目的：胎儿巨大膀胱（MC）可为严重的，主要由胎儿下尿路梗阻（LUTO）引起。由于肺发育不全和/或（慢性）肾功能不全，胎儿LUTO的死亡率可能很高。开发了几种用于膀胱羊膜分流术（VAS）的技术程序，以改善胎儿MC结局。
方法：我们介绍了9例使用Somatex®宫内分流系统在产前期间（14+6至27+6周GA）接受VAS的MC胎儿的结局。MC被定义为膀胱的增加的纵向测量值>15mm。出生后的中位随访时间为18个月。
结果：8例胎儿接受了简单的VAS干预。1例VAS后24小时出现PPROM导致流产。随后在另外两个病例中终止了妊娠。所有6名活产婴儿都接受了重症监护治疗。在一名因严重心脏抑制而在产后24小时死亡的病例中，有创机械通气是必要的。5例存活随访时间的婴儿出现慢性肾功能不全（CRI），一名婴儿发展为终末期肾衰竭，需要腹膜透析。
结论：总体而言，使用Somatex®子宫内分流系统进行VAS的9例LUTO胎儿中有5例（55％）显示出超过28天的新生期的长期存活（5/9；55％），发病率不同。
OBJECTIVE: Fetal
megacystis (MC) can be severe and is mainly caused by fetal lower urinary tract obstruction (LUTO). Mortality of fetal LUTO can be high as a result of pulmonary hypoplasia and/or (chronic) renal insufficiency. Several technical procedures for vesicoamniotic shunting (VAS) were developed to improve fetal MC outcomes.
METHODS: We present the outcome of nine fetuses with MC who received VAS in the prenatal period (14 + 6 to 27 + 6 weeks GA) using the Somatex® intrauterine shunt system. MC was defined as an increased longitudinal measurement of the bladder >15 mm. The median follow-up time after birth was 18 months.
RESULTS: Eight Fetuses had uncomplicated VAS intervention. One case developed PPROM 24 h after VAS leading to abortion. Pregnancy was later terminated in further two cases. All six live-born infants received intensive care treatment. Invasive-mechanical ventilation was necessary in one case who died 24 h post-partum of severe cardiac depression. Five infants who survived the follow-up time developed chronic renal insufficiency (CRI), with one infant developing end-stage renal failure requiring peritoneal dialysis.
CONCLUSIONS: Overall, 5 of 9 LUTO fetuses (55%) undergoing VAS with the Somatex® intrauterine shunt system showed long-term survival beyond the neonatal period of 28 d (5/9; 55%) with varying morbidity.
