射频消融选择性减胎术在复杂性单绒毛膜多胎妊娠中的临床应用研究  

Clinical application of radiofrequency ablation for selective fetal reduction in complicated monochorionic multiple pregnancy

作　　者：姜海利[1] 王欣[1] 王清[1] 张涛[1] 李莉[1] 李晓菲[2] 吴青青[2] JIANG Hai-li;WANG Xin;WANG Qing;ZHANG Tao;LI Li;LI Xiao-fei;WU Qing-qing(Beijing Obstetrics and Gynecology Hospital,Capital Medical University&Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院产科,北京100006 [2]首都医科大学附属北京妇产医院/北京妇幼保健院超声科,北京100006

出　　处：《中国实用妇科与产科杂志》2023年第4期457-461,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划“生育健康及妇女儿童健康保障”重点专项(2022YFC2703304);中青年学科骨干培养专项(FCYY201912)。

摘　　要：目的探讨射频消融选择性减胎术在复杂性单绒毛膜多胎妊娠中的临床应用特点、术后监测和围产期结局。方法选取2019年3月至2021年6月在首都医科大学附属北京妇产医院产前诊断中心行射频消融选择性减胎术的复杂性单绒毛膜性多胎妊娠孕妇25例,回顾性分析其手术指征、术中情况、术后监测以及围产期结局。结果(1)25例行射频消融选择性减胎术的孕妇,手术成功率为92.0%(23/25),保留胎儿存活率为80.0%(20/25),减胎平均孕周为(20.1±3.1)周,射频消融的平均时间为(133.7±57.1)s,循环次数为(2.6±0.6)个循环。(2)20例胎儿存活病例中,平均分娩孕周为(36.3±3.3)周,新生儿平均体重为(2639.6±560.2)g。(3)20例胎儿存活病例随访中,17例胎儿大脑中动脉血流峰值流速值正常,3例大于1.5 MoM,但在1周内均恢复正常;12例在孕25~31周时进行了胎儿磁共振成像(MRI)检测,结果未见异常。结论射频消融选择性减胎术在复杂性单绒毛膜性多胎妊娠的宫内治疗中安全有效,提高手术技巧和术后监测有助于改善围产期结局。Objective To investigate the clinical characteristics,postoperative monitoring and perinatal outcomes of radiofrequency ablation(RFA)for selective fetal reduction in complicated monochorionic multiple pregnancy.Methods Totally 25 pregnant women with monochorionic multiple pregnancy who underwent RFA for selective fetal reduction in the Prenatal Diagnosis Center of Beijing Obstetrics and Gynecology Hospital,Capital Medical University from March 2019 to June 2021 were selected.The operative indications,intraoperative conditions,postoperative monitoring,and perinatal outcomes were retrospectively analyzed.Results(1)In 25 cases of RFA,the overall success rate was 92.0%(23/25),the overall survival rate of fetus was 80.0%(20/25),the mean gestational age was(20.1±3.1)weeks,the mean RFA procedure time was(133.7±57.1)seconds and the cycle number was(2.6±0.6).(2)In the 20 cases of surviving fetuses,the mean gestational age at delivery was(36.3±3.3)weeks,the mean birth weight was(2639.6±560.2)g.(3)In the follow-up of 20 cases of surviving fetuses,17 cases showed a normal MCA-PSV value,but the value increased in 3 cases(>1.5 MoM)and returned to normal within 1 week.Fetal MRI was performed at 25-31 gestational weeks in 12 cases and the results were normal.Conclusion Radiofrequency ablation for selective fetal reduction is safe and effective in complicated monochorionic multiple pregnancy.Improving surgical skills and subsequent postoperative monitoring helps to improve perinatal outcome.

关 键 词：复杂性单绒毛膜多胎妊娠 射频消融选择性减胎术 围产期结局 

分 类 号：R714.23[医药卫生—妇产科学]