In utero repair of myelomeningocele: A comparison of endoscopy and hysterotomy
In utero repair of myelomeningocele: A comparison of endoscopy and hysterotomy
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DOI：
10.1159/000020981
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发表时间：
2000-03-01
影响因子：
2.2
通讯作者：
Vrabcak, EK
中科院分区：
文献类型：
--
作者：
Bruner, JP;Tulipan, NB;Vrabcak, EK
目的：比较子宫内采用母体刃厚皮片移植治疗脊髓脊膜膨出的内镜覆盖与通过子宫切开术进行明确的神经外科闭合。研究方法：4例孤立性脊髓脊膜膨出的胎儿在妊娠22-24周时在CO2环境中进行了内窥镜下用母体刃厚皮片覆盖缺损，随后，4例胎儿在妊娠28-29周时进行了标准神经外科手术闭合脊髓脊膜膨出。结果如下：内窥镜手术的平均手术时间为297 +/- 69分钟。2例胎儿丢失分别是由于绒毛膜炎和胎盘粘连。第三个婴儿在妊娠28周时分娩，原因是胎膜长时间破裂。2名幸存者在分娩后需要标准的脊髓脊膜膨出闭合术。子宫切开术的平均手术时间为125 +/- 8 min。无死亡发生，所有婴儿在33 - 36周之间分娩，脊髓脊膜膨出瘢痕愈合良好。目前，所有婴儿的功能水平接近病变的解剖水平。结论：以目前的技术，通过子宫切开术在子宫内修复先天性脊髓脊膜膨出似乎在技术上上级内窥镜手术，版权所有（C）2000 S。Karger AG，巴塞尔。
Objective: To compare endoscopic coverage of myelomeningocele with a maternal split-thickness skin graft in utero to definitive neurosurgical closure through a hysterotomy. Methods: Four fetuses with isolated myelomeningocele underwent endoscopic coverage of the defect with a maternal split-thickness skin graft in a CO2 environment at 22-24 weeks' gestation, Subsequently, 4 fetuses underwent standard neurosurgical closure of their myelomeningoceles at 28-29 weeks' gestation. Results: The mean operating time for the endoscopic procedures was 297 +/- 69 min. Two fetal losses occurred as a result of chorioamnionitis and placental abruption, respectively. A third baby delivered at 28 weeks' gestation after prolonged disruption of the membranes. The 2 survivors required standard closure of the myelomeningocele after delivery. The mean operating time for the hysterotomy procedures was 125 +/- 8 min. No mortality occurred, and all the infants delivered between 33 and 36 weeks with well-healed myelomeningocele scars. At present, the functional levels of all infants approximate the anatomical levels of the lesions. Conclusion: With current technology, in utero repair of congenital myelomeningocele through a hysterotomy appears to be technically superior to procedures performed endoscopically, Copyright (C) 2000 S. Karger AG, Basel.