Objective: To summarize the clinical value of fetoscopy in the prenatal diagnosis and treatment of amniotic band syndrome (ABS). Methods: A retrospective analysis was conducted on the clinical data of seven ABS fetuses who underwent prenatal fetoscopic intervention at the Third Affiliated Hospital of Zhengzhou University from December 2020 to August 2023. Literatures related to fetoscopic treatment of ABS were searched in databases including China National Knowledge Infrastructure, Wanfang Data, and PubMed. Clinical data were extracted and the characteristics and intervention effects of fetoscopic surgery in the treatment of ABS were summarized. Results: (1) Preoperative evaluation: the gestational age at diagnosis for the seven ABS fetuses was (19.8±4.4) weeks, and the gestational age at fetoscopic intervention was (22.2±2.8) weeks. The indications for fetoscopic intervention included umbilical cord involvement (3 cases), limb amniotic band with circular constriction (2 cases), and unclear visualization of digits (3 cases). (2) Pregnancy outcomes: among the seven ABS fetuses, four cases underwent selective termination of pregnancy due to severe intrauterine limb amputation, and three cases underwent fetoscopic lysis of amniotic bands. Among the latter three cases, one case experienced intrauterine fetal death (IUFD) two weeks after the procedure, and two cases had good postoperative outcomes. (3) Literature review: a total of 40 cases, including 37 cases from 17 articles and three cases from our institution, were included in the analysis. The indications for fetoscopic surgery included limb amniotic band with circular constriction and involvement of the umbilical cord. The success rate of the surgery was 82% (33/40), and 78% (29/37) of the affected limbs retained good functionality. Premature rupture of membranes was the most common complication, with an incidence rate of 48% (16/33). The average interval from the surgery to membrane rupture was (6.1±5.1) weeks, and the average interval from the surgery to delivery was (10.5±4.1) weeks, with an average gestational age at delivery of (33.7±3.6) weeks. The pregnant women were divided into single Trocar group (27 cases) and double Trocar group (13 cases) based on the surgical approach. The success rates in single Trocar group and double Trocar group were 78% (21/27) and 12/13, respectively, and the difference was not statistically significant (χ2=0.474, P=0.491). The gestational age of delivery in the single Trocar group and double Trocar group was (32.7±3.4) and (35.4±3.2) weeks, respectively, and the difference was statistically significant (t=-2.185, P<0.05). There were no statistically significant differences in the success rate of the surgery, incidence of premature rupture of membranes, interval between surgery and membrane rupture, interval between surgery and delivery, and preterm delivery rate between the two groups (all P>0.05). Conclusions: Fetoscopy could be used for prenatal assessment and intrauterine treatment of ABS. Fetoscopic lysis of amniotic bands may be an effective method for treating ABS, which helps preserve limb function and prevent intrauterine limb amputation and IUFD.
目的： 探讨胎儿镜在羊膜带综合征（ABS）宫内诊断和治疗中的临床应用价值。 方法： 回顾性分析2020年12月至2023年8月于郑州大学第三附属医院行宫内胎儿镜干预的7例ABS胎儿的临床资料。在中国知网、万方、PubMed数据库检索胎儿镜治疗ABS的文献，提取临床资料，总结胎儿镜手术治疗ABS的特点和干预效果。 结果： （1）胎儿镜干预前评估：7例ABS胎儿的诊断孕周为（19.8±4.4）周，干预孕周为（22.2±2.8）周，胎儿镜干预指征包括：脐带受累（3例），肢体羊膜带出现缩窄环（2例），指端显示不清（3例）。（2）妊娠结局：7例ABS胎儿中，4例因胎儿镜检查发现严重宫内截肢或截指选择优生引产；3例行胎儿镜羊膜带松解术，其中1例术后2周发生胎儿宫内死亡（IUFD），2例预后良好。（3）文献复习结果：纳入文献17篇（共37例ABS胎儿），加上本院实施胎儿镜手术治疗的3例，共纳入40例胎儿镜羊膜带松解术，手术指征包括肢体羊膜带伴缩窄环形成、脐带受累，手术成功率82%（33/40），33例手术成功胎儿累及的37例次肢体受累中，78%（29/37）的受累肢体保留了良好的功能。33例手术成功胎儿中，胎膜早破是最主要的并发症，发生率为48%（16/33），手术至胎膜早破的时间间隔为（6.1±5.1）周，手术至分娩的时间间隔（10.5±4.1）周，分娩孕周为（33.7±3.6）周；按手术路径使用穿刺套管（Trocar）数目，分为单Trocar组（27例）与双Trocar组（13例），成功率分别为78%（21/27）、12/13，两组比较，差异无统计学意义（χ2=0.474，P=0.491）；手术成功者的分娩孕周分别为（32.7±3.4）、（35.4±3.2）周，两组比较，差异有统计学意义（t=-2.185，P<0.05），两组的手术成功率、胎膜早破发生率、手术至胎膜早破时间间隔、手术至分娩时间间隔、早产率分别比较，差异均无统计学意义（P均>0.05）。 结论： 胎儿镜可用于ABS的宫内诊断和治疗，胎儿镜羊膜带松解术可能是治疗ABS的有效方法，有助于保留肢体功能、防止宫内截肢和IUFD的发生。.