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Federación Mexicana de Ginecología y Obstetricia, A.C.

2014, Número 05

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Ginecol Obstet Mex 2014; 82 (05)


Cirugía fetal endoscópica

Cruz-Martínez R, Gratacos E

Idioma: Español
Referencias bibliográficas: 62
Paginas: 325-336
Archivo PDF: 438.60 Kb.


RESUMEN

En la actualidad, el feto se considera “paciente” y, como tal, puede enfermarse y en algunos casos sólo una intervención quirúrgica puede mejorar su pronóstico de vida extrauterina. Hoy día, la cirugía fetal se limita casi exclusivamente a procedimientos endoscópicos. Con el propósito de mejorar el pronóstico de algunas patologías fetales mortales, diversas técnicas han ganado aceptación clínica. En casos de síndrome de transfusión feto-fetal el láser placentario, en gemelos monocoriales con restricción del crecimiento intrauterino selectivo, y la oclusión de cordón son los procedimientos de elección con supervivencia de 80- 90% para, al menos, un feto y 60% para ambos gemelos. En fetos con hernia diafragmática congénita aislada e hipoplasia pulmonar grave, la oclusión traqueal endoscópica puede mejorar las probabilidades de supervivencia de 5 a 55% en hernia izquierda y de 1 a 33% en hernia derecha; con ello disminuye el riesgo de hipertensión pulmonar y la morbilidad neonatal. En casos seleccionados con obstrucción urinaria baja (megavejiga) y sin insuficiencia renal, la cistoscopia fetal es un método diagnóstico que excluye la posibilidad de estenosis o atresia uretral y puede permitir una ablación láser de valvas de la uretra posterior y con ello restaurar la permeabilidad uretral y preservar la función vesical y respiratoria. En fetos con masas pulmonares primarias o debidas a obstrucción de la vía aérea existe un alto riesgo de mortalidad por compresión cardiaca e hipoplasia pulmonar contralateral. En estos casos la broncoscopia fetal es un procedimiento terapéutico de mínima invasión factible para liberar la obstrucción.


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