CAJ | 학술논문

目的通过分析双胎妊娠产前诊断结果及妊娠结局,探讨双胎介入性产前诊断技术的有效性及安全性.方法超声介导下对有各种产前诊断指征的164例双胎妊娠行介入性产前诊断操作,包括羊膜腔穿刺(简称羊穿)111例、脐带穿刺(简称脐穿)53例,分析产前诊断结果,追踪术后并发症及妊娠结局.率的比较采用x2检验或Fisher精确概率法.结果 (1)共261个胎儿行染色体检查,染色体异常检出率为6.13%(16/261).(2)羊穿组与脐穿组的术后2周内胎儿丢失率分别为0.00%(0/191)、3.85%(3/78),P=0.024;总的胎儿丢失率分别为3.87%(6/155)和5.45%(3/55),P=0.618;早产率分别为51.22%(42/82)和38.71%(12/31),P=0.235.(3)产前诊断后18例双胎行选择性减胎术,其中2例自然流产,1例早产儿死亡,余15例均获一健康活婴.结论 (1)介入性产前诊断技术在双胎妊娠中有效可行,羊穿相对安全、简单,脐穿操作难度大、风险稍高.(2)双胎妊娠产前诊断后的中孕期选择性减胎术仍然是安全的,应根据其绒毛膜性质和胎儿异常的情况,选择合适的减胎方式.
목적 통과분석쌍태임신산전진단결과 급임신결국,탐토쌍태개입성산전진단기술적유효성급안전성.방법 초성개도하대유각충산전진단지정적164례쌍태임신행개입성산전진단조작,포괄양막강천자(간칭양천)111례、제대천자(간칭제천)53례,분석산전진단결과,추종술후병발증급임신결국.솔적비교채용x2검험혹Fisher정학개솔법.결과 (1)공261개태인행염색체검사,염색체이상검출솔위6.13%(16/261).(2)양천조여제천조적술후2주내태인주실솔분별위0.00%(0/191)、3.85%(3/78),P=0.024;총적태인주실솔분별위3.87%(6/155)화5.45%(3/55),P=0.618;조산솔분별위51.22%(42/82)화38.71%(12/31),P=0.235.(3)산전진단후18례쌍태행선택성감태술,기중2례자연유산,1례조산인사망,여15례균획일건강활영.결론 (1)개입성산전진단기술재쌍태임신중유효가행,양천상대안전、간단,제천조작난도대、풍험초고.(2)쌍태임신산전진단후적중잉기선택성감태술잉연시안전적,응근거기융모막성질화태인이상적정황,선택합괄적감태방식.
Objective To evaluate the effectiveness and safety of invasive procedures of prenatal diagnosis for twin gestations through analysing the results and outcomes of twins.Methods Invasive prenatal diagnostic procedures guided by ultrasound were introduced to 164 twin pregnancies with various indications,including 111 amniocentesis,and 53 cordocentesis.The results of prenatal diagnosis,complications and outcomes of these twins were analyzed with Chi-square test or Fisher's exact test.Results (1) Chromosome was examined in 261 fetuses and 6.13% (16/261)had abnormal karyotypes.(2) Comparing amniocentesis with cordocentesis,the fetal loss rate within two weeks after the procedure were 0.00% (0/191) and 3.85% (3/78),respectively (P=0.024).The total fetal loss rate and preterm delivery rates in amniocentesis and cordocentesis group were 3.87% (6/155) and 5.45% (3/55),51.22% (42/82)and 38.71% (12/31),respectively (P=0.235and 0.618).(3) Selective feticide was performed on 18 cases after prenatal diagnosis.Fifteen cases had survival neonates,two cases suffered from spontaneous abortion,and two cases had preterm labor with neonatal death.Conclusions (1) Invasive prenatal diagnostic procedures are effective and feasible in twins.Amniocentesis is a relative safer and simpler alternative to cordocentesis,which demanding higher skill and carrying higher fetal loss rate.(2) Mid-trimester selective feticide after prenatal diagnosis appears safety.Before the procedure,the chorionicity and fetal condition should be considered,in order to choose suitable feticide procedures.