PDF(Pubmed)
Abstract：
BACKGROUND: The purpose of this report is to describe the seminal case of a near-term human fetus with a life-threatening left diaphragmatic hernia that underwent fetoscopic tracheal occlusion (FETO) combined with fetoscopic partial removal of herniated bowel from the fetal chest by fetoscopic laparoschisis (FETO-LAP).
METHODS: A life-threatening left diaphragmatic hernia (liver-up; o/e LHR of ≤25%; MRI lung volume ≤ 20%) was observed in a human fetus at 34 weeks of gestation. After counselling the mother about the high risks of postnatal demise if left untreated, the expected limitations of fetoscopic tracheal occlusion (FETO), and the previously untested option of combining FETO with fetoscopic laparoschisis, i.e., partial removal of the herniated bowel from the fetal chest (FETO-LAP), she consented to the latter novel treatment approach. FETO-LAP was performed at 36 + 5 weeks of gestation under general maternofetal anesthesia. Mother and fetus tolerated the procedure well. The neonate was delivered and the balloon removed on placental support at 37 + 2 weeks of gestation. On ECMO, a rapid increase in tidal volume was seen over the next eight days. Unfortunately, after this period, blood clots obstructed the ECMO circuit and the neonate passed away.
CONCLUSIONS: This seminal case shows that in a fetus with severe left diaphragmatic hernia, partial removal of the herniated organs from the fetal chest is not only possible by minimally invasive fetoscopic techniques but also well tolerated. As the effect of FETO alone is limited in saving severely affected fetuses, combining FETO with fetoscopic laparoschisis (FETO-LAP) offers a new therapeutic route with multiple, potentially life-saving implications.
METHODS: A life-threatening left diaphragmatic hernia (liver-up; o/e LHR of ≤25%; MRI lung volume ≤ 20%) was observed in a human fetus at 34 weeks of gestation. After counselling the mother about the high risks of postnatal demise if left untreated, the expected limitations of fetoscopic tracheal occlusion (FETO), and the previously untested option of combining FETO with fetoscopic laparoschisis, i.e., partial removal of the herniated bowel from the fetal chest (FETO-LAP), she consented to the latter novel treatment approach. FETO-LAP was performed at 36 + 5 weeks of gestation under general maternofetal anesthesia. Mother and fetus tolerated the procedure well. The neonate was delivered and the balloon removed on placental support at 37 + 2 weeks of gestation. On ECMO, a rapid increase in tidal volume was seen over the next eight days. Unfortunately, after this period, blood clots obstructed the ECMO circuit and the neonate passed away.
CONCLUSIONS: This seminal case shows that in a fetus with severe left diaphragmatic hernia, partial removal of the herniated organs from the fetal chest is not only possible by minimally invasive fetoscopic techniques but also well tolerated. As the effect of FETO alone is limited in saving severely affected fetuses, combining FETO with fetoscopic laparoschisis (FETO-LAP) offers a new therapeutic route with multiple, potentially life-saving implications.
摘要：
背景：本报告的目的是描述一例近期人类胎儿患有危及生命的左膈疝的精液病例，该病例接受了胎儿镜气管阻塞（FETO），并通过胎儿镜腹腔镜（FETO-LAP）从胎儿胸部部分切除了疝状肠。
方法：在妊娠34周时，在人胎儿中观察到危及生命的左膈疝（肝脏上升；o/eLHR≤25％；MRI肺体积≤20％）。在向母亲咨询如果不及时治疗产后死亡的高风险后，胎儿镜下气管阻塞（FETO）的预期局限性，以及先前未经测试的将FETO与胎儿腹腔镜结合的选择，即，从胎儿胸部（FETO-LAP）部分切除疝肠，她同意后一种新颖的治疗方法。FETO-LAP在妊娠36+5周时在一般母胎麻醉下进行。母亲和胎儿对该程序的耐受性良好。在妊娠37+2周时,分娩新生儿并在胎盘支持物上移除球囊。在ECMO上，在接下来的八天里，潮气量迅速增加。不幸的是,在这段时间之后，血凝块阻塞了ECMO回路，新生儿去世了。
结论：这个有开创性的病例显示，在一个患有严重左膈疝的胎儿中，通过微创胎儿镜技术，不仅可以从胎儿胸部部分切除疝器官，而且耐受性良好。由于仅FETO的效果在拯救受严重影响的胎儿方面是有限的，FETO与腹腔镜联合(FETO-LAP)提供了一种新的治疗途径,潜在的拯救生命的影响。
方法：在妊娠34周时，在人胎儿中观察到危及生命的左膈疝（肝脏上升；o/eLHR≤25％；MRI肺体积≤20％）。在向母亲咨询如果不及时治疗产后死亡的高风险后，胎儿镜下气管阻塞（FETO）的预期局限性，以及先前未经测试的将FETO与胎儿腹腔镜结合的选择，即，从胎儿胸部（FETO-LAP）部分切除疝肠，她同意后一种新颖的治疗方法。FETO-LAP在妊娠36+5周时在一般母胎麻醉下进行。母亲和胎儿对该程序的耐受性良好。在妊娠37+2周时,分娩新生儿并在胎盘支持物上移除球囊。在ECMO上，在接下来的八天里，潮气量迅速增加。不幸的是,在这段时间之后，血凝块阻塞了ECMO回路，新生儿去世了。
结论：这个有开创性的病例显示，在一个患有严重左膈疝的胎儿中，通过微创胎儿镜技术，不仅可以从胎儿胸部部分切除疝器官，而且耐受性良好。由于仅FETO的效果在拯救受严重影响的胎儿方面是有限的，FETO与腹腔镜联合(FETO-LAP)提供了一种新的治疗途径,潜在的拯救生命的影响。
