射频消融选择性减胎术和胎儿镜下选择性胎盘血管交通支凝结术治疗Ⅲ~Ⅳ期双胎输血综合征临床结局对比研究  

Comparison of clinical outcomes of Quintero Ⅲ-Ⅳ twin-to-twin transfusion syndrome treated with elective reduction by radiofrequency ablation and with fetoscopic selective laser coagulation of placental vessels

作　　者：尹少尉[1] 张志涛[1] 栗娜[1] 廖珊珊[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,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2016年第9期900-903,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：卫生公益性行业科研专项项目(201402006)

摘　　要：目的探讨射频消融(radiofrequency ablation,RFA)选择性减胎术和胎儿镜下选择性胎盘血管交通支凝结术(selective laser coagulation of placental vessels,SLCPV)两种不同方式治疗严重双胎输血综合征(twin-twin transfusion syndrome,TTTS)患者的临床结局。方法收集中国医科大学附属盛京医院2011年7月至2015年5月行RFA治疗(5例)、SLCPV治疗(15例)的Quintero分期Ⅲ~Ⅳ期TTTS患者的临床资料进行回顾性分析对比。结果 (1)RFA组手术孕周为22~26+1周,平均24.4周;平均手术时间15.6 min;SLCPV组手术孕周为17+5~27+4周,平均23.1周;平均手术时间30 min。RFA组无一例发生未足月胎膜早破(premature rupture of the membrane,PPROM),SLCPV组5例(P>0.05)。(2)SLCPV组患者有1例发生肠梗阻并最终发生流产;术后两组20例患者的胎儿染色体检测结果均未见异常。(3)RAF组患者分娩孕周为28^(+1)~36^(+1)周,平均32.2周,SLCPV分娩孕周为26^(+3)~37^(+1)周,平均30.3周。对新生儿定期随访发现:SLCPV组中1例胼胝体发育不良,而其同胞胎儿表现正常。至少一胎存活率全部20例患者为16/20,RAF组为5/5,SLCPV组为11/15(P>0.05)。结论 RAF选择性减胎术和胎儿镜SLCPV治疗严重双胎输血综合征均具有良好效果;射频消融手术是治疗严重双胎输血综合征一种可考虑的选择。Objective To evaluate the clinical outcome of severe twin-to-twin transfusion syndrome （TTTS） of Quintero m-Iv treated with selective reduction by radiofrequency ablation （RFA） and fetoscopic selective laser coagulation of placental vessels （SLCPV）. Methods Five cases of TTTS 1V treated with selective reduction by RFA and fifteen cases of TTTS Ⅲ-Ⅳ who were treated by SLCPV in Shengjing Hospital from July 2011 to May 2015 were included and their clinical data were collected and retrospectively analyzed. Results （1）The mean gestational age of RFA was 24.4 weeks （22 -26＋＇wks）,the average opertaion time was 15.6 minutes, and there was no case of PPROM and maternal complication. Of all the 15 cases of SLCPV, the mean gestational age was 23.1weeks （17＋5 - 2T4wks）.There were 12 cases at Quintero stage Ⅲ,3 at stage IV. The average operation time of SLCPV was 30 minutes, there was 1 case of PPROM and 1 case of maternal intestinal obstruction after the operation. （2） One case had maternal intestinal obstruction and miscarriage after SLCPV; Karyotype analyses of all the twins were normal. （3） All 20 cases had delivered, including one infant with callosum agenesis, but its co-twin was normal. The average gestational age at delivery after RFA was 32.2 weeks （28＋1 - 36＋1wks） and 30.3 weeks （26＋3 -37＋1wks） after SLCPV. The fetuses survival rate was 11/15 for at least one twin after SLCPV, and 5/5 after RFA（P〉0.05）.Conclusion RFA and SLCPV are both suitable for the treatment of severe TTTS, and selectiveablation by RFA is a kind of choice for the treatment of severe twin-to twin transfusion syndrome.

关 键 词：双胎输血综合征 胎儿镜 射频消融选择性减胎术 胎儿镜下选择性胎盘血管交通支凝结术 妊娠结局 

分 类 号：R714.23[医药卫生—妇产科学]