23例双胎反向动脉灌注序列症临床特点分析  

Twin Reversed Arterial Perfusion Sequence: A Clinical Analysis of 23 Cases

作　　者：李南[1] 苗永慧 王佳燕[1] 刘予 李于凡[1] 赖峥菲[1] 潘悦健[1] 陈敏[1] 陈敦金[1] LI Nan;MIAO Yonghui;WANG Jiayan(The 3 rd Affiliated Hospital of Guangzhou Medical Universtity,Guangzhou Guangdong 510150,China)

机构地区：[1]广州医科大学附属第三医院,广东广州510150

出　　处：《实用妇产科杂志》2018年第8期621-624,共4页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金面上项目(编号:81671470);广州市科技计划项目产学研协同创新重大专项(编号:201602040078)

摘　　要：目的:探讨双胎反向动脉灌注序列症(TRAPS)的病理生理、超声检查特点及临床处理,以提高临床医生对该疾病的认识。方法:选择我院2013年8月至2017年12月诊治的23例TRAPS病例资料进行回顾性分析,对临床超声检查、处理方式以及妊娠结局进行归纳总结。结果:孕期诊断为TRAPS病例23例,其中20例在本院超声检查确诊;3例外院误诊,转本院后超声检查明确诊断。23例中双胎妊娠病例20例,单绒毛膜双羊膜囊(MCDA)13例,单绒毛膜单羊膜囊7例;双绒毛膜三羊膜囊三胎妊娠病例3例。同意接受选择性射频消融减胎术的病例13例,平均手术孕周17.68周。28周后分娩的活产泵血胎儿病例11例,平均分娩孕周36.49±4.53周;35周以上分娩病例8例,新生儿出生平均体质量2292.60±779.56 g。电话随访足月婴幼儿生长发育及神经系统发育正常,早产儿纠正胎龄发育正常。未手术治疗的10例中因TRAPS导致一个和(或)双胎死亡的病例5例;于侵入性检查后发生流产病例2例;引产病例1例;孕35周活产病例1例;失访1例。结论:孕期超声检查是确诊TRAPS的重要方法。TRAPS患者主要为双胎妊娠,以MCDA多见。对患者及时选择性射频消融减胎术是安全可靠预后较好的治疗方法。Objective： To discuss the pathophysiological,ultrasonictraits and the treatment of twin reverse arterial perfusion syndrome（ TRAPS）,which may help to improve clinicians＇ understanding of this disease. Methods： 23 TRAPS were diagnosed in our hospital from August 2013 to December 2017 and the clinical data of these cases were collected and analyzedin this article,the clinical ultrasound examination,treatment and pregnancy outcome were summarized.Results： A total of 23 cases of TRAPS were diagnosed in our hospital with 3 cases were first misdiagnosed in other hospital.In all 23 cases,20 cases were twin pregnancy,including 13 MCDA cases and 7 MCMA cases.Another 3 cases were triple pregnancies.13 cases were accepted selective fetocideby radiofrequency ablation and the average operative gestation was 17. 68 weeks.11 cases of donor fetus live birth after 28 weeksand the average delivery gestation was 36. 49±4. 53 weeks.8 cases delivered above 35 weeks and the neonatal birth weight was 2292. 60 g±779. 56 g.Follow-up results showed that full-term infants＇ growth and the nervous system developments were normal,while the growth of preterm infants became normal after correction of age.There were 10 untreated cases and of half cases had 1 or 2 fetuses lost.2 cases miscarriaged after invasive examination.1 case chose abotion.1 casedeliveried at 35 weeks.1 casefailed to contact. Conclusions： Ultrasound examination playan important role in the diagnosis of TRAPS.Most TRAPS are twin pregnancies,especially MCDA.Selective radiofrequency ablation has been proved safe and reliable in TRAPS when treated timely,and the prognosis improved.

关 键 词：单绒毛膜双羊膜囊双胎 双胎反向动脉灌注序列症 选择性射频消融减胎术 

分 类 号：R714.53[医药卫生—妇产科学]