选择性激光凝固术式与Solomon术式治疗双胎输血综合征妊娠结局及胎盘特点比较  

Comparison of Pregnancy Outcomes and Placental Characteristics between Selective Laser Coagulation and Solomon in the Treatment of Twin to Twin Transfusion Syndrome

作　　者：王学举[1] 李璐瑶[1] 原鹏波[1] 王颖[1] 赵扬玉[1] 魏瑗[1] WANG Xueju;LI Luyao;YUAN Pengbo(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,北京100191

出　　处：《实用妇产科杂志》2021年第11期839-843,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:比较选择性激光凝固术式与Solomon术式治疗双胎输血综合征术后妊娠结局及胎盘特点的差异。方法:本研究回顾性分析2014年4月至2019年4月于北京大学第三医院产科接受胎儿镜激光治疗并最终于我院分娩的双胎输血综合征孕妇临床资料和分娩后胎盘灌注特点。研究分为选择性激光凝固术式组和Solomon术式组,比较两组术后妊娠结局和胎盘特点。结果:手术时间方面,选择性激光凝固术式组大于Solomon术式组(分别为23.5±8.8 min和22.4±6.3 min),差异有统计学意义(P=0.001)。在术后未满28周胎膜早破发生率方面,选择性激光凝固术式组高于Solomon术式组(分别为32.3%和3.8%),差异有统计学意义(P=0.008)。在残留吻合血管直径方面,动脉-动脉和静脉-静脉吻合血管大于动脉-静脉吻合血管[1.8(0.1~5.0)mm,1.3(0.7~6.4)mm和0.6(0.2~3.2)mm],差异有统计学意义(P<0.01)。结论:Solomon术式可能缩短胎儿镜激光手术时间,可降低术后未满28周胎膜早破发生率。两种术式术后残留动脉-动脉和静脉-静脉吻合血管的直径均大于动脉-静脉吻合血管。Objective:To compare the differences of pregnancy outcomes and placental characteristics between selective laser coagulation and Solomon in the treatment of twin to twin transfusion syndrome.Methods:We retrospectively analyzed the pregnancy outcomes and placental characteristics of patients with twin to twin transfusion syndrome from April 2014 to April 2019 in the Department of Obstetrics in Peking University Third Hospital,who had received laser surgery and ultimately delivered in our hospital.These patients were divided into the selective laser coagulation group and the Solomon group,and we compared the pregnancy outcomes and placental characteristics of the two groups.Results:In terms of operation time,the selective laser coagulation group was significantly longer than the Solomon group(23.5±8.8 min and 22.4±6.3 min,P=0.001).In terms of the incidence of premature rupture of membranes post operation significantly less than 28 gestational weeks,the selective laser coagulation group was higher than the Solomon group(32.3%and 3.8%,P=0.008).In terms of diameters of residual vascular anastomoses,the diameters artery to artery anastomoses and vein to vein anastomoses were significantly larger than that of artery to vein anastomoses[1.8(0.1-5.0)mm,1.3(0.7-6.4)mm and 0.6(0.2-3.2)mm,P<0.01].Conclusions:The Solomon may reduce the risk of premature rupture of membranes after surgery by shortening the intraoperative exposure time of fetoscopiclaser surgery in the treatment of twin to twin transfusion syndrome.Residual large artery-artery and vein-vein anastomoses may not affect the post operative pregnancy outcomes of the two procedures.

关 键 词：双胎输血综合征 胎儿镜下激光凝固胎盘吻合血管术 妊娠结局 胎盘 残留 吻合血管 

分 类 号：R714.56[医药卫生—妇产科学]