详细探讨宫内治疗程序与中心的具体进展

IF 0.1 Q4 SURGERY Surgical Techniques Development Pub Date : 2024-02-23 DOI:10.3390/std13010005
Marta Domínguez-Moreno, Á. Chimenea, María Remedios Viegas-González, Clara Morales-Muñoz, L. García-Díaz, Guillermo Antiñolo
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引用次数: 0

摘要

长期以来,宫内产前处理(EXIT)程序一直是处理复杂胎儿状况的重要工具,这些胎儿在从宫内到宫外的过渡时期需要气道干预。本技术说明深入探讨了EXIT术,强调了本中心引进的改进和创新技术。该技术侧重于细致的术前评估,并采用独特的技术和麻醉方法。一个多学科团队集合在一起制定EXIT手术计划,强调与患者的沟通和风险讨论。我们的技术涉及无创进入子宫腔,通过使用为此目的开发的子宫渐进牵引器来实现。使用该牵引器后,再使用血管钳和缝合装置(Premium Poly Cs-57 Autosuture®,美敦力公司)。我们的麻醉方法采用全身麻醉,并放置硬膜外导管。产妇手术包括低位横向开腹和术中超声引导下的子宫切开术。胎儿暴露包括轻柔取出或外翻,确保气道通畅。确保胎儿气道通畅后,脐带夹闭和产妇腹部闭合结束手术。通过重温EXIT的核心原则并结合中心的具体进展,我们加深了对其的理解并提高了专业技术水平。据我们所知,这是首次发表关于该技术的详细描述。
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A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements
The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.
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