胎儿镜下激光凝固胎盘吻合血管术治疗双胎输血综合征33例临床分析  

Fetoscopic guided laser occlusion for twin-to-twin transfusion syndrome in 33 cases

作　　者：刘新秀[1] 刘子建 王慧芳[3] 王秀美[4] 梁德杨[4] 

机构地区：[1]福建医科大学附属第一医院超声影像科,福州350005 [2]香港领峰医务中心 [3]深圳市第二人民医院超声科 [4]香港中文大学威尔斯亲王医院妇产科学系

出　　处：《中华妇产科杂志》2012年第8期587-591,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：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工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Quintem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Quinter0分期I期3例，Ⅱ期14例，Ⅲ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个胎儿宫内死产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“；分娩孕周中位数为31周”；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（350～2520g），受血胎为1930g（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Quintem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。Objective To evaluate the clinical effect of fetoseopie laser occlusion of chorioangiopagous vessels （ FLOC ） for monochorionie diamniotie twins （ MCDA ） pregnancies complicated with twin-to-twin transfusion syndrome（TTTS）. Methods The clinical data of 33 consecutive cases of TTTS from China's Mainland, 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 TITS 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 eases were Quintero staging IU 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 occurred 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 ＋6 weeks; 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,

关 键 词：双胎输血综合征 胎儿镜检查 激光凝固术 血管外科手术 

分 类 号：R714.5[医药卫生—妇产科学]