MOLECULAR MECHANISM OF THE TRACHEAL LIGATION FOR HYPOPLASTIC FETAL LUNG

1.微创技术在胎儿气管结扎术中的应用胎儿气管结扎术被认为是促进先天性膈疝肺发育不良的一种方法，但即使是胎儿镜下手术对胎儿也不安全。本研究在超声引导下建立了一种经单孔途径阻断胎儿气管的方法。将一个5mm的端口直接引入胎羊的口腔中，并在USG引导下完成气管插管。引入一个精细的可分离微球囊，并将其吹胀以闭塞气管。胎仔在子宫内保留长达5天，但是，所有胎仔均因宫内胎死而流产。目前的技术似乎是可行的胎儿治疗，虽然更细致的照顾，处理胎儿和妊娠子宫应重新考虑。KGF和Bmp4表达的变化。根据我们的前期研究，KGF在除草醚诱导的胎肺发育不良中可能表达减少。原位杂交结果显示，硝苯草醚处理后E14胎鼠肺组织中KGF mRNA表达增加。目前尚未发现KGF的表达在胎龄上有明显差异。Bmp4在两组胎儿E12均有表达，在除草醚组E16和对照组E18均出现低表达。结果提示，Bmp 4在妊娠晚期可能参与了除草醚所致肺发育不良的形成。

1. Development of the fetal tracheal ligation by minimally invasive techniqueFetal tracheal ligation is considered to be a modality to promote lung development of the hypoplastic lung of congenital diaphragmatic hernia, however, even fetoscopic approach could not be safe to the fetus. The present investigation developed single port approach to occlude the fetal trachea with the sophisticated guidance by USG. A 5 mm port was introduced directly into the oral cavity of the fetal goat and the tracheal intubation was accomplished by USG guidance. A fine detachable micro-balloon was introduced and blown up to occlude the trachea. Fetuses were kept up to five days in uterus, however, all were lost by miscarriage due to intra-uterine fetal death. The present technique seems to be feasible for fetal treatment, although more meticulous care to handle fetuses and pregnant uterus should be reconsidered.1. Change of expression of KGF and Bmp4.Based on our previous study KGF may be less expressed in Nitrofen induced hypoplastic fetal lung. In situ hybridization revealed KGF mRNA expression in the lunf of E14 fetal rat treated by Nitrofen. So far, distinct difference of KGF expression has not been observed in terms of fetal age. Bmp4 is expressed in E12 in both group and once becomes low in E16 of Nitrofen animal and E18 of control fetus. The result may suggest that a possible role of Bmp4 in the late gestational age in the formation of lung hypoplasia induced by Nitrofen.