射频消融选择性减胎术处理复杂性多胎妊娠的安全性及有效性  

Safety and efficiency of radiofrequency fetal ablation in the treatment of complicated multiple gestations

作　　者：李红燕[1] 王谢桐[1] 梁波[2] 李磊[1] 

机构地区：[1]山东大学附属省立医院产科,济南250021 [2]山东大学附属省立医院超声诊疗中心,济南250021

出　　处：《中华妇产科杂志》2012年第12期905-909,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨射频消融选择性减胎术处理复杂性多胎妊娠的安全性及有效性。方法2011年7月至2012年3月在山东大学附属省立医院产科就诊的6例多胎妊娠孕妇，其中双胎输血综合征（ms）Ⅳ期2例，双胎之一为无心畸形儿1例，双绒毛膜三羊膜囊三胎1例，双胎中1个胎儿下肢缺如1例，双胎之一发生选择性宫内生长受限（sFGR）1例。6例孕周为14周”一27周“，在超声监视下行射频消融选择性减胎术。结果（1）3例被减胎儿在射频消融术1个加热循环后血流停止，3例被减胎儿在2个加热循环后血流停止。1例在射频消融术后10min内血流停止；3例被减胎儿在术后心跳逐渐减慢，35min后心跳完全消失；2例被减胎儿在术后心跳减慢，3—7min后心跳完全消失。6例孕妇的保留胎儿的心跳均正常。射频消融选择性减胎术均成功。（2）在术后不同时间分别对保留胎儿行B超或MRI检查，结果显示：例1，保留胎儿的腹水由术前的4．0cm×2．3cm，降至术后2周腹水消失；脐动脉收缩期与舒张期最大血流速度（S／D）比值术前为3．35，术后6周时降至2．70；术后3周MRI检查显示保留胎儿颅内结构未见异常；羊水指数由术前的44．6cm，术后2周降至正常。例2，保留胎儿的心脏体积术前增大（心／胸比〉0．35），术后10d复查胎儿心脏超声，显示心脏结构已正常；脐血流S／D比值由术前的4．69，降至术后7d的3．39。3例孕妇的保留胎儿超声检查均正常，术后MRI检查保留胎儿颅内结构未见异常；例6保留胎儿的腹水由术前的2．3cm×1．5cm，降至术后16d腹水消失；术后3周MRI检查显示胎儿颅内结构未见异常；羊水深度由术前的11．0cm于术后2周降至正常。（3）3例孕妇早产临产，均分娩健康新生儿；3例足月分娩健康新生儿。目前，所有新生儿均在随访中，婴幼儿查体均无异常。结论射频消融选择性�Objective To investigate the safety and efficiency of radiofrequency ablation （RFA） in the treatment of complicated muhifetal gestations. Methods There were 6 muhifetal pregnant women （gestational age ranged from 14＋6 to 27 ＋2 weeks） diagnosed in the Department of Obstetrics, Provincial Hospital Affiliated to Shandong University：two with twin-twin transfusion syndrome （TITS） stage Ⅳ, one with reversed arterial perfusion sequence, one with dichorionic triamniotic triplets, one with absence of a lower limb, one with severe intrauterine growth restriction. All of them accepted ultrasound-guided selective fetocide by RFA. Results （ 1 ） Blood flow of three reduced fetuses stopped completely after one RFA circulation, whereas the other three stopped after two circulations. One reduced fetus stopped heartbeating in 10 minutes after RFA; three reduced fetuses＇ heartbeats slowed down and stopped completely in 35 minutes after RFA ; and the heartbeats of the other two cases stopped completely within 3 to 7 minutes after RFA. The heartbeats of the reserved fetuses were normal. All of the operations succeeded. （ 2 ） The reserved fetuses received a series of ultrasound examinations after the operations. In Case 1, the aseites of the reserved fetus, which was 4. 0 cm×2. 3 cm before RFA, disappeared two weeks later; and the umbilical artery systolic/ diastolic （S/D） ratio, which was 3.35 before the operation, decreased to 2. 70 six weeks later. Amnioticfluid depth decreased from 44. 6 cm to normal two weeks after RFA. The reserved fetus received brain MRI three weeks after RFA and no abnormality was detected. In Case 2, the increased heart size （ cardiothoracic ratio 〉 0. 35） of the reserved fetus recovered to normal size ten days after the operation ; and the umbilical artery S/D decreased from 4. 69 to 3.39 seven days after the operation. Reserved fetuses of the other three cases were normal on ultrasound and MRI after the operations. In Case 6, the ascites of the reserved fetus, which

关 键 词：妊娠减少 多胎 导管消融术 外科手术 选择性 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]