胎儿镜在胎儿下尿路梗阻中的应用  

Application of fetoscopy in management of fetal lower urinary tract obstruction

作　　者：郭涛[1] 周辉霞 尚丽新 王晶[2] 陈功立 王红[4] 卫炜 吴新淮 马立飞 李品 曹华林 Guo Tao;Zhou Huixia;Shang Lixin;Wang Jing;Chen Gongli;Wang Hong;Wei Wei;Wu Xinhuai;Ma Lifei;Li Pin;Cao Hualin(Department of Urology,Bayi Children's Hospital Affiliated to the PLA Army General Hospital,Beijing 100700,China;Department of Obstetrics and Gynecology,PLA Army General Hospital,Beijing 100700,China;Department of Obstetrics and Gynecology,Southwest Hospital,Third Military Medical University,Chongqing 400038,China;Department of Ultrasound,PLA Army General Hospital,Beijing 100700,China;Radiology Department,PLA Army General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院第七医学中心附属八一儿童医院泌尿外科,北京100700 [2]解放军总医院第七医学中心妇产科,北京100700 [3]陆军军医大学第一附属医院妇产科,重庆400038 [4]解放军总医院第七医学中心超声科,北京100700 [5]解放军总医院第七医学中心放射科,北京100700

出　　处：《中华腔镜外科杂志（电子版）》2019年第6期373-375,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：军队计生专项(18JS001);北京市科技计划(Z18110000718008)

摘　　要：目的探讨胎儿镜在胎儿下尿路梗阻诊治中的应用。方法局部麻醉下,通过超声引导,向胎儿膀胱置入胎儿镜,通过胎儿镜直接观察梗阻部位,区分下尿路梗阻原因,如后尿道瓣膜、尿道闭锁及尿道狭窄等。结果成功向胎儿膀胱内置入胎儿镜,明确胎儿下尿路梗阻的病因为尿道闭锁,经胎儿亲属同意给予进一步行膀胱羊膜腔引流术。结论此项技术操作难度大,孕妇及胎儿的手术风险大,必须是在有开展此项技术的医学中心进行手术。并且,胎儿必须满足因羊水严重过少导致宫内或新生儿期有极高死亡风险的条件,才能进行此项手术。产前干预对胎儿的获益,如预防肺发育不全、保护肾及膀胱功能等,暂时未明确,仍需更多的研究来证实。Objective To explore application of fetoscopy in management of fetal lower urinary tract obstruction.Methods Under local anesthesia, the fetoscopy was placed into the fetal bladder under the guidance of ultrasound, and it is easy to observe the focus of urinary tract obstruction directly to distinguish the causes of lower urinary tract obstruction, such as posterior urethral valve, urethral atresia and urethral stricture.Results The fetoscopy was successfully inserted into the fetal bladder to confirm that the cause of the lower urinary tract obstruction in the fetal was urethral atresia.Conclusions It is difficult and risky for pregnant women and fetuses, and must be performed at a medical center where the technique is being developed. In addition, the fetus must meet the conditions for severe oligohydramnios leading to a very high risk of death in utero or in the neonatal period. It may protect the function of kidney and bladder, help the urine excrete the amniotic cavity, prevent the pulmonary hypoplasia from happening. The exact role of this prenatal interventions is not yet clear and more studies are necessary to confirm these benefits.

关 键 词：胎儿下尿路梗阻 胎儿镜检查术 尿道闭锁 钥匙孔征 后尿道瓣膜 

分 类 号：R714.5[医药卫生—妇产科学]