Operating on placental support: The ex utero intrapartum treatment procedure
Operating on placental support: The ex utero intrapartum treatment procedure
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DOI：
10.1016/s0022-3468(97)90184-6
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发表时间：
1997-02-01
影响因子：
2.4
通讯作者：
Harrison, MR
中科院分区：
文献类型：
--
作者：
Mychaliska, GB;Bealer, JF;Harrison, MR
在治疗8例可预测气道阻塞的胎儿时，作者开发了一种系统的方法，即子宫外产时治疗程序，以确保分娩期间的气道安全。6例患者在子宫内进行气管堵塞或夹闭，以治疗先天性疝，2例患者产前诊断为颈部和口咽部的囊性水囊瘤。通过使用高剂量吸入性卤化剂在剖宫产期间促进子宫松弛，在胎儿-胎盘循环保持完整的同时固定胎儿气道，然后分离脐带，进行子宫外分娩治疗程序。在子宫外分娩治疗过程中进行了各种手术，包括支气管镜检查、经口气管插管、气管造口术、逆行经口气管插管气管造口术、气管成形术、取出气管内塞、取出气管外夹、中心线放置和滴注表面活性剂。手术期间母体或胎儿并发症极少。这种方法需要儿科外科医生、产科医生、麻醉师、超声医师和产科医生的协调努力。加强母胎监护、剖宫产术和最大程度的子宫松弛，以及维持完整的胎儿-胎盘循环的结合，为产前诊断为气道阻塞的婴儿提供了一个可控的环境，以保护气道。版权所有（C）1997，WB桑德斯公司
While treating eight fetuses with predictable airway obstruction, the authors developed a systematic approach, the ex utero intrapartum treatment procedure, to secure the airway during delivery Six patients had their trachea plugged or clipped in utero for treatment of congenital diaphragmatic hernia, and two patients had prenatally diagnosed cystic hygroma of the neck and oropharynx. The ex utero intrapartum treatment procedure was performed by using high doses of inhaled halogenated agents to facilitate uterine relaxation during cesarean section, securing the fetal airway while fete-placental circulation remained intact, and then dividing the umbilical cord. A variety of procedures were performed during the ex utero intrapartum treatment procedure including bronchoscopy, orotracheal intubation, tracheostomy, tracheostomy with retrograde orotracheal intubation,tracheoplasty, removal of internal tracheal plug, removal of external tracheal clip, central line placement, and instillation of surfactant. There were minimal maternal or fetal complications during the procedure. This approach requires the coordinated efforts of pediatric surgeons, obstetricians, anesthesiologists, sonographers, and neonatologists. The combination of intensive maternal-fetal monitoring, cesarean section with maximal uterine relaxation, and maintenance of intact fete-placental circulation provides a controlled environment for securing the airway in babies with prenatally diagnosed airway obstruction. Copyright (C) 1997 by W.B. Saunders Company.