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Fetale Chirurgie

Fetal surgery

Der Chirurg volume 76, pages 757–764 (2005)Cite this article

Zusammenfassung

Die fetale Chirurgie ist ein neuer interdisziplinärer Fachbereich, der sich in spezialisierten Zentren mit der Therapie von wenigen, stark selektierten Patienten beschäftigt. Ziel dieser Bemühungen ist es, Fehlbildungen während der fetalen Entwicklung operativ zu korrigieren. Es soll verhindert werden, dass am Ende der Gestationsphase irreparable Schäden der betroffenen Organe und Systeme entstehen, die eine hohe Morbidität und Letalität beim Neugeborenen verursachen. Beispiele sind die Therapie der obstruktiven Uropathie, die unbehandelt zu einer Niereninsuffizienz führen würde, die Therapie der Lungenhypoplasie bei angeborener Zwerchfellhernie, großer kongenitaler zystischer adenomatoider Malformationen der Lunge und großer sakrokokzygealer Teratome. Die vorliegende Übersicht beschreibt grundsätzliche Prinzipien der fetalen Chirurgie, die pathophysiologischen Prozesse einiger fetalchirurgisch korrigierbarer Fehlbildungen sowie die diagnostischen und therapeutischen Ansätze. Die bisher veröffentlichten Ergebnisse werden dargestellt und kritisch diskutiert.

Abstract

Fetal surgery is a newly evolving multidisciplinary medical field, being performed in specialized centers. It deals with the treatment of selected fetuses with congenital anomalies that cause high morbidity and mortality. The aim of the surgical treatment is to avoid the development of progressive and eventually irreversible damage at birth. Examples of entities treated are obstructive uropathy leading to renal insufficiency, lung hypoplasia in severe congenital diaphragmatic hernia, severe congenital cystic adenomatoid malformation of the lung, and sacrococcygeal teratoma. This review describes principles of fetal surgery, physiopathologic processes of some of the anomalies treated in this way, and diagnostic and therapeutic approaches. Recently published results are presented and discussed.

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Literatur

  1. Adzick NS, Outwater KM, Harrison MR (1985) Correction of congenital diaphragmatic hernia in utero IV. An early gestational fetal lamb model for pulmonary vascular morphometric analysis. J Pediatr Surg 20:673

    Google Scholar 

  2. Adzick NS, Harrison MR, Glick PL, Nakayama DK, Manning FA, de Lorimier AA (1985) Diaphragmatic hernia in the fetus: prenatal diagnosis and outcome in 94 cases. J Pediatr Surg 20:357

    Google Scholar 

  3. Adzick NS (2001) The fetus with a lung mass. In: Harrison MR, Evans MI, Adzick NS, Holzgreve W (Hrsg) The unborn patient. The art and science of fetal therapy. Saunders, Philadelphia, S 287–296

  4. Adzick NS, Kitano Y (2003) Fetal Surgery for lung lesions, congenital diaphragmatic hernia and sacrococcygeal teratoma. Semin Pediatr Surg 12:154

    Google Scholar 

  5. Adzick NS, Walsh DS (2003) Myelomeningocele: prenatal diagnosis, pathophysiology and management. Semin Pediatr Surg 12:168

    Google Scholar 

  6. Bouchard S, Johnson MP, Flake AW et al. (2002) The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg 37:418

    Google Scholar 

  7. Coplen DE (1997) Prenatal intervention for hydronephrosis. J Urol 157:227

    Google Scholar 

  8. Crombleholme TM, Albanese CT (2001) The fetus with airway obstruction. In: Harrison MR, Evans MI, Adzick NS, Holzgreve W (Hrsg) The unborn patient. The art and science of fetal therapy. Saunders, Philadelphia, S 357–372

  9. Deprest J, Gratacos E, Nicolaides KH (2004) Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results. Ultrasound Obstet Gynecol. 24:121

    Google Scholar 

  10. Di Fiore JW, Fauza DO, Slavin R et al. (1994) Experimental fetal tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia in congenital diaphragmatic hernia. J Pediatr Surg 29:248

    Google Scholar 

  11. Flake AW (1996) Fetal surgery for congenital diaphragmatic hernia. Sem Pediatr Surg 5:266

    Google Scholar 

  12. Flake AW (2001) The fetus with sacrococcygeal teratoma. In: Harrison MR, Evans MI, Adzick NS, Holzgreve W (Hrsg) The unborn patient. The art and science of fetal therapy. Saunders, Philadelphia, S 315–324

  13. Harrison MR, Mychaliska GB, Albanese CT et al. (1998) Correction of congenital diaphragmatic hernia in utero IX: fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion. J Pediatr Surg 33:1017

    Google Scholar 

  14. Harrison MR (2001) The rationale for fetal treatment: selection, feasibility, and risk. In: Harrison MR, Evans MI, Adzick NS, Holzgreve W (Hrsg) The unborn patient. The art and science of fetal therapy. Saunders, Philadelphia, S 39–52

  15. Harrison MR, Keller RL, Hawgood SB et al. (2003) A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med 349:1916

    Google Scholar 

  16. Hedrick HL (2003) Ex Utero Intrapartum Therapy. Semin Pediatr Surg 10:190

    Google Scholar 

  17. Hirose S, Farmer DL, Lee H, Nobuhara KK, Harrison MR (2004) The ex utero intrapartum treatment procedure: Looking back at the EXIT. J Pediatr Surg. 39:375

    Google Scholar 

  18. Holmes N, Harrison MR, Baskin LS (2001) Fetal surgery for posterior urethral valves: long term postnatal outcomes. Pediatrics 108:1

    Google Scholar 

  19. Hubbard AM (2003) Ultrafast fetal MRI and prenatal diagnosis. Semin Pediatr Surg 12:143

    Google Scholar 

  20. Johnson MP (2001) Fetal obstructive uropathy. In: Harrison MR, Evans MI, Adzick NS, Holzgreve W (Hrsg) The unborn patient. The art and science of fetal therapy. Saunders, Philadelphia, S 259–286

  21. Lim FY, Crombleholme TM, Hedrick HL, Flake AW et al. (2003) Congenital high airway obstruction syndrome: natural history and management. J Pediatr Surg 38:940

    Google Scholar 

  22. Lipshutz GS, Albanese CT, Feldsein VA et al. (1997) Prospective analysis of lung-to-head-ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 32:1634

    Google Scholar 

  23. Meuli M, Meuli-Simmen C, Yingling CD et al. (1995) Creation of myelomeningocele in utero: a model of functional damage from spinal cord exposure in fetal sheep. J Ped Surg 30:1028

    Google Scholar 

  24. Meuli M, Meuli-Simmen C, Yingling CD et al. (1996) In utero repair of experimental myelomeningocele saves neurologic function at birth. J Pediatr Surg 31:397

    Google Scholar 

  25. Meuli M (2001) The fetus with myelomeningocele. In: Harrison MR, Evans MI, Adzick NS, Holzgreve W (Hrsg) The unborn patient. The art and science of fetal therapy. Saunders, Philadelphia, S 443–452

  26. Quintero RA, Hume R, Smith C et al. (1995) Percutaneous fetal cystoscopy and endoscopic fulguration of posterior urethral valves. Am J Obstet Gynec 172:206

    Google Scholar 

  27. Paek BW, Jennings RW, Harrison MR et al. (2001) Radiofrequency ablation of human fetal sacrococcygeal teratoma. Am J Obstet Gynecol 184:503

    Google Scholar 

  28. Papadakis K, Luks FI, Deprest JA et al. (1998) Single-port tracheoscopic surgery in the fetal lamb. J Pediatr Surg 33:918

    Google Scholar 

  29. Shaaban AF, Kim HB, Flake AW (2003) In: Ziegler MM, Azizkhan RG, Weber TR (Hrsg) Oprative Pediatric Surgery. Mc Graw-Hill, New York, S 21–35

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Affiliations

  1. Kinderchirurgische Universitätsklinik, Klinikum Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg

    S. Hosie & C. Wollmann

  2. Institut für Klinische Radiologie, Klinikum Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg

    W. Neff

  3. Kinderchirurgische Klinik, Universitätsklinikum Heidelberg

    S. Holland-Cunz

  4. Kinderchirurgische Universitätsklinik, Theodor-Kutzer Ufer 1–3, 68167 , Mannheim

    S. Hosie

Authors
  1. S. Hosie
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  2. C. Wollmann
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  3. W. Neff
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  4. S. Holland-Cunz
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Correspondence to S. Hosie.

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Hosie, S., Wollmann, C., Neff, W. et al. Fetale Chirurgie. Chirurg 76, 757–764 (2005). https://doi.org/10.1007/s00104-005-1065-3

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  • DOI: https://doi.org/10.1007/s00104-005-1065-3

Schlüsselwörter

  • Fetale Chirurgie
  • Angeborene Zwerchfellhernie
  • Obstruktive Uropathie
  • Sakrokokzygeales Teratom
  • Kongenitale zystische adenomatoide Malformation der Lunge

Keywords

  • Fetal surgery
  • Congenital diaphragmatic hernia
  • Obstructive uropathy
  • Sacrococcygeal teratoma
  • Congenital cystic adenomatoid malformation of the lung