胎儿镜诊治87例次临床观察  

Clinical observation on 87 cases of fetoscopy diagnosis and treatment

作　　者：吕艳红 刘朵朵 贺媛媛 潘东晟 陈必良 LV Yanhong;LIU Duoduo;HE Yuanyuan(Department of Gynecology and Obstetrics,Xijing Hospital,Air Force Medical University,Xi’an 710032)

机构地区：[1]空军军医大学西京医院妇产科,西安710032 [2]空军军医大学西京医院骨科,西安710032

出　　处：《陕西医学杂志》2020年第9期1102-1105,1109,共5页Shaanxi Medical Journal

基　　金：陕西省重点研发计划项目(2018SF-075)。

摘　　要：目的:探讨使用胎儿镜的适应证及合适操作器械的选择。方法:收集行胎儿镜手术的81例患者(87次手术)临床资料,包括双胎输血综合征治疗73例(其中6例接受2次手术),反向灌注序列治疗2例,单绒双胎减胎2例,白化病检查3例,羊膜束带综合征治疗1例。对其中不同病种使用不同器械及手术方式进行回顾分析。结果:79例行双胎输血综合征激光治疗,65例获存活新生儿,一次手术新生儿存活率48.51%(65/134),手术治疗至少一胎存活率56.16%(41/73)。3例白化病检查手术显示胎儿头发黑色,出生后均为正常新生儿。2例反向灌注序列激光治疗失败后行羊水减量术。2例单绒双胎双极及激光脐带阻断手术困难,其中1例行羊膜束带综合征松解手术。结论:胎儿镜手术在双胎输血综合征及白化病检查中所需设备简单,开展相对容易,但是在特殊病例处理中需要射频消融、超声聚焦等设备方可解决。羊膜束带综合征病理机制不明确,宫内手术能力有限。Objective:To explore the indications of fetal endoscopy and the selection of appropriate instruments.Methods:The clinical data of 81 patients who underwent fetal endoscopy surgery(87 times)were collected,including 73 cases of twin-to-twin transfusion syndrome(TTTS)(6 of them received two operations),2 cases of twin reversed arterial perfusion sequence(TRAPS),2 cases of monochorionic twins,3 cases of albinism,1 case of amniotic band syndrome.The use of different instruments and surgical methods for different diseases were reviewed.Results:79 cases of TTTS were treated by selective laser photocoagulation,65 cases had survival newborns,fetal survival rate in first surgery was 48.51%(65/134),at least one fetal survival rate was 56.16%(41/73).The examination and operation of 3 cases of albinism showed that the fetus had black hair and were normal after birth.The amniotic fluid decrement were performed in 2 cases of TRAPS after laser treatment failed.The bipolar and laser umbilical cord blocking were difficult in 2 cases of monochorionic twins,and the amniotic banding syndrome lysis was performed in 1 case.Conclusion:Fetoscopy requires simple equipment and is relatively easy to carry out in treatment of TTTS and examination of albinism.However,in some special cases,the radiofrequency ablation,ultrasonic focusing and other equipment are needed.The pathological mechanism of amniotic band syndrome is unclear,and the ability of intrauterine surgery is limited.

关 键 词：胎儿镜 双胎输血综合征 白化病 羊膜束带综合征 减胎术 反向灌注序列 

分 类 号：R714.5[医药卫生—妇产科学]