子宫动脉血流、子宫静脉血氧饱和度、动脉血氧饱和度和子宫肌电图（对照组）。6只母羊接受了吻合器子宫切开术，4只母羊接受了三个内镜手术套管置入和羊水输注。子宫收缩出现的时间占52%（范围为34%至72%），对照组、子宫切开术组和内镜入路组之间无显著差异。子宫切开术后静息时子宫动脉血流和子宫胎盘氧输送减少（降至对照组的73%）（P <.05），但内镜检查后未出现这种情况。各组之间胎儿+子宫胎盘氧消耗无显著差异。总之，（1）单纯子宫切开术后子宫胎盘氧输送降至对胎儿充分氧合至关重要的水平；（2）内镜检查未改变子宫胎盘氧输送；（3）在开放性胎儿手术期间，由于子宫和脐血管的牵拉以及胎儿应激，可能会进一步出现氧需求/输送不匹配的情况。
