Abstract：
Fetal surgery has become a lifesaving reality for hundreds of fetuses each year. The development of a formidable spectrum of safe and effective minimally invasive techniques for fetal interventions since the early 1990s until today has led to an increasing acceptance of novel procedures by both patients and health care providers. From his vast personal experience of more than 20 years as one of the pioneers at the forefront of clinical minimally invasive fetal surgery, the author describes and comments on old and new minimally invasive approaches, highlighting their lifesaving or quality-of-life-improving potential. He provides easy-to-use practical information on how to perform partial amniotic carbon dioxide insufflation (PACI), how to assess lung function in fetuses with pulmonary hypoplasia, how to deal with giant CPAMS, how to insert shunts into fetuses with LUTO and hydrothorax when conventional devices are not available, and how to resuscitate a fetus during fetal cardiac intervention. Furthermore, the author proposes a curriculum for future fetal surgeons, solicits for the centralization of patients, for adequate maternal counseling, for adequate pain management and adequate hygienic conditions during interventions, and last but not least for starting the process of academic recognition of the matured field as an independent specialty. These steps will allow more affected expectant women and their unborn children to gain access to modern minimally invasive fetal surgery and therapy. The opportunity to treat more patients at dedicated centers will also result in more opportunities for the research of rare diseases and conditions, promising even better pre- and postnatal care in the future.
摘要：
胎儿手术已成为每年数以百计的胎儿的救生现实。自1990年代初直到今天，用于胎儿干预的一系列安全有效的微创技术的发展已经导致患者和医疗保健提供者越来越多地接受新的程序。从他20多年来作为临床微创胎儿外科最前沿的先驱者之一的丰富个人经验来看，作者对新旧微创方法进行了描述和评论，强调他们拯救生命或改善生活质量的潜力。他提供了有关如何进行部分羊水二氧化碳吹气（PACI）的易于使用的实用信息，如何评估肺发育不全胎儿的肺功能，如何处理巨型CPAMS，当传统设备不可用时，如何使用LUTO和胸腔积液将分流器插入胎儿，以及如何在胎儿心脏介入治疗期间复苏胎儿。此外，作者提出了未来胎儿外科医生的课程，征集患者的集中化，充分的产妇咨询，为了在干预期间进行适当的疼痛管理和适当的卫生条件，最后但并非最不重要的是开始对成熟领域作为独立专业的学术认可过程。这些步骤将使更多受影响的孕妇及其未出生的孩子获得现代微创胎儿手术和治疗。在专门中心治疗更多患者的机会也将为研究罕见疾病和病症带来更多机会，承诺在未来更好的产前和产后护理。
