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

(1)胎羊实验模型的建立9只妊娠90~120天的母羊。行正中剖腹手术，显露妊娠子宫。做了一个小子宫切开术，暴露了胎儿的腹壁。对胎儿进行了右侧肋骨下剖腹手术。将OK-432加生理盐水注入胎儿的胆囊腔内。胎儿、子宫和妊娠母羊伤口分层闭合。术后对妊娠母羊给予抗生素和酵解剂治疗。根据术后3周出生的新生羔羊的放射学和病理学研究，明显地诱导了胆囊局灶性炎症改变。但未见广泛胆管炎、胆管梗阻性改变和肝脏特殊病理改变。(1)胎儿内窥镜过程的发育研究3只妊娠95~120天的母羊。孕妇剖腹探查，显露妊娠子宫。经子宫荷包切开术插入内窥镜插管。去除部分羊水，并持续注入温生理盐水，以改善内窥镜检查的可视化。用一个精细的望远镜和一个穿过插管的柔性纤维显微镜对胎儿进行检查。气囊顶置插管可有效防止羊水流失和子宫内膜脱离。该技术可对胎儿体表、呼吸道、上、下肠道进行详细、安全的检查。

(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.