Extrauterine Fetal Treatment for Congenital Diaphragmatic Hernia

先天性膈疝的宫外胎儿治疗

• 批准号: 06454505
• 负责人: KATO Tetsuo
• 金额: $ 4.42万
• 依托单位: Akita University School of Medicine
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1994
• 资助国家: 日本
• 起止时间: 1994 至 1996
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-06454505/
• 关键词: Fetal surgery; Congenital diaphragmatic hernia; Hypoplastic lung; Artificial placenta.; ECMO; Lamb; 胎児治療; 子宮内胎児治療; 子宮外胎児治療

The results of intrauterine fetal surgery for congenital diaphragmatic hernia remain poor because of difficulties in the surgical techniques and in preventing premature birth or abortion as well as problems in intrauterine management of the fetus after surgery. In addition, intrauterine fetal treatment causes large intervention to the mother. Due to these circumstances, we attempted to develop extrauterine fetal treatment using an artificial placenta.Diaphragmatic hernia was created in fetal lambs between 120 and 135 days. The fetuses were incubated in an artificial amniotic container with cervical V-A ECMO.Umbilical vessels were canulated for measurment of blood pressure, blood gas, ACT and other laboratry deta. Extracorporeal circulation was maintained between 80 and 100 ml/kg/min. Heparin was continuously infused into the circuit to maintain the ACT between 180 and 250 seconds. Diaphragmatic hernia was repaired after fetal vital signs were statabilized.The fetuses undergoing extrauterine treatment survived for 9-24 hours. There were no remarkable histological changes in brains and lungs.

由于手术技术困难，在预防早产或流产以及手术后胎儿宫内管理方面的问题，胎儿宫内手术治疗先天性横隔疝的效果仍然很差。此外，宫内胎儿治疗对母亲造成较大的干预。由于这些情况，我们试图开发使用人造胎盘的宫外胎儿治疗。在120至135天的胎羊中产生了横隔疝。将胎儿置于人工羊膜容器中，宫颈V-A ECMO，脐带血管插管，测量血压、血气、ACT等实验室指标。体外循环维持在80~100ml/kg/min。持续向回路注入肝素以维持ACT在180-250秒之间。胎儿生命体征稳定后修补横隔疝，宫外治疗的胎儿存活9~24小时。脑和肺组织学未见明显变化。

项目成果

Tetsuo Kato, Tatsuzou Hebiguchi, Hiroaki Yoshino, and Kenji Koyama: "Extrauterine Fetal Treatment for Congenital Diaphragmatic Hernia" Jpn.J.Pediatr.Surg.26(9). 1050-1054 (1994)

Tetsuo Kato、Tatsuzou Hebiguchi、Hiroaki Yoshino 和 Kenji Koyama：“先天性膈疝的宫外胎儿治疗”Jpn.J.Pediatr.Surg.26(9)。

Kato,T.: "Evaluation of the lung in congenital diaphragmatic hernia by histometry and three dimentional image" Pediatr.Surg.International. 10. (1995)

Kato,T.：“通过组织测量和三维图像评估先天性膈疝的肺部”Pediatr.Surg.International。

Kato,T.: "Eualuation of the lung in consenital diaphuagpatic hennia by histometry and three dirmensional image necosstruction" Pediatr.Sung.Int.11. 29-32 (1995)

Kato,T.：“通过组织测量和三维图像 necosstruction 对先天性膈疝的肺部进行评估”Pediatr.Sung.Int.11。

加藤哲夫: "生後24時間未満発生の先天性横隔膜ヘルニアの臨床的検討" 小児科診療. 58. 1073-1076 (1995)

Tetsuo Kato：“出生后 24 小时内发生的先天性膈疝的临床回顾”《儿科学》58. 1073-1076 (1995)。

加藤 哲夫: "横隔膜ヘルニアに対する胎児治療-子宮外胎児治療へ向けて-" 小児外科. 26(9). 1050-1054 (1994)

Tetsuo Kato：“膈疝的胎儿治疗 - 走向宫外胎儿治疗”小儿外科 1050-1054 (1994)。