中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2014年
7期
490-494
,共5页
张志涛%刘彩霞%尹少尉%栗娜%廖姗姗
張誌濤%劉綵霞%尹少尉%慄娜%廖姍姍
장지도%류채하%윤소위%률나%료산산
双胎疾病%心脏缺损,先天性%导管消融术%妊娠减少,多胎
雙胎疾病%心髒缺損,先天性%導管消融術%妊娠減少,多胎
쌍태질병%심장결손,선천성%도관소융술%임신감소,다태
Diseases in twins%Heart defects,congenital%Catheter ablation%Pregnancy reduction,multifetal
目的：探讨不同期别双胎反向动脉灌注序列征（TRAP）的治疗方法选择及其围产结局。方法收集2012年8月至2013年12月在中国医科大学附属盛京医院母胎医学中心诊断的11例TRAP患者，按TRAP分期Ⅰa期3例，Ⅱa期7例，Ⅱb期1例。3例Ⅰa期患者行期待治疗；7例Ⅱa期患者中，3例行射频消融选择性减胎术，4例行期待治疗[其中1例（例9）进展为Ⅱb期行急诊剖宫产术终止妊娠]；1例Ⅱb期行急诊剖宫产术终止妊娠。除例1、4外所有患者均行剖宫产术终止妊娠。患者出院后随访新生儿的生长发育情况。结果（1）3例TRAPⅠa期患者行动态超声检查，未发现供血儿有异常情况，2例患者的无心胎血流供应自行消失，足月后行剖宫产术终止妊娠；1例于孕30周发生胎膜早破，于34周+5自然分娩一活婴。3例存活新生儿平均出生体质量为2923 g。（2）7例TRAPⅡa期患者中，3例行射频消融选择性减胎术，其中2例新生儿存活，平均分娩孕周35周+1，平均出生体质量2050 g。行期待治疗的3例患者中，1例于34周+5胎膜早破，行剖宫产术终止妊娠；1例行期待治疗3周，超声检查发现供血儿胎死宫内而引产；1例在期待治疗过程中病情进展为Ⅱb期，于34周+5行剖宫产术终止妊娠。1例失访。（3）2例TRAPⅡb期患者中，1例由Ⅱa期进展而来；另1例于孕32周+4就诊时即诊断为TRAPⅡb期，立即行剖宫产术终止妊娠，新生儿于产后第2天死于心功能衰竭。（4）随访存活的7例新生儿，除1例于产后超声检查提示动脉导管未闭、房间隔缺损、体质量小于同龄儿（7个月时6 kg）外，其余存活儿的生长发育指标均达到正常同龄儿水平。结论对TRAP患者应尽早做出诊断，根据分期及孕周不同选择适宜的治疗方案，Ⅰa期患者在动态超声检查中行期待治疗；Ⅱa期患者可行射频消融选择性减胎术，以改善供血儿预后，可获得较好的围产结局。
目的：探討不同期彆雙胎反嚮動脈灌註序列徵（TRAP）的治療方法選擇及其圍產結跼。方法收集2012年8月至2013年12月在中國醫科大學附屬盛京醫院母胎醫學中心診斷的11例TRAP患者，按TRAP分期Ⅰa期3例，Ⅱa期7例，Ⅱb期1例。3例Ⅰa期患者行期待治療；7例Ⅱa期患者中，3例行射頻消融選擇性減胎術，4例行期待治療[其中1例（例9）進展為Ⅱb期行急診剖宮產術終止妊娠]；1例Ⅱb期行急診剖宮產術終止妊娠。除例1、4外所有患者均行剖宮產術終止妊娠。患者齣院後隨訪新生兒的生長髮育情況。結果（1）3例TRAPⅠa期患者行動態超聲檢查，未髮現供血兒有異常情況，2例患者的無心胎血流供應自行消失，足月後行剖宮產術終止妊娠；1例于孕30週髮生胎膜早破，于34週+5自然分娩一活嬰。3例存活新生兒平均齣生體質量為2923 g。（2）7例TRAPⅡa期患者中，3例行射頻消融選擇性減胎術，其中2例新生兒存活，平均分娩孕週35週+1，平均齣生體質量2050 g。行期待治療的3例患者中，1例于34週+5胎膜早破，行剖宮產術終止妊娠；1例行期待治療3週，超聲檢查髮現供血兒胎死宮內而引產；1例在期待治療過程中病情進展為Ⅱb期，于34週+5行剖宮產術終止妊娠。1例失訪。（3）2例TRAPⅡb期患者中，1例由Ⅱa期進展而來；另1例于孕32週+4就診時即診斷為TRAPⅡb期，立即行剖宮產術終止妊娠，新生兒于產後第2天死于心功能衰竭。（4）隨訪存活的7例新生兒，除1例于產後超聲檢查提示動脈導管未閉、房間隔缺損、體質量小于同齡兒（7箇月時6 kg）外，其餘存活兒的生長髮育指標均達到正常同齡兒水平。結論對TRAP患者應儘早做齣診斷，根據分期及孕週不同選擇適宜的治療方案，Ⅰa期患者在動態超聲檢查中行期待治療；Ⅱa期患者可行射頻消融選擇性減胎術，以改善供血兒預後，可穫得較好的圍產結跼。
목적：탐토불동기별쌍태반향동맥관주서렬정（TRAP）적치료방법선택급기위산결국。방법수집2012년8월지2013년12월재중국의과대학부속성경의원모태의학중심진단적11례TRAP환자，안TRAP분기Ⅰa기3례，Ⅱa기7례，Ⅱb기1례。3례Ⅰa기환자행기대치료；7례Ⅱa기환자중，3례행사빈소융선택성감태술，4례행기대치료[기중1례（례9）진전위Ⅱb기행급진부궁산술종지임신]；1례Ⅱb기행급진부궁산술종지임신。제례1、4외소유환자균행부궁산술종지임신。환자출원후수방신생인적생장발육정황。결과（1）3례TRAPⅠa기환자행동태초성검사，미발현공혈인유이상정황，2례환자적무심태혈류공응자행소실，족월후행부궁산술종지임신；1례우잉30주발생태막조파，우34주+5자연분면일활영。3례존활신생인평균출생체질량위2923 g。（2）7례TRAPⅡa기환자중，3례행사빈소융선택성감태술，기중2례신생인존활，평균분면잉주35주+1，평균출생체질량2050 g。행기대치료적3례환자중，1례우34주+5태막조파，행부궁산술종지임신；1례행기대치료3주，초성검사발현공혈인태사궁내이인산；1례재기대치료과정중병정진전위Ⅱb기，우34주+5행부궁산술종지임신。1례실방。（3）2례TRAPⅡb기환자중，1례유Ⅱa기진전이래；령1례우잉32주+4취진시즉진단위TRAPⅡb기，립즉행부궁산술종지임신，신생인우산후제2천사우심공능쇠갈。（4）수방존활적7례신생인，제1례우산후초성검사제시동맥도관미폐、방간격결손、체질량소우동령인（7개월시6 kg）외，기여존활인적생장발육지표균체도정상동령인수평。결론대TRAP환자응진조주출진단，근거분기급잉주불동선택괄의적치료방안，Ⅰa기환자재동태초성검사중행기대치료；Ⅱa기환자가행사빈소융선택성감태술，이개선공혈인예후，가획득교호적위산결국。
Objective To discuss the methods and outcomes of twin reversed arterial perfusion sequence in different stage. Methods From August 2012 to December 2013, 11 cases were diagnosed with twin reversed arterial perfusion sequence (TRAP) by 3d color Doppler ultrasound in the Maternal ang Fetal Medicine Center ,Affiliated Shengjing Hospital, China Medical University, including 3 cases in stageⅠa, 7 in stageⅡa and 1 case in stageⅡb. We performed expected therapy to 3 cases in stageⅠa and 4 cases in stageⅡa [1 case (case 9) in stageⅡa developed to stageⅡb and was terminated by emergency cesarean section], radio frequency ablation (RFA) selective reduction to 3 cases in stage Ⅱa, emergency cesarean section to 1 case in stageⅡb. All cases except case 1,4 took cesarean section to terminate pregnancy and would be followed up on the aspect of infant′s growth. Results (1) 3 cases in stageⅠa were monitored by sequential ultrasound examination, all donors grew normally, in which 2 acardias arised spontaneous cessation of flow and were implemented of cesarean section after the normal period of gestation; 1 case suffered premature rupture of membrane and experienced the natural childbirth at 34 gestation weeks plus 5 days. The survived average labor weight was 2 923 g. (2) In the 7 stage Ⅱa cases, 3 cases were implemented of RFA selective reduction, 2 cases survived and the average labor gestation was 35 weeks plus 1 day and average labor weight was 2 050 g;in 3 expected therapy cases, 1 case suffered premature rupture of membrane at 34 gestation weeks plus 5 days and experienced cesarean section; 1 case was observed for 3 weeks and the donor was stillborn; 1 case progressed to stage Ⅱb and experienced cesarean section at 34 gestation weeks plus 5 days;and 1 case was lost of follow up. (3) For 2 cases of stageⅡb cases, one was progressed from stage Ⅱa during expected therapy; the other one had been already in stage Ⅱb since visiting and experimented an emergency cesarean section, but the neonate died of heart failure two days after labor. (4) 7 survived neonates were followed up, all had a normal condition compared to kids of the same age, except one suffering a congenital heart disease, patent ductus arteriosus and atrial septal defect and whose weight (6 kg at 7 months) was lighter. Conclusions We should make the diagnosis of TRAP as early as soon and choose appropriate therapy according to the stage. According to our research, cases in stage Ⅰa can undergo an expected therapy under a sequential ultrasound examination;cases in stageⅡa can undergo a RFA selective reduction to improve the prognosis of the donor, which can make a good perinatal outcome.
