胎儿镜手术治疗对子宫肌层的影响：绵羊脊髓脊膜膨出模型的实验研究

原文

OBJECTIVE: To investigate uterine healing at delivery after fetoscopic myelomeningocele (MMC) closure in an ovine model. METHODS: This descriptive study was conducted in Romane ewes. Fetal MMC lesions were created after hysterotomy at 75 days of gestation. Fetoscopic MMC closure using three trocars was performed at 90 days of gestation and cesarean delivery at 143 days. Subtotal hysterectomy was performed, and each hysterectomy specimen was examined in fresh condition. The areas of interest and the surrounding intact tissue were then sampled en bloc and fixed in 4% buffered formaldehyde solution for 3-6 weeks. Macroscopic appearance of the scars was assessed in fresh condition. Microscopic examinations were conducted in fixed samples. RESULTS: The uteri of six ewes were studied. Macroscopic examination revealed identifiable fetoscopic scars without any scar dehiscence. There was no evidence of a difference in thickness between scarred and healthy adjacent myometrium, although a slightly lower proportion of muscle fibers was observed in scarred areas. CONCLUSIONS: Our study demonstrates that myometrial healing of trocar orifices is complete 53 days after fetoscopic MMC closure in an ovine model. Given the limitations of an ovine model, further studies are needed to determine the risk of uterine rupture and the optimal obstetric management of patients after fetoscopic MMC closure.