不同期别双胎反向动脉灌注序列征的治疗方法选择与围产结局分析  

Clinical management and perinatal outcome of twin reversed arterial perfusion sequence in different stage

作　　者：张志涛[1] 刘彩霞[1] 尹少尉[1] 栗娜[1] 廖姗姗[1] 

机构地区：[1]中国医科大学附属盛京医院母胎医学中心,沈阳110004

出　　处：《中华妇产科杂志》2014年第7期490-494,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨不同期别双胎反向动脉灌注序列征（TRAP）的治疗方法选择及其围产结局。方法收集2012年8月至2013年12月在中国医科大学附属盛京医院母胎医学中心诊断的11例TRAP患者，按TRAP分期Ⅰa期3例，Ⅱa期7例，Ⅱb期1例。3例Ⅰa期患者行期待治疗；7例Ⅱa期患者中，3例行射频消融选择性减胎术，4例行期待治疗[其中1例（例9）进展为Ⅱb期行急诊剖宫产术终止妊娠]；1例Ⅱb期行急诊剖宫产术终止妊娠。除例1、4外所有患者均行剖宫产术终止妊娠。患者出院后随访新生儿的生长发育情况。结果（1）3例TRAPⅠa期患者行动态超声检查，未发现供血儿有异常情况，2例患者的无心胎血流供应自行消失，足月后行剖宫产术终止妊娠；1例于孕30周发生胎膜早破，于34周＋5自然分娩一活婴。3例存活新生儿平均出生体质量为2923 g。（2）7例TRAPⅡa期患者中，3例行射频消融选择性减胎术，其中2例新生儿存活，平均分娩孕周35周＋1，平均出生体质量2050 g。行期待治疗的3例患者中，1例于34周＋5胎膜早破，行剖宫产术终止妊娠；1例行期待治疗3周，超声检查发现供血儿胎死宫内而引产；1例在期待治疗过程中病情进展为Ⅱb期，于34周＋5行剖宫产术终止妊娠。1例失访。（3）2例TRAPⅡb期患者中，1例由Ⅱa期进展而来；另1例于孕32周＋4就诊时即诊断为TRAPⅡb期，立即行剖宫产术终止妊娠，新生儿于产后第2天死于心功能衰竭。（4）随访存活的7例新生儿，除1例于产后超声检查提示动脉导管未闭、房间隔缺损、体质量小于同龄儿（7个月时6 kg）外，其余存活儿的生长发育指标均达到正常同龄儿水平。结论对TRAP患者应尽早做出诊断，根据分期及孕周不同选择适宜的治疗方案，Ⅰa期患者在动态超声检查中行期待治疗；Ⅱa期患者可行射频消融选择性减胎术，以改善供血儿Objective To discuss the methods and outcomes of twin reversed arterial perfusion sequence in different stage. Methods From August 2012 to December 2013, 11 cases were diagnosed with twin reversed arterial perfusion sequence （TRAP） by 3d color Doppler ultrasound in the Maternal ang Fetal Medicine Center ,Affiliated Shengjing Hospital, China Medical University, including 3 cases in stageⅠa, 7 in stageⅡa and 1 case in stageⅡb. We performed expected therapy to 3 cases in stageⅠa and 4 cases in stageⅡa [1 case （case 9） in stageⅡa developed to stageⅡb and was terminated by emergency cesarean section], radio frequency ablation （RFA） selective reduction to 3 cases in stage Ⅱa, emergency cesarean section to 1 case in stageⅡb. All cases except case 1,4 took cesarean section to terminate pregnancy and would be followed up on the aspect of infant′s growth. Results （1） 3 cases in stageⅠa were monitored by sequential ultrasound examination, all donors grew normally, in which 2 acardias arised spontaneous cessation of flow and were implemented of cesarean section after the normal period of gestation; 1 case suffered premature rupture of membrane and experienced the natural childbirth at 34 gestation weeks plus 5 days. The survived average labor weight was 2 923 g. （2） In the 7 stage Ⅱa cases, 3 cases were implemented of RFA selective reduction, 2 cases survived and the average labor gestation was 35 weeks plus 1 day and average labor weight was 2 050 g;in 3 expected therapy cases, 1 case suffered premature rupture of membrane at 34 gestation weeks plus 5 days and experienced cesarean section; 1 case was observed for 3 weeks and the donor was stillborn; 1 case progressed to stage Ⅱb and experienced cesarean section at 34 gestation weeks plus 5 days;and 1 case was lost of follow up. （3） For 2 cases of stageⅡb cases, one was progressed from stage Ⅱa during expected therapy; the other one had been already in stage Ⅱb since visiting and experimented an emergency cesarean secti

关 键 词：双胎疾病 心脏缺损 先天性 导管消融术 妊娠减少 多胎 

分 类 号：R714.5[医药卫生—妇产科学]