射频消融减胎技术治疗34例单绒毛膜性双胎妊娠并发症的妊娠结局  

Perinatal outcomes following selective feticide by radiofrequency ablation in complex monochorionic ;pregnancies

作　　者：孙路明[1] 周奋翮[1] 邹刚[1] 杨颖俊[1] 周艳[1] 孙琦[1] 段涛[1] 

机构地区：[1]同济大学附属第一妇婴保健院产科,上海200040

出　　处：《中华围产医学杂志》2014年第6期365-369,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的：评估射频消融减胎技术治疗单绒毛膜性双胎妊娠并发症的安全性和有效性。方法回顾性分析2012年1月1日至2013年12月31日，在同济大学附属第一妇婴保健院胎儿医学部接受射频消融减胎技术治疗并已分娩的单绒毛膜性双胎妊娠孕妇共34例的临床资料。记录手术孕周、手术所需的循环数、母儿并发症及分娩孕周等情况，并随访保留胎儿出生后的生长发育情况。保留胎儿出生后28 d仍存活计为存活儿，存活率=（存活儿例数/保留胎儿例数）×100%。分析影响保留胎儿存活率的相关因素。采用Fisher精确概率法进行统计分析。结果（1）手术情况：平均手术孕周（20.7±3.1）周（16^＋1～27^＋6周），穿刺成功率100%（34/34），手术循环数1～6次。（2）保留胎儿存活率：34例保留胎儿中，2例因妊娠28周前胎膜早破流产或引产，3例因严重贫血胎死宫内或引产，2例不明原因胎死宫内，共7例保留胎儿死亡。活产27例，平均分娩孕周（36.4±4.1）周（26＋4～40周），新生儿平均出生体重（2913±978） g（1080～4600 g）。27例保留胎儿出生后28 d仍存活，存活率79%（27/34），随访至3月～1.5岁，均未发现严重神经系统后遗症。（3）影响保留胎儿结局的因素：妊娠16＋1～、20～和24～27＋6周行射频消融减胎术的3组比较，保留胎儿严重贫血或胎死宫内发生率（2/15、2/13与1/6）、妊娠28周前胎膜早破发生率（1/15、4/13与1/6）及保留胎儿出生后28 d存活率（13/15、10/13与4/6）的差异均无统计学意义（P值均〉0.05）。手术指征为严重的选择性胎儿生长受限（50%，17/34）、单绒毛膜性双胎合并一胎结构异常（24%，8/34）、双胎反向动脉灌注序列（18%，6/34）和双绒毛膜性三羊膜囊三胎（9%，3/34），不同手术指征组保留胎儿严重贫血或胎死宫内发生率（3/17、2/8、0/6与0/3）、妊娠28周前胎膜�To assess the perinatal outcomes following selective feticide through radiofrequency ablation （RFA） in complex monochorionic pregnancies. Methods In this retrospective observational study, 34 cases of complex monochorionic pregnancies treated with RFA for selective feticide and delivered at the Shanghai First Maternity and Infant Hospital between January 1, 2012 and December 31,2013, were included. Gestational age at RFA, the number of RFA cycles, maternal and fetal complications, gestational age at delivery, neonatal outcomes at 28 days after birth and neonatal development after birth were recorded. Fetal survival rate were defined as the number of survivors at 28 days after birth divided by the number of remaining fetuses after RFA. Factors affecting fetal survival rate were also analyzed. Statistical analysis was performed using Fisher＆#39;s exact test. Results （1） The process for RFA：The gestatinal age for the procedure was （20.7±3.1） weeks（16＋1-27＋6 weeks）. The successful rate of procedures was 100%（34/34） and the cycle number for RFA was 1-6 times. （2）Fetal complications and survival rate of remaining fetuses after RFA：there were six pregnant women suffering from premature rupture of membrane （PROM） before 28 weeks. Among those women, one had miscarriaged at 25 weeks, one chose to terminate at 26 weeks and the remaining four chose to continue the pregnancy. There were three remaining fetuses developing fetal severe anemia with hydrops after RFA. Two of them had fetal demises 2 days after the procedures and one chose to have termination. Another two cases with discordant fetal anomalies had fetal demises with unknown reasons one day after RFA. There were 27 remaining fetuses after RFA who survived until 28 days after birth. The mean gestational age at delivery was（36.4±4.1）weeks （26^＋4-40 weeks） and the mean birth weight was （2 913± 978） g （1 080-4 600 g）. The overall fetal survival rate 28 days after birth was 79%（27/34）. There were no abnormal

关 键 词：双生 单绒毛膜 妊娠并发症 妊娠减少 多胎 导管消融术 妊娠结局 

分 类 号：R719[医药卫生—妇产科学]