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

用12只妊娠100 ~ 120天的日本山羊进行了胎羊疝的实验研究。在氟烷全身麻醉下。剖腹手术后在子宫内识别胎儿。通过剖腹手术打开一只胎仔的左膈，另一只胎仔作为对照。如果双胞胎怀孕。6例胎儿在手术后存活超过1周，4例为对照。用胎儿超声和肺/体重比连续测量肺/胸横面积比（L/T）和多普勒检查。尸检时检查肺内放射状肺泡计数和卵磷脂/鞘磷脂比值，术后L/T逐渐降低，最后测量值与对照组比较差异有统计学意义（0.41 <plus-minus>± 0.07 vs0.58 ± <plus-minus>0.04）。虽然肺/体重比没有显著差异（0.019 <plus-minus>0.005 vs 0.025 <plus-minus>0.006）。在L/T和肺/体重比之间观察到显著的相关性。与右肺相比，疝模型左肺的径向肺泡计数显著降低。然而，左肺和右肺的卵磷脂/鞘磷脂比值之间没有观察到显著差异。Doppler检查显示疝模型与正常对照组之间无显著差异。这些结果表明，胎儿超声测量肺/胸横面积比值对评估胎儿疝肺发育不良是有用的。

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.