J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 2895KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 100(6): 366-372, 1999

Feature topic

EFFECT OF INTRAUTERINE REPAIR OF DIAPHRAGMATIC HERNIA ON ACCOMPANYING PULMONARY HYPOPLASIA IN THE FETAL RABBIT

Department of Pediatric Surgery, Akita University School of Medicine, Akita, Japan

Tetsuo Kato, Hiroaki Yoshino, Tatsuzo Hebiguchi, Masaru Mizuno

Severe pulmonary hypoplasia precluding the sustenance of life is often found in newborns with congenital diaphragmatic hernia (CDH) diagnosed within the first 24 hours of life. In utero repair of the hernia may thus be the only available method to salvage such patients.
To study the efficacy and feasibility of in utero repair of CDH, diaphragmatic hernia (DH) was successfully produced in 81 of 90 fetal rabbits by diaphragmatic perforation at 22 days’ gestation (term : 31 days). The DHs were repaired successfully in 25 of 50 fetal rabbits at 26 days’ gestation. The rabbits with repaired and nonrepaired DHs and their normal littermates (control group) were delivered at 29 days’ gestation by cesarean section. Some of the rabbits were killed and subjected to measurements of body and lung weight, determination of DNA and surfactant (disaturated phosphatidylcholine [DSPC]) contents of the lungs, and light and electron microscopic examination of the lungs. Some newborn rabbits underwent endotracheal intubation and measurement of pressure-volume curves and pulmonary compliance.
The total lung/body weight ratio and fetal lung DNA contents in the repair group were greater than those in the nonrepair group (P<0.01). There were no differences between the these groups in regard to body weight. When compared with the control group, both the repair and nonrepair groups had elevated DSPC content (P<0.01 and P<0.05, respectively), although there was no difference between the repair and nonrepair groups. Histologically, the thickness of the terminal air spaces was smaller and the size of the lung acini was larger in the repair groups than in the nonrepair group. Electron microscopically, the number of type II lung cells in both the repair and non repair groups tended to be larger than that in the control group. When compared with the nonrepair group, the repair group showed increased values for pressure-volume curves (P<0.01) and pulmonary compliance (P<0.01).
In conclusion, in utero repair of CDH is effective in improving the lung hypoplasticity accompanying this anomaly.

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