中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
8期
587-591
,共5页
刘新秀%刘子建%王慧芳%王秀美%梁德杨
劉新秀%劉子建%王慧芳%王秀美%樑德楊
류신수%류자건%왕혜방%왕수미%량덕양
双胎输血综合征%胎儿镜检查%激光凝固术%血管外科手术
雙胎輸血綜閤徵%胎兒鏡檢查%激光凝固術%血管外科手術
쌍태수혈종합정%태인경검사%격광응고술%혈관외과수술
Fetofetal transfusion%Fetoscopy%Laser coagulation%Vascular surgical procedures
目的 探讨胎儿镜下激光凝固胎盘吻合血管术( FLOC)治疗单绒毛膜双羊膜囊双胎(MCDA)并发双胎输血综合征(TTTS)的临床效果.方法 收集2003年11月-2010年12月香港中文大学威尔斯亲王医院妇产科学系胎儿医学组收治的来自内地的33例TTTS孕妇的临床资料,按Quintero分期标准进行分期,并分析实施FLOC时术中和术后的并发症,随访其妊娠结局及胎儿存活情况.结果 (1) FLOC时孕周及Quintero分期:33例TTTS孕妇的平均年龄为30岁,行FLOC时孕周中位数是23周+4,按Quintero分期Ⅰ期3例,Ⅱ期14例,m期7例,Ⅳ期9例.其中Ⅰ期的手术指征为受血胎儿出现非常严重的心功能不全1例和重度羊水过多2例.(2)并发症:术中并发症5例,其中穿刺点宫腔内出血4例,较大的胎盘吻合血管破裂出血1例；术后并发症6例,其中术后1周内流产2例,1周内1个胎儿宫内死亡1例,术后2～4周流产2例,术后2～4周发生羊膜带综合征1例.(3)妊娠结局及胎儿存活率:33例孕妇行FLOC治疗至分娩的间隔时间中位数为9周+4；分娩孕周中位数为31周+6；分娩孕周＜24周者为6％( 2/33),24～28周者为21％ (7/33),28 ～ 32周者为18％(6/33),32 ～37周者为55％(18/33).出生体质量供血胎为1600g(350～2520 g),受血胎为1930 g(400～3040g)；胎儿整体存活率为59％( 39/66),双胎存活率为52％(17/33),单胎存活率为15％(5/33),至少1胎存活率为67％(22/33).整体胎儿存活率从Quintero分期Ⅱ期的61％(17/28)下降到Ⅳ期的9/18.结论 FLOC治疗MCDA并发TTTS的临床效果良好,可将胎儿整体存活率提升到接近60％,至少1胎存活率则更高,且严重并发症少；TTTS孕妇的妊娠结局除与Quintero期别有关外,还与FLOC后严密监测和管理、适时终止妊娠有关.
目的 探討胎兒鏡下激光凝固胎盤吻閤血管術( FLOC)治療單絨毛膜雙羊膜囊雙胎(MCDA)併髮雙胎輸血綜閤徵(TTTS)的臨床效果.方法 收集2003年11月-2010年12月香港中文大學威爾斯親王醫院婦產科學繫胎兒醫學組收治的來自內地的33例TTTS孕婦的臨床資料,按Quintero分期標準進行分期,併分析實施FLOC時術中和術後的併髮癥,隨訪其妊娠結跼及胎兒存活情況.結果 (1) FLOC時孕週及Quintero分期:33例TTTS孕婦的平均年齡為30歲,行FLOC時孕週中位數是23週+4,按Quintero分期Ⅰ期3例,Ⅱ期14例,m期7例,Ⅳ期9例.其中Ⅰ期的手術指徵為受血胎兒齣現非常嚴重的心功能不全1例和重度羊水過多2例.(2)併髮癥:術中併髮癥5例,其中穿刺點宮腔內齣血4例,較大的胎盤吻閤血管破裂齣血1例；術後併髮癥6例,其中術後1週內流產2例,1週內1箇胎兒宮內死亡1例,術後2～4週流產2例,術後2～4週髮生羊膜帶綜閤徵1例.(3)妊娠結跼及胎兒存活率:33例孕婦行FLOC治療至分娩的間隔時間中位數為9週+4；分娩孕週中位數為31週+6；分娩孕週＜24週者為6％( 2/33),24～28週者為21％ (7/33),28 ～ 32週者為18％(6/33),32 ～37週者為55％(18/33).齣生體質量供血胎為1600g(350～2520 g),受血胎為1930 g(400～3040g)；胎兒整體存活率為59％( 39/66),雙胎存活率為52％(17/33),單胎存活率為15％(5/33),至少1胎存活率為67％(22/33).整體胎兒存活率從Quintero分期Ⅱ期的61％(17/28)下降到Ⅳ期的9/18.結論 FLOC治療MCDA併髮TTTS的臨床效果良好,可將胎兒整體存活率提升到接近60％,至少1胎存活率則更高,且嚴重併髮癥少；TTTS孕婦的妊娠結跼除與Quintero期彆有關外,還與FLOC後嚴密鑑測和管理、適時終止妊娠有關.
목적 탐토태인경하격광응고태반문합혈관술( FLOC)치료단융모막쌍양막낭쌍태(MCDA)병발쌍태수혈종합정(TTTS)적림상효과.방법 수집2003년11월-2010년12월향항중문대학위이사친왕의원부산과학계태인의학조수치적래자내지적33례TTTS잉부적림상자료,안Quintero분기표준진행분기,병분석실시FLOC시술중화술후적병발증,수방기임신결국급태인존활정황.결과 (1) FLOC시잉주급Quintero분기:33례TTTS잉부적평균년령위30세,행FLOC시잉주중위수시23주+4,안Quintero분기Ⅰ기3례,Ⅱ기14례,m기7례,Ⅳ기9례.기중Ⅰ기적수술지정위수혈태인출현비상엄중적심공능불전1례화중도양수과다2례.(2)병발증:술중병발증5례,기중천자점궁강내출혈4례,교대적태반문합혈관파렬출혈1례；술후병발증6례,기중술후1주내유산2례,1주내1개태인궁내사망1례,술후2～4주유산2례,술후2～4주발생양막대종합정1례.(3)임신결국급태인존활솔:33례잉부행FLOC치료지분면적간격시간중위수위9주+4；분면잉주중위수위31주+6；분면잉주＜24주자위6％( 2/33),24～28주자위21％ (7/33),28 ～ 32주자위18％(6/33),32 ～37주자위55％(18/33).출생체질량공혈태위1600g(350～2520 g),수혈태위1930 g(400～3040g)；태인정체존활솔위59％( 39/66),쌍태존활솔위52％(17/33),단태존활솔위15％(5/33),지소1태존활솔위67％(22/33).정체태인존활솔종Quintero분기Ⅱ기적61％(17/28)하강도Ⅳ기적9/18.결론 FLOC치료MCDA병발TTTS적림상효과량호,가장태인정체존활솔제승도접근60％,지소1태존활솔칙경고,차엄중병발증소；TTTS잉부적임신결국제여Quintero기별유관외,환여FLOC후엄밀감측화관리、괄시종지임신유관.
Objective To evaluate the clinical effect of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) for monochorionic diamniotic twins ( MCDA ) pregnancies complicated with twin-to-twin transfusion syndrome(TTTS).Methods The clinical data of 33 consecutive cases of TTTS from Mainland China,who had FLOC in the Department of Obstetrics and Gynaecology of Prince of Wales Hospital (The Chinese University of Hong Kong) from November 2003 to December 2010,were reviewed and analyzed for peri-operative complications,perinatal outcomes and fetal survival rate.Clinical stage of TTTS was according to the Quintero staging system.Results ( 1 ) Pregnancy characteristics:the mean maternal age was 30; the median gestational age at FLOC was 23+4 weeks;according to the Quintero staging system,3 cases were Quintero staging Ⅰ,14 cases were Quintero staging Ⅱ,7 cases were Quintero staging Ⅲ and 9 cases were Quintero staging Ⅳ.For the 3 stage Ⅰ cases,FLOC was performed for severe maternal symptoms of polyhyramnios or severe fetal cardiac dysfunction. (2) Complications:intraoperative complications occurred in 5 patients including four uterine bleedings at the puncture site,one placental vascular anastomosis bleeding.Postoperative complications occurred in 6 patients including 2 abortions and 1 intrauterine death within one week after operation,2 abortions and 1 amniotic band syndrome oceurred from two to four weeks after operation. (3) Perinatal outcome and fetal survival rate:the median interval of 33 patients between FLOC and delivery was 9+4 weeks; the median gestational age at delivery was 31 +6weeks; the gestation at delivery was less than 24 weeks in 6％ (2/33),24 to 28 weeks in 21％ (7/33),28 to 32 weeks in 18％ (6/33),32 to 37 weeks in 55％ ( 18/33 ).The mean birth weight of the donor was 1600 g (350- 2520 g); the mean birth weight of the recipiert was 1930 g (400-3040 g).The overall survival rate,the double infant survival rate,the single survival rate and survival rate for at least one twin was 59％ ( 39/66 ),52％ ( 17/33 ),15％ ( 5/33 ) and 67％ ( 22/33 ),respectively.The overall survival rate dropped from 61％ (17/28) in Quintero staging Ⅱ to 9/18 in Quintero staging Ⅳ.Conclusions FLOC for MCDA complicated with TTTS is associated with an overall survival of about 60％.Major complications are rare.The outcome is not only related to Quintero staging but also the close monitoring and timely termination of pregnancy.
