胎儿镜选择性胎盘血管交通支凝结术治疗前壁胎盘双胎输血综合征患者的临床结局及其影响因素分析  

Analysis of clinical outcome and impact factors of twin-to-twin transfusion syndrome with anterior placenta treated by fetoscopic laser photocoagulation

作　　者：尹少尉[1] 张志涛[1] 栗娜[1] 刘彩霞[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004

出　　处：《中华妇产科杂志》2015年第5期329-333,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的：探讨胎儿镜选择性胎盘血管交通支凝结术（SLCPV）治疗前壁胎盘双胎输血综合征（TTTS）患者的临床结局及其影响因素。方法收集中国医科大学附属盛京医院2011年7月至2014年4月10例经SLCPV治疗的前壁胎盘TTTS患者（前壁胎盘TTTS组）的临床资料进行回顾性分析，并与同期8例经SLCPV治疗的后壁胎盘TTTS患者（后壁胎盘TTTS组）进行对比。患者Quintero分级均在Ⅱ级以上，或者Quintero分级Ⅰ级但同时按美国费城儿童医院心血管功能评分≥5分。前壁胎盘TTTS组患者接受弧形胎儿镜SLCPV治疗，后壁胎盘TTTS组患者接受直形胎儿镜SLCPV治疗。结果（1）手术情况：两组共18例患者，施行手术时的孕周为17周＋5～27周＋4，平均24.1周；Quintero分级为Ⅲ级12例，Ⅱ级4例；Ⅰ级2例。其中，前壁胎盘TTTS组患者施行手术时的孕周为22周～27周＋4，平均25.2周；Quintero分级为Ⅲ级6例，Ⅱ级2例，Ⅰ级2例；平均手术时间40 min，术后发生未足月胎膜早破（PPROM）5例，母体并发症1例（为肠梗阻）。后壁胎盘TTTS组患者施行手术时的孕周为17周＋5～27周＋4，平均22.7周；Quintero分级为Ⅲ级6例，Ⅱ级2例；平均手术时间28 min；术后发生PPROM 1例，母体并发症1例（为阴沟杆菌败血症）。两组患者均能耐受胎儿镜手术，无术中并发症。（2）术后情况：前壁胎盘TTTS组患者中术后有1例发生肠梗阻并最终发生流产；后壁胎盘TTTS组患者中有1例发生阴沟杆菌败血症。术后两组18例患者的胎儿染色体检测结果均未见异常。（3）两组患者施行手术后已有17例妊娠终止，1例仍在继续妊娠中。其中，前壁胎盘TTTS组患者全部分娩，分娩孕周为24～37周＋1，平均32.6周；后壁胎盘TTTS组患者中7例已经分娩，分娩孕周为25周＋6～36周＋2，平均28.2周。对新生儿定期随访发现1例有胼胝体发育不良，而其同胞胎儿�Objective To analyze the clinical outcome and impact factors of twin-to-twin transfusion syndrome （TTTS） with anterior placenta treated by fetoscopic selective laser coagulation of placental vessels（SLCPV）. Methods Ten cases of TTTS with anterior placenta and 8 cases with posterior placenta were treated by SLCPV in Shengjing Hospital from July 2011 to April 2014. Clinical data were＆amp;nbsp;analyzed retrospectively. Some cases were at Quintero stageⅡor higher stage, others were at Quintero stageⅠbut with cardiovascular score≥5 according to the scoring system of Children′s Hospital of Philadelphia. The anterior placenta cases were treated by curve fetoscopy and the posterior placenta cases were treated by straight fetoscopy. Results （1） Of all the 18 cases, the mean gestational age at SLCPV was 24.1 weeks （17＋5 to 27＋4 weeks）. There were 2 cases at Quintero stageⅠ, 4 at stageⅡand 12 at stageⅢ. The mean gestational age of anterior placenta cases at SLCPV was 25.2 weeks （22 to 27＋4 weeks）, with 2 cases at Quintero stageⅠ, 2 cases at stage Ⅱ and 6 at stage Ⅲ;5 cases had preterm prelabour rupture of the membranes （PPROM）and 1 case had maternal intestinal obstruction after the operation;the average operation time was 40 minutes. Of the posterior placenta cases, the mean gestational age at SLCPV was 22.7 weeks （17＋5 to 27＋4 weeks）;2 cases were at Quintero stageⅡand 6 cases at stageⅢ. PPROM happened in one case;one case had maternal enterobacter cloacae septicemia;the average operation time was 28 minutes. All the 18 cases could tolerate the operations. There was no intraoperative complication. （2） One anterior placenta case had maternal intestinal obstruction and miscarriage; and one posterior placenta case had enterobacter cloacae septicemia. Karyotype analyses of the all the twins were normal. （3） 17 cases delivered already, including all the 10 anterior placenta cases and 7 posterior placenta cases. One infant had corpus callosum agenesis, but it

关 键 词：双胎输血综合征 胎儿镜检查 激光凝固术 妊娠结局 

分 类 号：R714.56[医药卫生—妇产科学]