台湾胎儿内窥镜修复脊髓膜膨出症的临床经验：产前决策的困境与首例成功案例

IF 2 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Taiwanese Journal of Obstetrics & Gynecology Pub Date : 2024-10-29 DOI:10.1016/j.tjog.2024.07.018

Ming Feng , Pei-Chen Chen , Guan-Ru Lin , Tzu-Yi Lin , T'sang-T'ang Hsieh , Steven W. Shaw

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引用次数: 0

摘要

目的Objective：脊柱裂（Myelomeningocele，MMC）是脊柱裂中最严重的一种，在台湾的发病率为每万名活产婴儿中有 1.87 例。病变部位暴露在羊水中会加重神经系统的预后，而胎儿手术修补脊柱裂已成为常规做法，可改善产后预后。然而，亚洲妇女及其家庭往往难以接受产前缺陷，导致几乎所有胎儿MMC妊娠都选择终止妊娠，而不考虑胎儿手术。材料与方法在台湾首次批准的胎儿镜下MMC修复试验中，我们在2020年至2023年期间前瞻性地招募了15个病例。最终诊断由核磁共振成像和超声波确诊。医疗团队提供非直接咨询，与家属讨论胎儿手术的可能结果。对于选择胎儿手术的患者，我们提供了全经皮胎儿镜MMC修补术。结果在30个月内，15例患者中有14例（93%）选择在胎龄18至26周之间终止妊娠。决定因素包括潜在的残疾、疾病、经济、社会和心理因素。尽管中国有很多支持终止妊娠的团体，但终止妊娠率仍然很高。15例中有1例成功进行了胎儿手术，术后患儿30个月大，无运动功能障碍，能自然行走和奔跑。通过媒体持续开展社会教育，对于改变人们的观念和提高胎儿手术的接受度至关重要。

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The clinical experience of fetoscopic repair of myelomeningocele in Taiwan: The dilemma in prenatal decision-making and first successful case

Objective

Objective: Myelomeningocele (MMC) is the most severe type of spina bifida, with an incidence of 1.87 per 10,000 live births in Taiwan. Exposure of the lesion to amniotic fluid exacerbates neurological outcomes, while fetal surgery for MMC repair, now a routine practice, improves postnatal outcomes. However, Asian women and their families often find it difficult to accept prenatal defects, leading nearly all pregnancies with fetal MMC to opt for termination without considering fetal surgery.

Materials and methods

In Taiwan's first approved trial of fetoscopic MMC repair, we prospectively recruited 15 cases from 2020 to 2023. Final diagnoses were confirmed using MRI and ultrasound. The medical team provided non-direct consultations to discuss possible outcomes of fetal surgery with family members. For those opting for fetal surgery, we offered total percutaneous fetoscopic MMC repair.

Results

Over 30 months, 14 of 15 cases (93%) chose to terminate their pregnancies between 18 and 26 weeks of gestational age. Decision factors included potential disabilities, morbidities, economic, social, and psychological aspects. Despite supportive groups in the country, the termination rate remained high among the Chinese population. One out of the 15 cases underwent fetal surgery successfully, resulting in a 30-month-old child without motor function delays, able to walk and run naturally.

Conclusion

We initiated the first fetoscopic MMC repair in Taiwan with promising outcomes, though we faced a high termination rate here and similar situation in other Asian countries. Continuous social education through media could play a crucial role in changing perceptions and increasing acceptance of fetal surgery.

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来源期刊

Taiwanese Journal of Obstetrics & Gynecology OBSTETRICS & GYNECOLOGY-

CiteScore

3.60

自引率

23.80%

发文量

207

审稿时长

4-8 weeks

期刊介绍： Taiwanese Journal of Obstetrics and Gynecology is a peer-reviewed journal and open access publishing editorials, reviews, original articles, short communications, case reports, research letters, correspondence and letters to the editor in the field of obstetrics and gynecology. The aims of the journal are to: 1.Publish cutting-edge, innovative and topical research that addresses screening, diagnosis, management and care in women''s health 2.Deliver evidence-based information 3.Promote the sharing of clinical experience 4.Address women-related health promotion The journal provides comprehensive coverage of topics in obstetrics & gynecology and women''s health including maternal-fetal medicine, reproductive endocrinology/infertility, and gynecologic oncology. Taiwan Association of Obstetrics and Gynecology.