双胎输血综合征宫内治疗后供血胎和受血胎预后的比较  

Prognosis of Recipient and Donor in Twin to Twin Transfusion Syndrome with Different Mangements

作　　者：彭软[1] 李珠玉[2] 谢红宁[1] 郑菊[1] 周祎[2] 朱云晓[1] 

机构地区：[1]中山大学附属第一医院超声科,广东广州510080 [2]中山大学附属第一医院妇产科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2015年第1期102-107,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81071166);广东省科技计划项目(2009B080701061)

摘　　要：【目的】评价双胎输血综合征（TTTS）经不同治疗方式,包括羊水减量术（SA）、双极脐带电凝减胎术（BCC）和胎盘吻合血管激光凝固术（LCPV）后,供血胎和受血胎的临床结局。【方法】回顾性分析2008年1月至2013年12月在我院诊断治疗的双胎输血综合征93例,追踪妊娠结局和新生儿情况,分析比较供血胎和受血胎的临床结局。【结果】不同治疗方式组中严重的TTTS（TTTSⅢ期及以上）所占比例分别是：羊水减量术组50.0%（27/54）,脐带电凝减胎术组93.9%（31/33）,胎盘吻合血管激光凝固术组83.3%（5/6）,P〈0.001,因此,3种治疗方式妊娠结局比较时仅纳入TTTSⅢ期及以上病例。SA组、BCC组和LCPV组双胎总体存活率分别是53.7%、24.2%和60.0%,P=0.002。SA组、BCC组和LCPV组分娩孕周中位数分别是31＋3（20＋3~38＋2）、28＋5（20＋2~38＋6）和27＋6（23＋3~37＋4）周,其差异无统计学意义（P=0.204）。SA组胎膜早破的发生率是29.6%而BCC组和LCPV组胎膜早破的发生率分别是32.3%和60.0%,P=0.410。LCPV组28周前分娩的比例较SA组和BCC组高（分别是60.0%、18.5%和48.4%;P=0.033）。TTTS双胎中受血胎存活率是44.1%（41/93）而供血胎存活率是46.2%（43/93）,P=0.768;受血胎神经系统发育迟缓发生率是2.4%（1/41）而供血胎神经系统发育迟缓发生率是11.6%（5/43）,其差异无统计学意义（P=0.202）。【结论】胎盘吻合血管激光凝固术可提高TTTS的总体存活率;TTTS受血胎和供血胎的预后无明显差异。【Objective】 The purpose of this study was to compare survival and complication rates of the recipient and the donor in twin to twin transfusion syndrome with different managements,including serial amnioreduction,bipolar umbilical cord coagulation and laser coagulation of placental vascular anastomoses.【Methods】 A retrospective review was undertaken of all 93 cases of twin to twin transfusion syndrome that were performed with serial amnioreduction（SA）,bipolar umbilical cord coagulation（BCC） or laser coagulation of placental vascular anastomoses（LCPV） at the first affiliated hospital of Sun Yat-sen university from January 2008 to December 2013.【Results】 The ratios of severe TTTS（including stage Ⅲ and higher） were significantly different in these three groups,with 50.0% for the SA group,93.9% for the BCC group and 83.3% for the LCPV group（P〈0.001）.Only cases of stage Ⅲand higher were included into the analysis of the outcomes.Overall survival was 53.7% in the SA group,24.2% in the BCC group and60.0% in the LCPV group,which was significantly different in these three groups（P = 0.002）.The median gestational age at delivery was 31＋3weeks（range from 20＋3to 38＋2weeks） for the BCC group,28＋5weeks（range from 20＋2to 38＋6weeks） in the BCC group and27＋4（range from 23＋3to 37＋4weeks） in the LCPV group,which was not significantly different in these three groups（P = 0.204）.Premature rupture of the membranes occurred in 29.6% in the SA group whereas 32.3% and 60.0% in the BCC group and the LCPV group（P = 0.410）.Delivery before 28 gestational weeks was more common in the LCPV group than in the SA and BCC groups（60.0%,18.5%,and 48.4%,respectively;P = 0.033）.Overall survival for the recipients was 44.1%（41/93） whereas 46.2%（43/93） for the donors（P = 0.768）.The incidence rate of neurodevelopmental delay was 2.4%（1/41） for the recipients and it was 11.6%（5/43） for the donors and the difference was not significant（P = 0.202）.【Co

关 键 词：双胎输血综合征 胎盘吻合血管激光凝固术 受血胎 供血胎 预后 

分 类 号：R71[医药卫生—妇产科学]