胎儿镜激光治疗后双胎输血综合征活产儿神经发育预后分析  

Prognosis analysis of neurodevelopment of infants with twin-to-twin transfusion syndrome after fetoscopic laser treatment

作　　者：尹少尉[1,2] 孟伊琳 贾宝龙 吕远[1,2] 刘彩霞 YIN Shao-wei;MENG Yi-lin;JIA Bao-long;LYU Yuan;LIU Cai-xia(Department of Obsterics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

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 [2]中国医科大学出生队列中心,辽宁沈阳110004 [3]辽宁省母胎医学重点实验室,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2020年第2期154-158,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划（2018YFC1002902）;国家自然科学基金（81701462）

摘　　要：目的探讨影响胎儿镜胎盘血管交通支激光凝固术(FLS)治疗双胎输血综合征(TTTS)后活产儿在校正6个月龄时神经发育的相关因素。方法收集2016年6月至2018年12月于中国医科大学附属盛京医院妇产科经FLS治疗的TTTS活产儿病例资料,在校正6个月龄时应用Gesell发育量表(GDS)进行发育商评分。结果共有62例TTTS接受胎儿镜激光治疗,其中双胎活产率为61.29%(19/31),至少一胎活产率为90.32%(28/31);至校正6个月龄时共有44例活产儿,GDS评价有12例临界发育异常,6例存在神经系统发育异常;存活儿粗大运动、精细运动、应物能、言语能、应人能发育商(DQ)值分别为85.95±11.72、87.23±14.21、84.91±11.58、86.25±12.34、85.75±10.14;在影响发育商的相关因素中,术后继续妊娠时间、胎儿生长受限和重度脑损伤具有统计学意义。结论重度脑损伤和胎儿生长受限是影响神经发育的高危因素,延长胎儿术后的继续妊娠时间能够改善神经发育情况。ObjectiveTo investigate the related factors of nerve development in 6-month-old infants with Twin-to-Twin Transfusion Syndrome(TTTS)who receive fetoscopic laser surgery(FLS).MethodsFrom June 2016 to December2018,the data of infants with TTTS treated by FLS in Department of Obsterics and Gynecology,Shengjing Hospital ofChina Medical University were collected. The Gessell scale was used to evaluate the developmental quotient of infants at6 months of age.ResultsA total of 62 cases of TTTS were treated by FLS. The two-fetus survival rate was 61.29%(19/31),and the at least one-fetus survival rate was 90.32%(28/31). At the age of 6 months,there were 44 survival infants;by GDS evaluation,there were 12 cases of critical abnormal development and 6 cases of abnormal nervous systemdevelopment,and the DQ values of survival infants were 85.95±11.72,87.23±14.21,84.91±11.58,86.25±12.34,85.75±10.14,respectively. Among the related factors affecting DQ,time from FLS to delivery,growth restriction and severebrain injury were statistically significant.ConclusionSevere brain injury and growth restriction are high risk factorsaffecting nerve development. Prolonging pregnancy time after operation may improve nerve development.

关 键 词：双胎输血综合征 胎儿镜胎盘血管交通支激光凝固术 Gessell发育量表 神经发育 

分 类 号：R714.23[医药卫生—妇产科学]