Kuroda T, Saeki M, Tanaka K, Komura M, Honna T, Nakano M, Sugiyama M, Nakagawa S, Miyasaka K
Department of Surgery, National Children's Hospital, Tokyo, Japan.
J Pediatr Surg. 1998 Nov;33(11):1641-4. doi: 10.1016/s0022-3468(98)90598-x.
BACKGROUND/PURPOSE: To develop practical and less invasive techniques for fetal endoscopic surgery, new methods of lifting the uterine wall to allow fetal surgery without maternal laparotomy were developed and assessed.
Fetal endoscopic surgical procedures, including tracheostomy and umbilical vascular cannulation, were performed using one of the three methods to enter the uterus without maternal laparotomy in pregnant goats (n = 6; 105 to 115 days' gestation): (1) direct uterine lifting with an air-cushion device; (2) indirect uterine lifting, in which the uterine wall was fixed to the maternal abdominal wall using balloon tip ports inserted percutaneously by Seldinger's method, then the maternal abdomen was lifted mechanically; and (3) combined method, in which low pressure CO2 (5 mm Hg for initial inflation and 2 mm Hg for maintenance) was insufflated into the uterus in addition to the indirect uterine lifting cited above.
The direct uterine lifting caused massive injury of myometrium and uterine membranes. The creation of intrauterine space and the protection of the membranes were not accomplished effectively by the indirect uterine lifting only. The combined method provided the adequate intrauterine space and excellent endoscopic visibility for completion of the endoscopic procedures with minimal uterine injury.
The fetal endoscopic surgery may be accomplished simply and safely by the combined method, a novel technique of uterine lifting to allow fetal surgery without maternal laparotomy.
背景/目的：为开发实用且侵入性较小的胎儿内镜手术技术，研发并评估了将子宫壁抬起以在不进行母体剖腹手术的情况下进行胎儿手术的新方法。
在妊娠山羊（n = 6；妊娠105至115天）中，使用三种无需母体剖腹手术进入子宫的方法之一进行胎儿内镜手术操作，包括气管造口术和脐血管插管：（1）使用气垫装置直接抬起子宫；（2）间接抬起子宫，即通过Seldinger法经皮插入带气囊尖端的端口将子宫壁固定于母体腹壁，然后机械性抬起母体腹部；（3）联合方法，除上述间接抬起子宫外，向子宫内注入低压二氧化碳（初始充气为5 mmHg，维持为2 mmHg）。
直接抬起子宫导致子宫肌层和胎膜大量损伤。仅通过间接抬起子宫不能有效地形成子宫内空间和保护胎膜。联合方法提供了足够的子宫内空间和良好的内镜视野，可在子宫损伤最小的情况下完成内镜手术操作。
联合方法作为一种无需母体剖腹手术即可进行胎儿手术的新型子宫抬起技术，可简单、安全地完成胎儿内镜手术。
