Prenatal Evaluation of Lung Hypoplasia and Circulatory Failure in Fetal Diaphragmatic Hernia

选用妊娠100~120d的日本山羊12只，进行胎儿横隔疝的实验研究。在氟烷全身麻醉下。剖腹手术后在子宫内发现胎儿。其中1例经剖腹手术切开左横隔膜，另1例作为对照。如果是双胞胎怀孕。其中6例胎儿在手术后存活超过1周，4例为对照组。采用胎儿超声和肺/体重比值连续测量肺/胸横面积比(L/T)和多普勒检查。术后L/T逐渐降低，与对照组比较差异有统计学意义(0.41&lt；+-gt；0.07 vs0.58&lt；0.04)。虽然肺/体重比率没有显著差异(0.019；正负&gt；0.005 vs 0.025&lt；正负&0.006)。L/T与肺/体重比值呈显著正相关。与右肺相比，横隔疝模型大鼠左肺的放射状肺泡计数明显减少。左、右肺卵磷脂/鞘磷脂比值无显著差异。结果表明，胎儿超声测量肺/胸横截面积比值可用于评价胎儿横断性腹股沟疝肺发育不良。

Fetal diaphragmatic hernia was experimentally made by using 12 pregnant Japanese goats from 100 to 120 days in gestation. Under general anesthesia with fluothane. fetuses were identified in uterus after laparotomy. Left diaphragm was surgically opened through laparotomy in one fetus and the other fetus was treated as a control. if twin pregnancy. In 6 fetuses survived more than 1 week after surgical creation of diaphragmatic hernia and 4 their controls. measurements of lung /thorax transverse area ratio (L/T) and Doppler examination were serially performed by fetal ultrasound and lung/body weight ratio. radial alveolar counts and lecithin/sphingomyelin ratio in the lung were examined at autopsy.L/T gradually decreased after operation and a statistillay significant difference was observed to the controls at the final measurements (0.41<plus-minus>0.07 vs 0.58<plus-minus>0.04). Although no significant difference was noted in lung/body weight ratio (0.019<plus-minus>0.005 vs 0.025<plus-minus>0.006). a significant correlation was observed between L/T and lung/body weight ratio. Radial alveolar counts significantly decreased in the left lung of diaphragmatic hernia models compared to the right lung. However, no significant difference was observed between lecithin/sphingomyelin ratio of the left and right lung. Doppler examination revealed no significant difference between diaphragmatic hernia models and the cThese results indicated that measurements of lung/thorax transverse area ratio by fetal ultrasound should be useful for the assessment of lung hypoplasia in fetal diaphragmatic hernia.