针式胎儿胸腔镜检查:一种在超声引导下辅助进行高难度胸羊膜分流术的技术。

IF 1.6 3区 医学 Q3 OBSTETRICS & GYNECOLOGY Fetal Diagnosis and Therapy Pub Date : 2024-05-15 DOI:10.1159/000539274
Steven T Papastefan, Daniel R Liesman, Katherine C Ott, Federico Scorletti, Xavier F Pombar, Aimen F Shaaban, Amir M Alhajjat
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引用次数: 0

摘要

引言胎儿胸羊膜分流术是常见的救生措施,但经常需要更换。针式胎儿胸腔镜是一种使用标准羊膜腔分流导管鞘的技术,可在分流管部署过程中直接观察甚至操作器械,从而在最具挑战性的病例中实现最佳定位和主要分流功能:本研究回顾了五例接受针式胎儿胸腔镜辅助羊膜腔分流术的患者。其中三例患者患有巨大囊性先天性肺气道畸形(CPAM),并伴有纵隔移位和/或水肿恶化的证据;两例患者患有巨大乳糜胸,并伴有胎儿水肿。四例患者之前曾进行过分流术,但因初次置入时声像图显示不清、囊肿隔膜、分流术阻塞或移位而失败。使用针式胎儿胸腔镜破坏囊壁和隔膜、清除血肿并确认分流管的最佳初始位置。在该系列手术中,一名宫颈短的重度 CPAM 患者术后出现早产,导致新生儿死亡。其余四名患者的水肿得到缓解,并顺利分娩,新生儿预后良好:结论:针刺胎儿胸腔镜手术可有选择性地应用于受反复失败、声像图窗口不佳和胎位困难影响的高难度胸羊膜腔分流术病例。
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Needle Fetal Thoracoscopy: A Technique to Assist with Ultrasound-Guided Placement of Challenging Thoracoamniotic Shunts.

Introduction: Fetal thoracoamniotic shunts are common lifesaving interventions but frequently require replacement. Needle fetal thoracoscopy is a technique that uses standard thoracoamniotic shunt introducer sheaths to permit direct visualization and even instrument manipulation during shunt deployment to facilitate optimal positioning and primary shunt function in the most challenging cases.

Case presentation: In this study, 5 patients who underwent needle fetal thoracoscopy-assisted thoracoamniotic shunt placement were reviewed. Three patients with large, macrocystic congenital pulmonary airway malformations (CPAMs) with evidence of worsening mediastinal shift and/or hydrops and 2 patients with large chylothorax with fetal hydrops were treated. Four cases had previous shunts that failed due to poor sonographic visualization during initial placement, cyst septations, shunt obstruction, or dislodgment. Needle fetal thoracoscopy was used to disrupt cyst walls and septations, clear hematoma, and confirm the optimal initial position of the shunt. In this series, 1 severe CPAM patient with a short cervix developed preterm labor postoperatively resulting in neonatal demise. The remaining 4 patients experienced resolution of hydrops and progressed to successful delivery with excellent neonatal outcomes.

Conclusion: Needle fetal thoracoscopy is a procedure that may be selectively deployed in challenging thoracoamniotic shunt cases impacted by recurrent failure, poor sonographic windows, and challenging fetal positioning.

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来源期刊
Fetal Diagnosis and Therapy
Fetal Diagnosis and Therapy 医学-妇产科学
CiteScore
4.70
自引率
9.10%
发文量
48
审稿时长
6-12 weeks
期刊介绍: The first journal to focus on the fetus as a patient, ''Fetal Diagnosis and Therapy'' provides a wide range of biomedical specialists with a single source of reports encompassing the common discipline of fetal medicine.
期刊最新文献
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