胎児上咽頭奇形腫に対してEXIT（ex-utero intrapartum treatment）下に気管切開を行った1症例

A Tracheostomy Performed with the Ex-utero Intrapartum Treatment（EXIT）Procedure for a Fetal Nasopharyngeal Teratoma

要旨

　Ex-utero intrapartum treatment（EXIT）とは主に気道閉塞を有する胎児を部分的に娩出し，胎盤血流を維持することで気道確保までの心肺機能を補助する方法である。今回，胎児上咽頭奇形腫に対してEXIT下に気管切開を施行した症例を経験した。術前評価から術中管理まで母体・胎児ともに綿密な麻酔計画を練り，合併症なく手技を完遂した。

　Ex-utero intrapartum treatment（EXIT）is performed mainly for fetuses with airway obstruction, bypassing fetal cardiopulmonary function with umbilical cord blood flow until the obstruction is removed. A 22-year-old pregnant patient presented to our hospital with a nasopharynx teratoma originating from inside the mouth of the fetus and progressing outwards. No other malformation was detected by preoperative magnetic resonance imaging. A fetal tracheotomy using the EXIT procedure was successfully done under maternal general anesthesia at 34 weeks and 5 days of gestation. The anesthetic management, which focused on maintaining uteroplacental function, resulted in a favorable outcome for both the mother and fetus.