中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
17期
1323-1327
,共5页
王学举%魏瑗%原鹏波%赵扬玉
王學舉%魏瑗%原鵬波%趙颺玉
왕학거%위원%원붕파%조양옥
动脉静脉吻合%双胎输血综合征%胎盘%双胎妊娠
動脈靜脈吻閤%雙胎輸血綜閤徵%胎盤%雙胎妊娠
동맥정맥문합%쌍태수혈종합정%태반%쌍태임신
Arteriovenous anastomosis%Fetofetal transfusion%Placenta%Pregnancy,twin
目的 通过对单绒毛膜双胎胎盘浅表吻合血管、胎盘份额、脐带附着位置的比较,探讨双胎输血综合征胎盘(TTTS)结构的特点.方法 收集2013年6月至2014年6月于北京大学第三医院终止妊娠后确定的单绒毛膜双胎共97例,剔除分娩后胎盘破损或孕期行胎儿镜激光治疗的胎盘18例,共取得79例孕期未行胎儿镜激光治疗且分娩后完整保存的胎盘,对该79例胎盘行浅表血管灌注.剔除选择性官内生长受限(sIUGR)胎盘23例,对TTTS胎盘24例和无并发症单绒毛膜双胎(未发生TTTS、sIUGR等复杂性双胎妊娠)胎盘32例进行比较研究.结果 (1)TTTS组胎盘A-A吻合血管发生率较无并发症组显著降低(37.5％比75.0％,P＜0.01),差异有统计学意义.两组之间A-V吻合血管发生率(87.5％比71.9％,P＞0.05)、V-V吻合血管发生率(20.8％比15.6％,P＞0.05)差异无统计学意义.(2)A-A吻合血管数目在TTTS组明显少于无并发症组(0.0比1.0,P＜0.01),A-A吻合血管直径总和在TTTS组明显低于无并发症组(0.00 mm比2.25 mm,P＜0.01),差异均有统计学意义.(3)两组之间脐带非中央附着发生率(70.8％比62.5％,P＞0.05)、脐带帆状附着(25.0％比6.3％,P ＞0.05)及胎盘面积差额比(0.33比0.22,P＞0.05),差异无统计学意义.结论 动脉—动脉吻合血管可能是单绒毛膜双胎免于TTTS的保护因素,缺少动脉—动脉吻合血管的单绒毛膜双胎,孕期发生TTTS风险明显增高.不同胎盘动脉—动脉吻合血管的代偿能力可能决定了TTTS发病的时间早晚.胎盘分割不均、脐带非中央附着和帆状附着都不是TTTS发病的危险因素.
目的 通過對單絨毛膜雙胎胎盤淺錶吻閤血管、胎盤份額、臍帶附著位置的比較,探討雙胎輸血綜閤徵胎盤(TTTS)結構的特點.方法 收集2013年6月至2014年6月于北京大學第三醫院終止妊娠後確定的單絨毛膜雙胎共97例,剔除分娩後胎盤破損或孕期行胎兒鏡激光治療的胎盤18例,共取得79例孕期未行胎兒鏡激光治療且分娩後完整保存的胎盤,對該79例胎盤行淺錶血管灌註.剔除選擇性官內生長受限(sIUGR)胎盤23例,對TTTS胎盤24例和無併髮癥單絨毛膜雙胎(未髮生TTTS、sIUGR等複雜性雙胎妊娠)胎盤32例進行比較研究.結果 (1)TTTS組胎盤A-A吻閤血管髮生率較無併髮癥組顯著降低(37.5％比75.0％,P＜0.01),差異有統計學意義.兩組之間A-V吻閤血管髮生率(87.5％比71.9％,P＞0.05)、V-V吻閤血管髮生率(20.8％比15.6％,P＞0.05)差異無統計學意義.(2)A-A吻閤血管數目在TTTS組明顯少于無併髮癥組(0.0比1.0,P＜0.01),A-A吻閤血管直徑總和在TTTS組明顯低于無併髮癥組(0.00 mm比2.25 mm,P＜0.01),差異均有統計學意義.(3)兩組之間臍帶非中央附著髮生率(70.8％比62.5％,P＞0.05)、臍帶帆狀附著(25.0％比6.3％,P ＞0.05)及胎盤麵積差額比(0.33比0.22,P＞0.05),差異無統計學意義.結論 動脈—動脈吻閤血管可能是單絨毛膜雙胎免于TTTS的保護因素,缺少動脈—動脈吻閤血管的單絨毛膜雙胎,孕期髮生TTTS風險明顯增高.不同胎盤動脈—動脈吻閤血管的代償能力可能決定瞭TTTS髮病的時間早晚.胎盤分割不均、臍帶非中央附著和帆狀附著都不是TTTS髮病的危險因素.
목적 통과대단융모막쌍태태반천표문합혈관、태반빈액、제대부착위치적비교,탐토쌍태수혈종합정태반(TTTS)결구적특점.방법 수집2013년6월지2014년6월우북경대학제삼의원종지임신후학정적단융모막쌍태공97례,척제분면후태반파손혹잉기행태인경격광치료적태반18례,공취득79례잉기미행태인경격광치료차분면후완정보존적태반,대해79례태반행천표혈관관주.척제선택성관내생장수한(sIUGR)태반23례,대TTTS태반24례화무병발증단융모막쌍태(미발생TTTS、sIUGR등복잡성쌍태임신)태반32례진행비교연구.결과 (1)TTTS조태반A-A문합혈관발생솔교무병발증조현저강저(37.5％비75.0％,P＜0.01),차이유통계학의의.량조지간A-V문합혈관발생솔(87.5％비71.9％,P＞0.05)、V-V문합혈관발생솔(20.8％비15.6％,P＞0.05)차이무통계학의의.(2)A-A문합혈관수목재TTTS조명현소우무병발증조(0.0비1.0,P＜0.01),A-A문합혈관직경총화재TTTS조명현저우무병발증조(0.00 mm비2.25 mm,P＜0.01),차이균유통계학의의.(3)량조지간제대비중앙부착발생솔(70.8％비62.5％,P＞0.05)、제대범상부착(25.0％비6.3％,P ＞0.05)급태반면적차액비(0.33비0.22,P＞0.05),차이무통계학의의.결론 동맥—동맥문합혈관가능시단융모막쌍태면우TTTS적보호인소,결소동맥—동맥문합혈관적단융모막쌍태,잉기발생TTTS풍험명현증고.불동태반동맥—동맥문합혈관적대상능력가능결정료TTTS발병적시간조만.태반분할불균、제대비중앙부착화범상부착도불시TTTS발병적위험인소.
Objective To explore the prevalence,number and size of anastomoses,placenta sharing and placental cord insertion in twin-to-twin transfusion syndrome (TTTS).Methods A total of 97 monochorionic placentas were collected from June 2013 to June 2014 during fetoscopic laser surgery or selective feticide.After eliminating 23 placentas of selective intrauterine growth restriction (sIUGR),79 placents were analyzed.There were 24 placentas of TTTS and 32 placentas of normal monochorionic twins (McT) without complex twin preganancy.Placental sharing,placental cord insertion,angioarchitecture and diameter of vascular anastomosis were assessed by placental injection with colored dye and compared between TTTS and McT without complex twin preganancy.Results (1) Arterio-arterial (AA) anastomoses were detected in 37.5 ％ of TTTS placentas versus 75.0％ in normal McT placentas (P ＜ 0.01).(2) The median number of AA anastomoses in TTTS group was significantly less than that in normal group (0.0 vs 1.0,P ＜ 0.01).And the median total diameter of AA anastomoses in TTTS group was significantly smaller than that in normal group (0.00 vs 2.25 mm,P ＜0.01).(3) The incidence of placentas with at least one cord noncentral insertion (70.8 ％ vs 62.5 ％,P ＞ 0.05),velamentous insertion (25.0％ vs 6.3 ％,P ＞ 0.05) in TTTS and normal McT had no difference respectively.The placental territory discordance (PTD) had no difference between TTTS and normal McT (0.33 vs 0.22,P ＞0.05).Conclusion AA anastomosis occurs less frequently in TTTS placentas,supporting the concept of a protective role of AA anastomoses in TTTS.McT placentas without AA anastomosis have high risk for TTTS.The compensatory ablitiy of AA anastomosis may determine the time of TTTS onset.Non-central or velamentous cord insertion,placental sharing discordance are not risk factors for TTTS.
