Deprest J A, Lerut T E, Vandenberghe K
Department of Obstetrics and Gynaecology, University Hospitals Leuven, Belgium.
Prenat Diagn. 1997 Dec;17(13):1247-60.
In a limited number of conditions in utero surgery may be life-saving, such as some cases of congenital diaphragmatic hernia, cystic adenomatoid malformation of the lung, sacrococcygeal teratoma and lower urinary tract obstruction. Postoperative premature labour and its extreme invasiveness have been major drawbacks for open fetal surgery. More recently the merger of fetoscopy and advanced video-endoscopic surgery has been the basis of the concept of endoscopic fetal surgery. In order to evaluate the opportunities of 'fetendo' surgery, animal models have been developed to test the safety of the endoscopic approach, and the feasibility of surgical manipulations on the fetus. In the non-human primate, a lesser invasiveness of endoscopy over open surgical approach was demonstrated, by a significant decrease in uterine activity in comparison with hysterotomy. The main application of fetoscopy today is the surgical treatment of complicated or abnormal monochorionic twin gestations. Fetoscopic laser coagulation of chorionic plate vessels is suggested as a causal therapy for severe feto-fetal transfusion syndrome. Survival rates are around 55 per cent with an incidence of five per cent of neurological morbidity. Fetoscopic cord ligation is associated with a 66 per cent survival rate, but unfortunately also with a risk of 30 per cent for PPROM prior to 32 weeks. Although still in its early experimental phase, endoscopy seems to offer new hope for surgical fetal therapy. Though conceptually very tempting, the development of endoscopic fetal surgery should follow the formal guidelines, as earlier formulated for open surgery by the International Fetal Medicine and Surgery Society. The prospective registration of worldwide experience is advocated and a randomized trial of laser therapy versus amniodrainage is announced.
在少数情况下，宫内手术可能挽救生命，比如某些先天性膈疝、肺囊性腺瘤样畸形、骶尾部畸胎瘤和下尿路梗阻病例。术后早产及其极高的侵入性一直是开放性胎儿手术的主要缺点。最近，胎儿镜检查与先进的视频内镜手术相结合成为了内镜胎儿手术概念的基础。为了评估“胎儿内镜手术”的机会，已经开发了动物模型来测试内镜手术方法的安全性以及对胎儿进行手术操作的可行性。在非人灵长类动物中，与子宫切开术相比，内镜检查的侵入性较小，子宫活动明显减少。如今胎儿镜检查的主要应用是对复杂或异常的单绒毛膜双胎妊娠进行手术治疗。胎儿镜激光凝固绒毛膜板血管被建议作为严重胎儿-胎儿输血综合征的病因治疗方法。存活率约为55%，神经疾病发病率为5%。胎儿镜脐带结扎术的存活率为66%，但不幸的是，在32周前发生胎膜早破的风险为30%。尽管仍处于早期实验阶段，但内镜检查似乎为胎儿手术治疗带来了新希望。尽管从概念上讲非常诱人，但内镜胎儿手术的发展应遵循正式指南，就像国际胎儿医学与外科学会 earlier formulated for open surgery所制定的那样。提倡对全球经验进行前瞻性登记，并宣布了一项激光治疗与羊水引流的随机试验。 （注：原文中“earlier formulated for open surgery by the International Fetal Medicine and Surgery Society”部分“earlier”前似乎少了个词，翻译时保留原文状态）
