Prenatal Tanı ve Fötal Cerrahi
Özet
Konjenital diyafram hernilerinde (KDH) antenatal tanı, gelişmiş obstetrik ultrasonografi ve fetal MRG teknikleri sayesinde önemli ölçüde artmıştır. Tanı genellikle 15–22. gebelik haftalarında konulmakta olup temel ultrasonografik bulgular arasında toraksta abdominal organların izlenmesi, mediastinal kayma ve midenin karın içinde görüntülenememesi yer alır. Sağ taraflı hernilerde karaciğer ekojenitesinin akciğere benzemesi tanıyı güçleştirdiğinden fetal MRG ayırıcı tanıda kritik rol oynar. MRG ayrıca akciğer hacminin nicel değerlendirilmesi ve karaciğer herniasyonunun belirlenmesinde altın standarttır. Fetal tedavide açık cerrahi yüksek komplikasyon oranları nedeniyle terk edilmiş, yerini minimal invaziv FETO (Fetoskopik Endoluminal Trakeal Oklüzyon) tekniği almıştır. TOTAL çalışmaları, FETO’nun özellikle ağır ve izole sol KDH olgularında sağkalımı artırdığını, ancak prematürite riskini yükselttiğini göstermiştir. Bu nedenle FETO, yalnızca deneyimli fetal cerrahi merkezlerinde, seçilmiş olgularda ve araştırma protokolleri kapsamında uygulanmalıdır.
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