胎児外科手技を用いた胆道閉鎖症モデル(肝外胆管および肝)作成による病態解明の試み

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(1) Production of Experimental Model in Fetal LambsNine pregnant ewes between 90 and 120 days of gestation were studied. A midline laparotomy was performed and the gravid uterus was exposed. A small hysterotomy was made and a fetal abdominal wall was exposed. A right subcostal laparotomy in the fetus was performed. OK-432 with saline was injectedinto the gall bladder of the fetus. Wound of the fetus, the uterus and the pregnant ewe were closed in layrs. Antibiotics and tocolytic agents were given to the pregnant ewe after the operation. According to the radiological and pathological studies on newborn lambs delivered at three post-operative weeks, local inflammatory change in the gall bladder was apparently induced. However, extensive cholangitis, obstructive change of the bile duct and specific pathological change in the liver were not observed. Further investigation should be needed on the optimum gestational age, and a route of injection in the fetus.(1) Development of Fetal Endoscopic ProcedureThree pregnant ewes between 95 and 120 days of gestation were studied. A pregnant uterine was exposed by maternal laparotomy. Endoscopic cannula was inserted through a pursestring hysterotomy. Amniotic fluid was partially removed and replaced with a constant infusion of warm physiologic saline to improve endoscopic visualization. The fetuses were examined with a fine telescope and a flexible fiberscope passing through the cannula. Balloon-tipped cannula was useful to prevent loss of amniotic fluid and detachment of endometruium. With this technique, the fetal body surface, the respiratory tract, upper and the lower intestinal tract could be examined safely in details.