单绒毛膜单羊膜囊双胎胎儿镜下激光离断脐带的妊娠结局分析  

Fetoscopic cord laser therapy in management of monochorionic monoamniotic twin pregnancies

作　　者：王颖[1] 原鹏波[1] 徐晓楠 王学举[1] 郭晓玥[1] 杨静[1] 赵诚[1] 魏瑗[1] 赵扬玉[1] Wang Ying;Yuan Pengbo;Xu Xiaonan;Wang Xueju;Guo Xiaoyue;Yang Jing;Zhao Cheng;Wei Yuan;Zhao Yangyu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华围产医学杂志》2021年第11期806-812,共7页Chinese Journal of Perinatal Medicine

基　　金：国家重点研发计划(2016YFC1000408)。

摘　　要：目的:探讨胎儿镜下激光离断脐带在单绒毛膜单羊膜囊(monochorionic monoamniotic,MCMA)双胎妊娠管理中的应用。方法:总结北京大学第三医院2020年1月至2021年1月共3例采用胎儿镜激光脐带电凝、切断并松解脐带缠绕的MCMA双胎病例,并检索Cochrane图书馆、PubMed、EMBASE、中国生物医学文献数据库、万方数据库和中国知网数据库,检索时限自建库至2020年12月,收集MCMA双胎通过激光阻断脐血流进行减胎的文献,汇总分析其临床情况、手术指征及方式、病情发展及母婴预后。结果:本院3例MCMA双胎于孕17~24周进行胎儿镜下脐带电凝、切断并松解脐带缠绕,其中2例足月分娩且无母婴并发症发生,1例因胎儿畸形引产。检索到7篇英文文献,无中文文献,共29例进行胎儿镜激光处理脐带的MCMA双胎病例,加上本文报道的3例,共32例。手术指征分别为双胎反向动脉灌注序列7例(21.9%),胎儿发育异常15例(46.9%),选择性胎儿生长受限7例(21.9%),双胎输血综合征1例(3.1%),双胎输血综合征合并选择性胎儿生长受限1例(3.1%),双胎之一胎死宫内1例(3.1%)。手术孕周14+1~27+3周,无手术相关的母体并发症发生。除外未松解脐带的2例和1例胎儿畸形引产外,余29例均活产。活产儿分娩孕周为24+3~40周,出生体重800~3800 g。随访时间1月龄~9岁,新生儿死亡4例(原因不详),产前即发现多发畸形1例(室间隔缺损、动脉导管未闭、肛门闭锁、副耳),余24例未发现生长发育异常、神经系统损伤等情况。结论:对于伴有脐带缠绕等需要减胎的MCMA双胎,采用激光脐带电凝、切断并松解缠绕的方式是安全有效的。Objective To analyze fetoscopic cord laser therapy for management of monochorionic monoamniotic(MCMA)twin pregnancies.Methods The clinical data of fetoscopic cord laser therapy,including cord occlusion,transection,and disentanglement in three pairs of MCMA twins from January 2020 to January 2021 in Peking University Third Hospital were summarized.Literature on cord occlusion and/or transection in MCMA twins were retrieved from Cochrane Library,PubMed,EMBASE,CBM,WanFang,and CNKI from the time at establishment to December 2020.The clinical conditions,surgical indications and methods,disease progression,and maternal and infant prognosis were analyzed.Results Three cases of MCMA twins in this study period received fetoscopic cord laser therapy between 17-24 weeks,among which two cases gave birth at full-term without any maternal or infant complications,and one was terminated due to fetal malformation.Seven English articles including 29 MCMA twin pregnancies were retrieved.In addition to the three cases reported in this article,a total of 32 cases were analyzed.The indication of cord occlusion and/or transection included twin-reversed arterial perfusion sequence(21.9%,7/32),fetal malformation(46.9%,15/32),selective fetal growth restriction(sFGR)(21.9%,7/32),twin-to-twin transfusion syndrome(TTTS)(3.1%,1/32),TTTS combined with sFGR(3.1%,1/32),single intrauterine death(3.1%,1/32).Gestational age at surgery was between 14+1 to 27+3 weeks.No maternal complication due to the operation was reported.After exclusion of two cases who did not receive cord transection and one case was terminated due to fetal malformation,all the other 29 co-twins were born alive at the gestational age between 24+3 to 40 weeks and birth weight between 800-3800 g.Among the 29 live born babies,four died soon after birth with unclarified reasons in the literature and one was born with multiple malformations which were detected prenatally,and the other 24 neonates were healthy during the follow-up from 1 month to 9 years old.Conclusions For MCMA twin

关 键 词：妊娠 双胎 脐带 胎儿镜检查 激光凝固术 脐带切断 脐带缠绕 胎儿期疗法 妊娠结局 

分 类 号：R714.5[医药卫生—妇产科学]