射频消融术选择性减胎在复杂性多胎妊娠中的应用分析  

Clinical application for pregnacy outcomes of radiofrequency ablation in complex multiple pregnancies

作　　者：孟新璐 王谢桐[1] 王红梅[1] 王燕芸[1] 李磊[1] 李红燕[1] Meng Xinlu;Wang Xietong;Wang Hongmei;Wang Yanyun;Li Lei;Li Hongyan(Department of Obstetrics and Gynecology,Provincial Hospital Affiliated to Shandong University,Ji′nan 250021,China)

机构地区：[1]燕山东大学附属省立医院妇产科,济南250021

出　　处：《中华妇产科杂志》2019年第11期730-735,共6页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨应用射频消融术(RFA)行选择性减胎术治疗复杂性多胎妊娠的安全性及有效性,并分析影响妊娠结局的因素。方法回顾性分析2011年7月22日至2018年9月12日在山东大学附属省立医院行RFA选择性减胎治疗的156例复杂性单绒毛膜多胎妊娠孕妇的临床资料。按照手术指征分为5组,单绒毛膜双胎之一胎儿畸形组46例,多胎妊娠减胎组42例,双胎输血综合征(TTTS)组40例,选择性宫内生长受限(sIUGR)组24例,双胎动脉反向灌注序列征(TRAPS)组4例;根据手术孕周不同分为两组,手术孕周<20周组(75例)及手术孕周≥20周组(81例);根据手术所需射频循环的次数不同分为两组,循环1次组(124例)及循环≥2次组(32例)。记录孕妇的一般情况、RFA选择性减胎治疗的手术情况、术后并发症及妊娠结局,并随访保留胎儿出生后的生长发育情况,分析影响妊娠结局的相关因素。结果(1)156例孕妇的中位手术孕周为妊娠20周(14周^+5~29周^+1),手术所需中位射频循环次数为1次(1~3次),其中循环1次者占79.5%(124/156)。(2)术后11例(7.1%,11/156)孕妇的保留胎儿胎死宫内而引产,27例(17.3%,27/156)流产,保留胎儿的总存活率为75.6%(118/156)。妊娠<34周早产的发生率为19.5%(23/118);新生儿共129例,其中位出生孕周为37周^+3(28周^+2~41周^+1),出生体重为(2657±700)g。(3)对不同手术指征组孕妇的妊娠结局分析发现,单绒毛膜双胎之一胎儿畸形组、多胎妊娠减胎组、TTTS组、sIUGR组与TRAP组孕妇的分娩孕周[分别为妊娠38周(30周^+1~41周^+1)、36周^+4(29~39周)、36周+4(28周^+2~39周^+5)、38周(31周~39周^+6)、38周^+3(30周^+4~38周^+4)]、新生儿出生体重[分别为(2820±671)、(2435±416)、(2497±843)、(2998±718)、(2517±1087)g],分别比较,差异均有统计学意义(P均<0.05)。而手术孕周<20周组与手术孕周≥20周组、循环1次组与循环≥2次组孕妇的妊娠结局分别比较,差异均无统计学意义Objective To investigate the safety and effectiveness of radiofrequency ablation(RFA)for selective fetal reduction in complex multiple pregnancies and analyze factors affecting perinatal outcomes.Methods This was a retrospective case series of 156 patients undergoing selective fetal reduction by RFA in Provincial Hospital Affiliated to Shandong University from July 22th,2011 to September 12th,2018.They were divided into five groups according to surgical indications,including 46 cases in the monochorionic twins discordant for fetal anomalies group,42 cases in the multiple pregnancies for reducing fetal numbers group,40 cases in the twin to twin transfusion syndrome(TTTS)group,24 cases in the selective intrauterine growth restriction(sIUGR)group and 4 cases in the twin reversed arterial perfusion sequence(TRAPS)group.According to the gestational age at surgery,patients were divided into two groups:the gestational age at surgery<20 weeks group(75 cases)and the gestational age at surgery≥20 weeks group(81 cases).According to the cycles of RFA required for surgery,patients were divided into two groups:one cycle group(124 cases)and≥2 cycles group(32 cases).Basic information of patients,surgical process,postoperative complications and pregnancy outcomes were recorded.The growth and development of survival newborns were also followed up.Factors affecting perinatal outcomes were analyzed.Results(1)The median gestational age at procedure of 156 patients was 20 weeks(14^+5-29^+1 weeks).The median cycles of RFA was 1 cycle(1-3 cycles),of which one cycle accounted for 79.5%(124/156).(2)Eleven(7.1%,11/156)patients experienced intrauterine fetal death,27(17.3%,27/156)patients miscarried,and the overall survival rate was 75.6%(118/156).Premature birth rate before 34 weeks was 19.5%(23/118).There were 129 neonates.The median gestational age at delivery was 37^+3 weeks(28^+2-41^+1 weeks)with a mean birth weight of(2657±700)g.(3)Analysis of pregnancy outcomes based on surgical indications found that,the gestational age at deli

关 键 词：射频消融术 妊娠减少 多胎 妊娠结局 

分 类 号：R71[医药卫生—妇产科学]