CAJ | 학술논문

目的探讨选择性胎儿镜下激光凝固(FLP)术治疗双胎输血综合征(TTTS)的临床效果和围产儿结局.方法回顾性分析2012年1月-2013年8月同济大学附属第一妇婴保健院胎儿医学中心行选择性FLP术治疗的33例TTTS患者的临床资料,观察围手术期母儿并发症及围产儿结局.对部分患者分娩后的胎盘进行灌注检查并观察其结果.结果 (1)33例TTTS患者行胎儿镜下选择性FLP术的平均孕周为(22.0±2.3)周,平均手术时间为(86±32) min,平均分娩孕周为33周+6,手术至分娩的时间平均为(9±5)周.(2)33例患者的胎儿总存活率为70％ (46/66);其中两胎均存活17例,两胎存活率为52％(17/33),仅一胎存活12例,仅一胎存活率为36％ (12/33),至少一胎存活29例,至少一胎存活率为88％(29/33).供血儿存活21例(64％,21/33),平均出生体质量为(1 805 ±523)g;受血儿存活25例(76％,25/33),平均出生体质量为(2 214±600)g.(3)TTTS分期Ⅰ期4例,至少一胎存活4例,胎儿总存活率为7/8;Ⅱ期9例,至少一胎存活7例,胎儿总存活率为12/18;Ⅲ期11例,至少一胎存活10例,胎儿总存活率为68％(15/22);Ⅳ期9例,至少一胎存活8例,胎儿总存活率为12/18.(4)选择性FLP术后有4例孕妇发生两胎均丢失;3例胎儿发生特殊并发症,其中2例为双胎贫血红细胞增多序列征(TAPS);2例孕妇术后3周内发生胎膜早破.(5)对7例患者进行分娩后胎盘灌注检查结果显示,6例未见残留血管吻合支,仅1例存在残留胎盘血管吻合支.结论选择性FLP术治疗TTTS临床效果可靠,能显著提高围产儿的存活率,明显改善围产儿结局;同时,伴发的母体并发症较少.
목적 탐토선택성태인경하격광응고(FLP)술치료쌍태수혈종합정(TTTS)적림상효과화위산인결국.방법 회고성분석2012년1월-2013년8월동제대학부속제일부영보건원태인의학중심행선택성FLP술치료적33례TTTS환자적림상자료,관찰위수술기모인병발증급위산인결국.대부분환자분면후적태반진행관주검사병관찰기결과.결과 (1)33례TTTS환자행태인경하선택성FLP술적평균잉주위(22.0±2.3)주,평균수술시간위(86±32) min,평균분면잉주위33주+6,수술지분면적시간평균위(9±5)주.(2)33례환자적태인총존활솔위70％ (46/66);기중량태균존활17례,량태존활솔위52％(17/33),부일태존활12례,부일태존활솔위36％ (12/33),지소일태존활29례,지소일태존활솔위88％(29/33).공혈인존활21례(64％,21/33),평균출생체질량위(1 805 ±523)g;수혈인존활25례(76％,25/33),평균출생체질량위(2 214±600)g.(3)TTTS분기Ⅰ기4례,지소일태존활4례,태인총존활솔위7/8;Ⅱ기9례,지소일태존활7례,태인총존활솔위12/18;Ⅲ기11례,지소일태존활10례,태인총존활솔위68％(15/22);Ⅳ기9례,지소일태존활8례,태인총존활솔위12/18.(4)선택성FLP술후유4례잉부발생량태균주실;3례태인발생특수병발증,기중2례위쌍태빈혈홍세포증다서렬정(TAPS);2례잉부술후3주내발생태막조파.(5)대7례환자진행분면후태반관주검사결과현시,6례미견잔류혈관문합지,부1례존재잔류태반혈관문합지.결론 선택성FLP술치료TTTS림상효과가고,능현저제고위산인적존활솔,명현개선위산인결국;동시,반발적모체병발증교소.
Objective To evaluate pregnancy outcomes after selective fetoscopic laser photocoagulation (SFLP) for twin-to-twin transfusion syndrome (TTTS).Methods A total of 33 cases of TTTS were treated by SFLP in Shanghai First Maternity and Infant Hospital from January 2012 to August 2013.Clinical data on perinatal outcomes,fetaland maternalcomplicationswere recorded and retrospectively analyzed.Results (1) The mean gestational age for SFLP was (22.0 ± 2.3) weeks,the mean time for SFLP was (86 ± 32) minutes,the mean gestational age for delivery was 33 +6 weeks,the gestational age between SFLP and delivery was (9 ± 5) weeks.(2) The perinatal survival rate 28 days after the delivery was 70％ (46/66).The survival rate was 52％ (17/33) for both twins,36％ (12/33) for one twin,88％ (29/33) for at least one twin.Of all the survival twins,there were 21 donor twins (64％,21/33) with the mean birth weight at delivery was (1 805 ± 523) g and 25 recipient twins (76％,25/33) with the mean birth weight (2 214 ±600) g.(3) There were 4 cases at TTTS stage Ⅰ,9 at TTTS stage Ⅱ,11 at TTTS stage Ⅲ,9 at TTTS stage Ⅳ ;the survival number for at least one twin was 4,7,10,8 respectively; the total survival rate was 7/8,12/18,68％ (15/22),12/18 respectively.(4) Four cases had both twins demises.3 fetuses had special fetal complications with 2 of them developing twin anemia-polycythemia sequence (TAPS).Two cases had preterm premature rupture of membrane (PPROM) within 3 weeks after SFLP.(5)Placental injections were performed in 7 cases with SFLP after delivery.Residual anastomosis was identified in one case.Conclusion As an emerging center,our study demonstrated favorable fetal outcomes with less maternal complications after SFLP for TTTS.