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首页> 外文期刊>Current opinion in anaesthesiology >Fetal surgery for anesthesiologists.
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Fetal surgery for anesthesiologists.

机译：麻醉医生的胎儿手术。

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PURPOSE OF REVIEW: We aimed to review the current clinical status and advances in endoscopic and open surgical interventions on the fetus in terms of indications, technical aspects and reported outcomes. RECENT FINDINGS: In numbers, there has been a move away from open toward fetoscopic surgery. The indications for each access modality are, however, different, and hence cannot substitute each other. Complications of monochorionic twinning are the leading indication today. Other increasingly frequent indications are severe congenital diaphragmatic hernia and myelomeningocele, and to a certain extent valvuloplasty by needle puncture. Although maternal safety is not at stake, rupture of the membranes and preterm delivery remain a problem. Today, there is level I evidence that fetoscopic laser surgery for twin-to-twin-transfusion syndrome is the preferred therapy. This has triggered the interest of several units to embark on fetoscopic surgery, although the complexity and the overall rare indications act as a limitation to sufficient turnover. SUMMARY: Fetal surgery seems safe and has therefore become a clinical reality. With the current state of technology, open and endoscopic interventions do not compete, each having their indications. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged rather than building up casuistic experience. Healthcare providers and individual centers should be encouraged to consider viability and efficacy of new treatment programs.
机译：审查的目的：我们旨在从适应症，技术方面和报告的结果等方面对胎儿的内窥镜和开放式外科手术的临床现状和进展进行回顾。最近的发现：从数量上看，已经从开放式转向了窥视镜手术。但是，每种访问方式的指示是不同的，因此不能互相替代。单绒毛膜孪晶的并发症是当今的主要指征。其他越来越频繁的适应症是严重的先天性diaphragm肌疝和脊髓膜膨出，并在一定程度上通过穿刺进行瓣膜成形术。尽管产妇的安全性不成问题，但膜的破裂和早产仍然是一个问题。如今，有I级证据表明，对于双胞胎/双胞胎输血综合征，采用窥镜激光手术是首选治疗方法。尽管复杂性和总体罕见的适应症限制了足够的周转率，但这引发了几个单位开始进行窥视镜手术的兴趣。摘要：胎儿手术似乎是安全的，因此已成为临床现实。在当前的技术水平下，开放式和内窥镜干预无法相互竞争，每种都有其适应症。尽管技术实验阶段已经结束，但大多数干预措施仍处于研究阶段。应鼓励将患者尽可能地纳入试验，而不是积累经验。应鼓励医疗保健提供者和个人中心考虑新治疗方案的可行性和功效。

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