双胎反向动脉灌注序列征围生期处理的探讨  

Perinatal treatment of twin reversed arterial perfusion sequence

作　　者：雷莹娟[1] 席惠[1] 骆迎春[1] 刘溯[1] 游一平 王华[1] LEI Yingjuan;XI Hui;LUO Yingchun;LIU Su;YOU Yiping;WANG Hua(Fetal Medical Center, Hunan Maternal and Child Health Hospital Changsha, Hunan 410008, China)

机构地区：[1]湖南省妇幼保健院胎儿医学中心,湖南长沙410008

出　　处：《中国医学工程》2018年第4期8-12,共5页China Medical Engineering

摘　　要：目的探讨双胎反向动脉灌注序列征的围生期处理。方法回顾性分析2016年1月‐2017年10月在湖南省妇幼保健院胎儿医学中心就诊的双胎反向动脉灌注序列征(TRAP)的临床处理和妊娠结局。结果 23例双胎反向动脉灌注序列征纳入研究,其中8例行期待治疗,分娩4例,分娩孕周为36~39周,1例引产,3例随访中。4例行射频消融减胎术,1例孕32周分娩,1例因骨骼发育异常终止妊娠,2例随访中。11例直接终止妊娠。随访者泵血胎均生长发育良好,分娩新生儿随访未见不良结局。结论 TRAP分期用于临床评估双胎反向动脉灌注序列征病情、评价有无宫内干预指征,简单有效。临床医师和超声医师应加强对双胎反向动脉灌注序列征的认识,重视早中孕期发现的双胎之一死胎,提高早期诊断率。期待治疗的双胎反向动脉灌注序列征者终止妊娠时机应个体化。【Objective】To explore the perinatal treatment of twin reversed arterial perfusion sequence（TRAP）.【Methods】A retrospective analysis of the clinical treatment and pregnancy outcome of TRAP from January 2016 to October 2017 was carried out at the fetal medical center of Hunan Maternal and Child Health Care Center.【Results】Twenty-three cases of twin artery reverse arterial perfusion sequence were included in the study. Of them, 8 cases chose expectant treatment, 4 cases already delivered at 36~39 weeks, 1 case was induced labor, and 3 cases were followed up. Radiofrequency ablation was performed in 4 cases, 1 case delivered at 32 weeks, 1 case was terminated pregnancy due to abnormal skeletal development, 2 cases were followed up. The pregnancies were terminated directly in 11 cases. The blood pumps of the follow-up were well developed, and no bad outcome was found in the follow-up of newborn babies.【Conclusion】TRAP staging is used to evaluate the condition of the disease and the intrauterine intervention, which is simple and effective. Clinicians and ultrasonic physicians should strengthen the understanding of TRAP and attach importance to one of the twin stillbirths found during the early and middle pregnancy, so as not to be misdiagnosed. As for expectant treatment of TRAP, the timing of final pregnancy should be individualized.

关 键 词：双胎反向动脉灌注序列征 期待治疗 射频消融减胎术 

分 类 号：R714.2[医药卫生—妇产科学]