目前可行宫内胎儿治疗的疾病已逐渐明确,作为治疗对象的环境羊水的存在而限制了治疗的方法和时间。现以胎儿尿路梗阻性疾病为中心阐述胎儿治疗与羊水的关系。 可行和正在探讨的宫内胎儿治疗疾病:(1)因母儿免疫反应引起的胎儿贫血及免疫性胎儿水肿可采用胎儿输血治疗。(2)某些胎儿循环不全:现在认为心动过速型心律失常是本疗法的最佳适应症,而心动过缓型心律失常中部分房室传导阻滞将成为今后本法治疗的疾病。治疗上可经母体、胎盘或胎儿直接给药。另外,双胎间输血综台征及骶尾部畸胎瘤引起的胎儿循环不全可做胎盘血管吻合术、肿瘤切除术。(3)肺发育不全:尿路梗阻性疾病特别是下尿路梗阻是早期妊娠胎儿外科治疗的最佳适应症,即行胎儿膀胱羊膜腔分流术。先天性膈疝可行胎儿疝还纳术。胎儿尿路梗阻性疾病的诊治:(1)胎儿尿路梗阻性疾病的病理改变:胎儿尿路梗阻使胎儿尿不能排入羊膜腔而引起无羊水症,可发生致死性肺发育不全。(2)尿路梗阻性疾病的筛选:孕14～15周胎儿尿开始 Currently available intrauterine fetal treatment of diseases has gradually become clear, as the treatment of environmental amniotic fluid exists to limit the treatment method and time. Fetal urinary tract obstruction disease is now centered on the relationship between fetal treatment and amniotic fluid. Feasible and are explored intrauterine fetal treatment of diseases: (1) due to maternal and fetal immune response caused by fetal anemia and immune fetal edema fetal transfusion can be used. (2) incomplete fetal circulation: Now that the tachycardia arrhythmia is the best indication for this therapy, and bradyarrhythmia part of the atrioventricular block will become the treatment of disease in the future. Treatment can be directly through the mother, placenta or fetus. In addition, twin twins transfusion syndrome and sacrococcygeal teratoma caused by incomplete fetal circulation can be done placental vascular anastomosis, tumor resection. (3) pulmonary hypoplasia: urinary tract obstruction disease, especially lower urinary tract obstruction is the best indication for fetal surgical treatment of early pregnancy, that is, fetal bladder amniotic shunt. Congenital diaphragmatic hernia feasible nanoblast surgery. Fetal urinary tract obstruction disease diagnosis and treatment: (1) fetal urinary tract obstructive disease pathological changes: fetal urinary tract obstruction so that fetal urine can not be discharged into the amniotic cavity caused by no amniotic fluid, can occur fatal lung hypoplasia. (2) screening of urinary tract obstruction disease: 14 to 15 weeks of pregnancy fetus began