胎儿镜下胎盘血管交通支凝固术治疗双胎输血综合征6例临床分析  

Retrospective analysis of fetoscopic photocoagulation of communicating placental vessels of twin-twin transfusion syndrome

作　　者：李俊男[1] 梁志清[1] 陈功立[1] 管唯靓[1] 胡华[1] 陈诚[1] 蒋凤[1] 余美佳[1] 常青[1] 王琳[1] 葛晓冬[2] 张晓航[3] 蔡萍[4] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038 [2]第三军医大学西南医院病理研究所,重庆400038 [3]第三军医大学西南医院超声科,重庆400038 [4]第三军医大学西南医院放射科,重庆400038

出　　处：《第三军医大学学报》2009年第22期2281-2283,共3页Journal of Third Military Medical University

摘　　要：目的探讨胎儿镜下胎盘血管交通支凝固术(选择性或非选择性)治疗双胎输血综合征(twin-twin transfusionsyndrome,TTTS)对围生结局的影响。方法6例TTTS接受胎儿镜下胎盘血管交通支凝固术治疗,在实时超声引导下,直径3mm胎儿镜经孕妇腹壁进入羊水过多的受血儿羊膜腔,在胎儿镜下找到胎盘血管交通支,采用Nd:YAG激光光纤或双极电凝凝固血管交通支。结果6位母亲均能耐受手术过程,没有严重的并发症发生。至少有1胎存活率50%(3/6),双胎儿存活率为33.33%(2/6),胎儿总存活率41.6%(5/12)。结论胎儿镜下胎盘血管交通支凝固术治疗TTTS能提高围生儿的存活率。Objective To investigate the effect of fetoscopic photocoagulation of communicating placental vessels in twin-twin transfusion syndrome（TTTS）（selective or non-selective） on the perinatal outcomes.Methods Six cases of TTTS admitted in our department from Dec.2006 to Jun.2008 underwent fetoscopic photocoagulation of communicating vessels.Under direct real-time sonographic guidance,a 3-mm-diameter fetoscope was percutaneously inserted through the maternal abdominal wall into the amniotic cavity of the recipient twin. A combination of ultrasonographic and fetoscopic vision was used to identify the crossing vessels which were systematically coagulated using Nd ：YAG laser fiber or bipolar electrocoagulation. Results All the 6 mothers tolerated the procedure without major complications. Two fetal survival rate was 33.33%. Conclusion Feto scopic photocoagulation of communicating placental vessels in TFFS can effectively improve perinatal outcomes.

关 键 词：双胎输血综合征 单绒毛膜双胎 胎儿镜下胎盘血管交通支凝固术 

分 类 号：R616[医药卫生—外科学] R714.43[医药卫生—临床医学]