Abstract：
BACKGROUND: Fetal thoracoamniotic shunts are common lifesaving interventions but frequently require replacement. Needle fetal thoracoscopy is a technique that uses standard thoracoamniotic shunt introducer sheaths to permit direct visualization and even instrument manipulation during shunt deployment to facilitate optimal positioning and primary shunt function in the most challenging cases.
METHODS: In this study, 5 patients who underwent needle fetal thoracoscopy-assisted thoracoamniotic shunt placement were reviewed. Three patients with large, macrocystic congenital pulmonary airway malformations (CPAMs) with evidence of worsening mediastinal shift and/or hydrops and 2 patients with large chylothorax with fetal hydrops were treated. Four cases had previous shunts that failed due to poor sonographic visualization during initial placement, cyst septations, shunt obstruction, or dislodgment. Needle fetal thoracoscopy was used to disrupt cyst walls and septations, clear hematoma, and confirm the optimal initial position of the shunt. In this series, 1 severe CPAM patient with a short cervix developed preterm labor postoperatively resulting in neonatal demise. The remaining 4 patients experienced resolution of hydrops and progressed to successful delivery with excellent neonatal outcomes.
CONCLUSIONS: Needle fetal thoracoscopy is a procedure that may be selectively deployed in challenging thoracoamniotic shunt cases impacted by recurrent failure, poor sonographic windows, and challenging fetal positioning.
METHODS: In this study, 5 patients who underwent needle fetal thoracoscopy-assisted thoracoamniotic shunt placement were reviewed. Three patients with large, macrocystic congenital pulmonary airway malformations (CPAMs) with evidence of worsening mediastinal shift and/or hydrops and 2 patients with large chylothorax with fetal hydrops were treated. Four cases had previous shunts that failed due to poor sonographic visualization during initial placement, cyst septations, shunt obstruction, or dislodgment. Needle fetal thoracoscopy was used to disrupt cyst walls and septations, clear hematoma, and confirm the optimal initial position of the shunt. In this series, 1 severe CPAM patient with a short cervix developed preterm labor postoperatively resulting in neonatal demise. The remaining 4 patients experienced resolution of hydrops and progressed to successful delivery with excellent neonatal outcomes.
CONCLUSIONS: Needle fetal thoracoscopy is a procedure that may be selectively deployed in challenging thoracoamniotic shunt cases impacted by recurrent failure, poor sonographic windows, and challenging fetal positioning.
摘要：
背景：胎儿胸羊膜分流术是常见的救生干预措施，但经常需要更换。针胎胸腔镜检查是一种技术，使用标准的胸羊膜分流导引鞘，以允许在分流部署期间直接可视化甚至器械操作，以促进在最具挑战性的情况下的最佳定位和主要分流功能。
方法：在本研究中，对5例接受胎儿胸腔镜辅助胸羊膜分流术的患者进行了回顾.三个大患者，治疗了有纵隔移位和/或积液恶化的证据的大囊性先天性肺气道畸形（CPAM）和两名患有大乳糜胸并胎儿积液的患者。4例先前的分流失败，由于在初始放置期间超声可视化效果不佳，囊肿间隔,分流阻塞或移位。胎儿胸腔镜检查用于破坏囊肿壁和隔膜，清除血肿,并确定分流器的最佳初始位置。在这个系列中,1例宫颈短的重度CPAM患者术后出现早产,导致新生儿死亡.其余四名患者经历了水肿的消退，并成功分娩，新生儿结局良好。
结论：针式胎儿胸腔镜检查是一种可以在反复失败的具有挑战性的胸羊膜分流病例中选择性使用的手术，超声波检查窗口差，具有挑战性的胎儿定位。
方法：在本研究中，对5例接受胎儿胸腔镜辅助胸羊膜分流术的患者进行了回顾.三个大患者，治疗了有纵隔移位和/或积液恶化的证据的大囊性先天性肺气道畸形（CPAM）和两名患有大乳糜胸并胎儿积液的患者。4例先前的分流失败，由于在初始放置期间超声可视化效果不佳，囊肿间隔,分流阻塞或移位。胎儿胸腔镜检查用于破坏囊肿壁和隔膜，清除血肿,并确定分流器的最佳初始位置。在这个系列中,1例宫颈短的重度CPAM患者术后出现早产,导致新生儿死亡.其余四名患者经历了水肿的消退，并成功分娩，新生儿结局良好。
结论：针式胎儿胸腔镜检查是一种可以在反复失败的具有挑战性的胸羊膜分流病例中选择性使用的手术，超声波检查窗口差，具有挑战性的胎儿定位。
