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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2019, Vol. 12 ›› Issue (06): 373 -375. doi: 10.3877/cma.j.issn.1674-6899.2019.06.014

所属专题： 经典病例； 文献资源库；

病例报告 上一篇    下一篇

胎儿镜在胎儿下尿路梗阻中的应用
郭涛 1, 周辉霞 1 , †( ), 尚丽新 2, 王晶 2, 陈功立 3, 王红 4, 卫炜 4, 吴新淮 5, 马立飞 1, 李品 1, 曹华林 1   
  1. 1. 100700 北京，解放军总医院第七医学中心附属八一儿童医院泌尿外科
    2. 100700 北京，解放军总医院第七医学中心妇产科
    3. 400038 重庆，陆军军医大学第一附属医院妇产科
    4. 100700 北京，解放军总医院第七医学中心超声科
    5. 100700 北京，解放军总医院第七医学中心放射科
  • 收稿日期:2019-12-06 出版日期:2019-12-30
  • 通信作者: 周辉霞
  • 基金资助:
    军队计生专项(18JS001); 北京市科技计划(Z18110000718008)

Application of fetoscopy in management of fetal lower urinary tract obstruction

Tao Guo 1, Huixia Zhou 1 , †( ), Lixin Shang 2, Jing Wang 2, Gongli Chen 3, Hong Wang 4, Wei Wei 4, Xinhuai Wu 5, Lifei Ma 1, Pin Li 1, Hualin Cao 1   

  1. 1. Department of Urology, Bayi Children＇s Hospital Affiliated to the PLA Army General Hospital, Beijing 100700, China
    2. Department of Obstetrics and Gynecology, PLA Army General Hospital, Beijing 100700, China
    3. Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
    4. Department of Ultrasound, PLA Army General Hospital, Beijing 100700, China
    5. Radiology Department, PLA Army General Hospital, Beijing 100700, China
  • Received:2019-12-06 Published:2019-12-30
  • Corresponding author: Huixia Zhou
  • About author:
    Corresponding author: Zhou Huixia, Email:
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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。

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
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.

Key words: Fetal lower urinary tract obstruction, Fetoscopy, Urethral atresia, Keyhole sign, Posterior urethral valves
图4 后尿道入口为一盲端
[1]
Johnson MP, Danzer E, Koh J, et al. Natural history of fetal lower urinary tract obstruction with normal amniotic fluid volume at initial diagnosis[J]. Fetal Diagn Ther, 2018, 44(1): 10-17.
[2]
Debska M, Kolesnik A, Kretowicz P, et al. Ultrasound guided balloon catheterisation: a new method of fetal lower urinary tract obstruction management[J]. Ginekol Pol, 2017, 88(5): 255-259.
[3]
Sananes N, Favre R, Koh CJ, et al. Urological fistulas after fetal cystoscopic laser ablation of posterior urethral valves: surgical technical aspects[J]. Ultrasound Obstet Gynecol, 2015, 45(2): 183-189.
[4]
Chevalier RL. Congenital urinary tract obstruction: the long view[J]. Adv Chronic Kidney Dis, 2015, 22(4): 312-319.
[5]
Edouga D, Hugueny B, Gasser B, et al. Recovery after relief of fetal urinary obstruction: morphological, functional and molecular aspects[J]. Am J Physiol Renal Physiol, 2001, 281(1): 26-37.
[6]
Quintero RA, Johnson MP, Romero R, et al. In－utero percutaneous cystoscopy in the management of fetal lower obstructive uropathy[J]. Lancet, 1991, 346(8974): 537-540.
[7]
Tonni G, Vito I, Ventura A, et al. Fetal lower urinary tract obstruction and its management[J]. Arch Gynecol Obstet, 2013, 287(2): 187-194.
[8]
Morris RK, Ruano R, Kilby MD. Effectiveness of fetal cystoscopy as a diagnostic and therapeutic intervention for lower urinary tract obstruction: a systematic review[J]. Ultrasound Obstet Gynecol, 2011, 37(6): 629-637.
[9]
罗朵朵，董刚. 超声诊断胎儿后尿道瓣膜病1例[J]. 中华超声影像学杂志，2010, 23(4)：884-884.
[10]
Bernardes LS, Aksnes G, Saada J, et al. Keyhole sign: how specific is it for the diagnosis of posterior urethral valves[J]. Ultrasound Obstet Gynecol, 2009, 34(4): 419-423.
[11]
Sananes N, Cruz－Martinez R, Favre R, et al. Two－year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction[J]. Prenat Diagn, 2016, 36(4): 297-303.
[12]
Poutamo J, Vanninen R, Partanen K, et al. Diagnosing fetal urinary tract abnormalities: benefits of MRI compared to ultrasonography[J]. Acta Obstet Gynecol Scand, 2000, 79(1): 65-71.
[13]
Lissauer D, Morris RK, Kilby MD. Fetal lower urinary tract obstruction[J]. Semin Fetal Neonatal Med, 2007, 12(6): 464-470.
[14]
Savelli S, Di Maurizio M, Perrone A, et al. MRI with diffusion－weighted imaging (DWI) and apparent diffusion coefficient (ADC) assessment in the evaluation of normal and abnormal fetal kidneys: preliminary experience[J]. Prenat Diagn, 2007, 27(12): 1104-1111.
[15]
Holmes N, Harrison MR, Baskin LS. Fetal surgery for posterior urethral valves: long－term postnatal outcomes[J]. Pediatrics, 2001, 108(1): 7-7.
[16]
Muller F, Bernard MA, Benkirane A, et al. Fetal urine cystatin c as a predictor of postnatal renal function in bilateral uropathies[J]. Clin Chem, 2000, 45(12): 2292-2293.
[17]
梁志清，李俊男. 胎儿下尿路梗阻的宫内诊断与治疗进展[J]. 实用妇产科杂志，2009, 25(12): 714-716.
[18]
Ruano R, Duarte S, Bunduki V, et al. Fetal cystoscopy for severe lower urinary tract obstruction－－initial experience of a single center[J]. Prenat Diagn, 2010, 30(1): 30-39.
[1] 周辉霞, 陈功立, 尚立新, 王红, 王晶. 胎儿镜检查术(胎儿镜在胎儿下尿路梗阻中的应用）[J]. 中华腔镜外科杂志(电子版), 2019, 12(06): 0-0.
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