Pastore F S, Patricolo M, De Caro G M, Giuffrè R
Istituto di Neurochirurgia, Università di Roma Tor Vergata.
Ann Ital Chir. 1998 May-Jun;69(3):295-301.
Fetal surgery failed up to now to correct early in gestation nervous system pathologies before an irreversible damage occurs. The major hindrance is the induction of preterm labour considered for fetal surgery what rejection is for organ transplantation. Pharmacological tocolytic control seems an essential step before a routine surgery is established. In the meanwhile miniinvasive endoscopic surgery holds out the best promises, minimizing fetal and maternal stress. There are many convincing experimental evidences that endoscopic surgery may prevent secondary neurological damage of spinal cord in the myelomeningocele. Vascularized latissimus dorsi muscle flap or skin graft were effectively used, with endoscopic techniques, to create a protective patch to preserve the nervous tissue from mechanical and/or chemical damage. Endoscopic implant of neurons-rich grafts in damaged cerebral sites, with beneficial behavioural effects and increased learning capacity in the recipient animal with respect to controls, disclose further perspectives to fetoscopic surgery.
迄今为止，胎儿手术无法在不可逆损伤发生之前，于妊娠早期矫正神经系统病变。主要障碍在于引发早产，这对于胎儿手术而言就如同排斥反应对于器官移植一样。在建立常规手术之前，药物性宫缩抑制控制似乎是必不可少的一步。与此同时，微创内镜手术最具前景，可将胎儿和母体的应激降至最低。有许多令人信服的实验证据表明，内镜手术可预防脊髓脊膜膨出中脊髓的继发性神经损伤。利用内镜技术，带血管蒂的背阔肌肌瓣或皮肤移植有效地用于创建一个保护贴片，以保护神经组织免受机械和/或化学损伤。将富含神经元的移植物内镜植入受损脑区，与对照组相比，受体动物出现有益的行为效应且学习能力增强，这为胎儿镜手术揭示了进一步的前景。
