双胎输血综合征行胎儿镜激光凝固术后未足月胎膜早破发生影响因素分析  

Analysis of factors for the occurrence of preterm premature rupture of membranes after fetoscopic laser coagulation in twin-twin transfusion syndrome

作　　者：彭羽 尹少尉[1] 刘嘉欣 刘彩霞[1] PENG Yu;YIN Shao-wei;LIU Jia-xin;LIU Cai-xia(Department of Obstetrics 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省母胎医学重点实验室中国医科大学出生队列中心,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2022年第2期191-195,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2018YFC1002902,2018YFC1002900);中国医科大学2019年度医疗新技术新项目(112-3111190311)。

摘　　要：目的探讨双胎输血综合征(TTTS)行胎儿镜激光凝固术(FLC)后未足月胎膜早破(PPROM)发生的影响因素。方法采用回顾性研究方法纳入2011年6月至2020年6月于中国医科大学附属盛京医院行FLC的75例TTTS病例,分为未发生PPROM组(n=48)和PPROM组(n=27)。分析影响PPROM发生的相关因素。结果单因素分析显示,未发生PPROM组和PPROM组间Trocar插入点与子宫颈内口平均距离[(14.98±4.69)cm vs.(10.67±3.59)cm(P<0.001)]、镇静剂使用率[37.50%vs.14.81%(P=0.038)]、中位手术时间[31.5(25.5,40.0)min vs.40.0(30.0,55.0)min(P=0.009)]、术中羊水减量速率[(50.40±18.06)mL/min vs.(63.43±14.56)m L/min(P=0.002)]、中位分娩孕周[31.93(27.36,35.61)周、29.43(25.29,32.14)周(P=0.038)]差异有统计学意义。多因素分析显示,Trocar插入点与子宫颈内口距离(P=0.004)和术中羊水减量速率(P=0.008)在两组间差异有统计学意义。结论影响TTTS行FLC术后PPROM发生的因素是多方面的,其中Trocar插入点位置以及胎膜本身的机械属性和子宫形态快速改变带来的力学变化不可忽视。Objective To investigate the factors influencing the occurrence of preterm premature rupture of membranes(PPROM)in twin-twin transfusion syndrome(TTTS)undergoing fetoscopic laser coagulation(FLC).Methods This was a retrospective study of 75 cases of TTTS who underwent FLC in Shengjing Hospital of China Medical University from June 2011 to June 2020.They were divided into two groups:no-PPROM group(n=48)and PPROM group(n=27).Results In no-PPROM group and PPROM group,the mean distance between the Trocar insertion point and the internal cervical os was(14.98±4.69)cm vs.(10.67±3.59)cm(P<0.001). The sedation use rate was 37.50% vs.14.81%(P=0.038).The median operation time was 31.5(25.5,40.0)min and 40.0(30.0,55.0)min,respectively(P=0.009).The intraoperative amnioreduction rate was(50.40 ± 18.06)mL/min vs.(63.43 ± 14.56)m L/min(P=0.002).The median gestational weeks of delivery were 31.93(27.36,35.61)weeks and 29.43(25.29,32.14)weeks,respectively(P=0.038).Multivariate analysis of the distance between the Trocar insertion point and the internal cervical os(P=0.004)and the rate of intraoperative amnioreduction(P=0.008)showed statistically significant differences in the two groups. Conclusion The factors affecting the occurrence of PPROM after FLC in TTTS are multiple,among which location of Trocar insertion site as well as the mechanical properties of the fetal membrane itself and the mechanical changes brought about by the rapid change in uterine morphology are not negligible.

关 键 词：双胎输血综合征 未足月胎膜早破 胎儿镜激光凝固术 应变率 TROCAR 

分 类 号：R714.23[医药卫生—妇产科学]