Benachi A, Dommergues M, Delezoide A L, Bourbon J, Dumez Y, Brunnelle F
Unité de Médecine Foetale, Hôpital Port-Royal-Baudelocque, Paris, France.
Prenat Diagn. 1997 Jul;17(7):629-34.
Congenital diaphragmatic hernia (CDH) is associated with a neonatal mortality of up to 50 per cent resulting from pulmonary hypoplasia. Experimental ligation of the trachea increases pulmonary growth in fetuses with experimental diaphragmatic hernia (EDH). To provide a potentially reversible tracheal occlusion (TO) using a minimally invasive procedure, we designed the endoscopic placement of a latex tracheal balloon in fetal lambs with EDH. Following surgical creation of a left EDH at 85 days' gestation, endoscopic occlusion of the fetal trachea was performed at 120 days. The fetuses were retrieved at 139 days. The procedure was successful in 5/11 attempts, resulting in liveborns in which the balloon occluded the trachea completely with expanded lungs and reduction of the herniated viscera into the abdomen. These cases were compared with five cases of EDH without TO and six controls. In the TO group, the lung weight was significantly greater but the radial alveolar count, DNA content, and protein content were similar to normal controls. All lung growth parameters were greater in the TO than in the EDH group. Occlusion of the trachea using an endoscopic technique could provide a useful alternative to open fetal surgery in fetuses with CDH.
先天性膈疝（CDH）与高达50%的新生儿死亡率相关，其原因是肺发育不全。实验性结扎气管可增加患有实验性膈疝（EDH）胎儿的肺生长。为了通过一种微创手术提供一种潜在可逆的气管阻塞（TO）方法，我们设计了在患有EDH的胎羊中通过内镜放置乳胶气管球囊。在妊娠85天时通过手术造成左侧EDH，在120天时对胎儿气管进行内镜阻塞。在139天时取出胎儿。该操作在11次尝试中有5次成功，产下的活胎中球囊完全阻塞气管，肺扩张，疝入的内脏回纳到腹腔。将这些病例与五例未进行TO的EDH病例及六例对照进行比较。在TO组中，肺重量显著更大，但肺泡半径计数、DNA含量和蛋白质含量与正常对照相似。TO组的所有肺生长参数均高于EDH组。使用内镜技术阻塞气管可为患有CDH的胎儿提供一种替代开放性胎儿手术的有用方法。
