Endoscopic tracheal balloon occlusion in congenital diaphragmatic hernia sheep model

目的：建立大鼠先天性左膈裂孔疝动物模型，并进行内窥镜下气管闭塞治疗。方法：1.制作左侧横隔疝；2.可脱性气囊气管内封堵术。结果：1.小动物横隔疝的基本手术方法。取妊娠40天的豚鼠制作左侧横隔疝模型。另取大鼠，用硝苯乙酸乙酯内窥镜制作大鼠肝突出模型。用可脱性气囊对3只妊娠90天的绵羊施行内窥镜下气管闭塞手术。每三个胎儿中就有一个死于胎盘过早脱离。其余均顺利完成剖宫产手术。绵羊左横隔疝的产生。我们在妊娠75天的绵羊身上制造了外科手术后的左侧横隔疝。一项由哈里森先生等人进行的人类胎儿内窥镜气管闭塞的随机试验。在加州大学旧金山分校。气管闭塞组11个胎儿中有8个存活到90天(P=1.00)，接受标准护理的13个胎儿中有10个存活到90天(P=1.00)。气管闭塞并未提高先天性横隔疝胎儿的存活率或发病率。这些结果不能提供任何支持证据，证明这种治疗方法也适用于日本的先天性横隔疝胎儿。肺/头比(LHR)小于0.9的重度先天性膈疝是未来需要解决的问题。

Aim : We aimed to produce animal model with left congenital diaphragmatic hernia and performed endoscopic tracheal occlusion treatment. We also discussed the clinical application for human fetal treatment in Japan.Methods : 1.Left diaphragmatic hernia production 2.Endotracheal occlusion by detachable balloonResults :1. Basic operative technique for diaphragmatic hernia in small animal. Guinea pigs at 40 days of gestation were used for left diaphragmatic hernia production. Also rats were used as a liver herniation model produced by nitrofen.2 Endoscopic apparatus. We performed endoscopic tracheal occlusion by detachable balloon on three sheep at 90days of gestation. One fetus of three died intrauterine due to premature detachment of the placenta. The rest underwent successfully Caesarean section.3. Left diaphragmatic hernia production in sheep. We produced surgically left diaphragmatic hernia in sheep at 75 days of gestation.4. A randomized trial of human fetal endoscopic tracheal occlusion performed by Harrison MR. et al. at UCSF. Eight of 11fetuses (73 percent) in the tracheal-occlusion group and 10 of 13 (77 percent) in the group that received standard care survived to 90 days of age (P=1.00). The tracheal occlusion did not improve survive or morbidity rates in he cohort of fetuses with congenital diaphragmatic hernia.These results do not give any supporting evidences to apply this treatment for human fetuses with congenital diaphragmatic hernia also in Japan. Severe congenital diaphragmatic hernias of Lung to head ratio (LHR) less than 0.9 must be a future issue to solve.