Abstract：
The objective of this study was to determine the effects of in utero bipedicle flaps on maternal-fetal morbidity/mortality, the need for CSF diversion, and long-term functional outcomes.
Eighty-six patients who underwent fetal myelomeningocele repair from 2011 to 2021 at a single institution were reviewed. Primary outcomes included intrauterine fetal demise, postnatal death, postnatal myelomeningocele repair dehiscence, and CSF diversion by final follow-up.
The cohorts were no different with regard to race, ethnicity, maternal age at fetal surgery, body mass index, gravidity, parity, gestational age at fetal surgery, estimated fetal weight at fetal surgery, or fetal lesion level. Of the 86 patients, 64 underwent primary linear repair and 22 underwent bipedicle flap repair. There were no significant differences in rates of intrauterine fetal demise, postnatal mortality, midline repair site dehiscence, or the need for CSF diversion by final follow-up. Operative times were longer (32.5 vs 18.7 minutes, p < 0.001) and gestational age at delivery was lower (232 vs 241 days, p = 0.01) in the bipedicle flap cohort, but long-term functional outcomes were not different.
Analysis of the total cohort affirms the long-term benefits of fetal myelomeningocele repair. In utero bipedicle flaps are safe and can be used for high-tension lesions without increasing perioperative risks to the mother or fetus. In utero flaps preserve the long-term benefits seen with primary linear repair and may expand inclusion criteria for fetal repair, providing life-changing care for more patients.
Eighty-six patients who underwent fetal myelomeningocele repair from 2011 to 2021 at a single institution were reviewed. Primary outcomes included intrauterine fetal demise, postnatal death, postnatal myelomeningocele repair dehiscence, and CSF diversion by final follow-up.
The cohorts were no different with regard to race, ethnicity, maternal age at fetal surgery, body mass index, gravidity, parity, gestational age at fetal surgery, estimated fetal weight at fetal surgery, or fetal lesion level. Of the 86 patients, 64 underwent primary linear repair and 22 underwent bipedicle flap repair. There were no significant differences in rates of intrauterine fetal demise, postnatal mortality, midline repair site dehiscence, or the need for CSF diversion by final follow-up. Operative times were longer (32.5 vs 18.7 minutes, p < 0.001) and gestational age at delivery was lower (232 vs 241 days, p = 0.01) in the bipedicle flap cohort, but long-term functional outcomes were not different.
Analysis of the total cohort affirms the long-term benefits of fetal myelomeningocele repair. In utero bipedicle flaps are safe and can be used for high-tension lesions without increasing perioperative risks to the mother or fetus. In utero flaps preserve the long-term benefits seen with primary linear repair and may expand inclusion criteria for fetal repair, providing life-changing care for more patients.
摘要：
目的：本研究的目的是确定子宫内双蒂皮瓣对母婴发病率/死亡率的影响，脑脊液分流的需要，和长期功能结果。
方法：回顾了2011年至2021年在一个机构接受胎儿脊髓膜膨出修复的86例患者。主要结局包括胎儿宫内死亡，产后死亡,出生后脊髓膜膨出修复裂开，以及最后随访的脑脊液改道。
结果：队列在种族方面没有差异，种族,胎儿手术的产妇年龄，身体质量指数,妊娠,奇偶校验，胎儿手术的胎龄，胎儿手术时估计的胎儿体重，或胎儿病变水平。86名患者中,64例接受了初次线性修复，22例接受了双蒂皮瓣修复。胎儿宫内死亡率无显著差异,产后死亡率，中线修复部位开裂，或者需要通过最后的后续行动转移脑脊液。手术时间更长（32.5对18.7分钟，p<0.001）和分娩时的胎龄较低（232天vs241天，p=0.01）在双蒂皮瓣队列中，但长期功能结局没有差异.
结论：对整个队列的分析证实了胎儿脊髓膜膨出修复的长期益处。子宫内双蒂皮瓣是安全的，可用于高张力病变，而不会增加母亲或胎儿的围手术期风险。子宫内皮瓣保留了原发性线性修复的长期益处，并可能扩大胎儿修复的纳入标准。为更多患者提供改变生活的护理。
方法：回顾了2011年至2021年在一个机构接受胎儿脊髓膜膨出修复的86例患者。主要结局包括胎儿宫内死亡，产后死亡,出生后脊髓膜膨出修复裂开，以及最后随访的脑脊液改道。
结果：队列在种族方面没有差异，种族,胎儿手术的产妇年龄，身体质量指数,妊娠,奇偶校验，胎儿手术的胎龄，胎儿手术时估计的胎儿体重，或胎儿病变水平。86名患者中,64例接受了初次线性修复，22例接受了双蒂皮瓣修复。胎儿宫内死亡率无显著差异,产后死亡率，中线修复部位开裂，或者需要通过最后的后续行动转移脑脊液。手术时间更长（32.5对18.7分钟，p<0.001）和分娩时的胎龄较低（232天vs241天，p=0.01）在双蒂皮瓣队列中，但长期功能结局没有差异.
结论：对整个队列的分析证实了胎儿脊髓膜膨出修复的长期益处。子宫内双蒂皮瓣是安全的，可用于高张力病变，而不会增加母亲或胎儿的围手术期风险。子宫内皮瓣保留了原发性线性修复的长期益处，并可能扩大胎儿修复的纳入标准。为更多患者提供改变生活的护理。
