Intrauterine fetale Chirurgie

Kernaussagen

Die fetale Chirurgie stellt ein neues interdisziplinäres Fachgebiet dar, welches das Ziel verfolgt, die fetale und neonatale Mortalität und Morbidität zu reduzieren und die durch Malformationen verursachten Organschäden während der embryonalen und fetalen Entwicklung zu minimieren. Beispiele für Indikationen zur fetalen Chirurgie sind u. a. folgende Erkrankungen:

• fetofetales Transfusionssyndrom in monochorialen Zwillingsschwangerschaften

• angeborene Zwerchfellhernie mit einer Lung-to-Head (L / H) Ratio < 1

• obstruktive Uropathie, die unbehandelt oft zu einer Niereninsuffizienz und bei Anhydramnion zur Lungenhypoplasie führt

• große kongenitale zystische adenomatoide Malformationen der Lunge

• sakrokokzygeales Teratom mit Hydrops fetalis

• hypoplastisches Linksherz-Syndrom

Regelmäßiges Training des Operationsteams und eine zunehmende Verfeinerung der intrauterinen fetoskopischen Technik ermöglichen eine signifikante Verbesserung des fetalen Outcomes. Die ständige Fortentwicklung von Methoden der Diagnostik und Patientenselektion sowie der chirurgischen Techniken etablieren die intrauterine mikroinvasive fetale Chirurgie zu einem Bestandteil der therapeutischen Möglichkeiten für diese Patienten in spezialisierten Zentren.

Literatur

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