射频消融减胎术治疗选择性胎儿生长受限的效果及影响预后的因素:75例分析  

Effects of selective feticide by radiofrequency ablation and risk factors for prognosis in 75 twins complicated by selective intrauterine growth restriction

作　　者：刘婧宇 刘权瑞 赵婧雅 周祎[1] Jingyu Liu;Quanrui Liu;Jingya Zhao;Yi Zhou(Fetal Medicine Center,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院产科胎儿医学中心,广州510080

出　　处：《中华围产医学杂志》2023年第4期277-285,共9页Chinese Journal of Perinatal Medicine

基　　金：国家重点研发计划(2018YFC1002900);广东省重点领域研发计划(2019B020227001)。

摘　　要：目的探讨射频消融(radiofrequency ablation,RFA)减胎术治疗选择性胎儿生长受限(selective intrauterine growth restriction,sIUGR)保留胎妊娠结局及其影响因素,初步评价活产儿神经发育情况。方法回顾性纳入2017年1月1日至2022年3月31日在中山大学附属第一医院接受RFA减胎术并已分娩的75例sIUGR。根据减胎孕周分为孕16~19周+6组(16例)、孕20~23周+6组(44例)和≥孕24周组(15例);根据是否合并双胎输血综合征(twin-twin transfusion syndrome,TTTS)分为sIUGR合并TTTS组(36例)和单纯型sIUGR组(39例),单纯型sIUGR进一步分为Ⅰ型(3例)、Ⅱ型(27例)及Ⅲ型(9例);按保留胎是否发生不良妊娠结局分为不良妊娠结局组(49例)和非不良妊娠结局组(26例)。采用两独立样本t检验、方差分析及LSD检验、非参数检验及Nemenyi检验、χ^(2)检验和Fisher精确概率法比较组间临床特征及妊娠结局的差异;采用Kaplan-Meier法和Log-rank检验进行生存分析;采用单因素logistic回归分析保留胎不良妊娠结局的影响因素。结果(1)75例sIUGR病例RFA减胎孕周为(21.9±2.3)周(16.6~26.0周)。孕16~19周+6减胎组术前双胎估重差及RFA时长均小于孕20~23周+6组和≥孕24周组[分别为(27.8±8.4)%与(36.2±12.0)%和(39.8±15.5)%;7 min(5~14 min)与10 min(5~16 min)和12 min(8~18 min),LSD检验或Nemenyi检验,P值均<0.017];孕16~19周+6减胎组合并TTTS的比例高于孕20~23周+6组和≥孕24周组[12/16与43%(19/44)和5/15,Bonferroni校正χ^(2)检验,P值均<0.017]。不同减胎孕周组间胎膜早破、流产、胎死宫内、早产发生率及分娩孕周差异均无统计学意义(P值均>0.05)。(2)sIUGR合并TTTS组与单纯型sIUGR组比较,术前双胎估重差更小[(29.6±11.4)%与(40.1±11.8)%,t=3.88,P<0.001],胎膜早破发生率更高[47%(17/36)与21%(8/39),χ^(2)=6.01,P=0.014],活产率更低[69%(25/36)与95%(37/39),χ^(2)=8.45,P=0.004],分娩孕周更早[34.1周(26.7~40.7周)与38.0周(29.3~40.0周),Z=311.50,P=0.018]。(3)�Objective To analyze the effects of selective feticide by radiofrequency ablation(RFA)and the risk factors for adverse pregnancy outcomes in twins complicated by selective intrauterine growth restriction(sIUGR)and evaluate the neurodevelopment in live births during a short-term follow-up.Methods This study retrospectively enrolled 75 twins with sIUGR who underwent RFA for selective feticide and were delivered in the First Affiliated Hospital of Sun Yat-sen University between January 1,2017 and March 31,2022.According to the gestational age at the procedure,they were divided into three groups including 16-19+6 weeks of gestation(Group A,n=16),20-23+6 weeks of gestation(Group B,n=44)and≥24 weeks of gestation(Group C,n=15).They were also grouped according to the presence or absence of twin-twin transfusion syndrome(TTTS):sIUGR with TTTS group(n=36)and isolated sIUGR group(n=39).The 39 cases in the isolated sIUGR group were further divided into three groups according to the Doppler flow in the smaller co-twin:typeⅠ(n=3),typeⅡ(n=27)and typeⅢ(n=9).According to pregnancy outcomes,the 75 cases were divided into adverse pregnancy outcome group(n=49)and non-adverse pregnancy outcome group(n=26).Statistical analysis was performed using two independent sample t-test,one-way analysis of variance and LSD test,nonparametric test and Nemenyi test,as well as Chi-square test and Fisher's exact test to compare the difference in clinical characteristics and perinatal outcomes among groups.Kaplan-Meier survival curves and Log-rank test were used to analyze the duration of pregnancy after the procedure.Univariate logistic regression analysis was used to identify the risk factors for adverse pregnancy outcomes.Results(1)The gestational age at the time of procedure was(21.9±2.3)weeks(16.6-26.0 weeks)for all cases.The intertwin estimated fetal weight discordance(ΔEFW)was less and the duration of RFA was shorter in group A than in group B or C[(27.8±8.4)%vs(36.2±12.0)%and(39.8±15.5)%;7 min(5-14 min)vs 10 min(5-16 min)and 12 m

关 键 词：胎儿生长迟缓 射频消融术 妊娠减少 多胎 预后 

分 类 号：R714.5[医药卫生—妇产科学]