不同单绒毛膜双羊膜囊双胎妊娠并发症射频消融减胎术后妊娠结局分析  

Analysis of pregnancy outcomes after radiofrequency ablation reduction for different MCDA complications

作　　者：李根霞[1] 李孟宇 张俊雅 谢明坤[1] 李娇 冯帆[2] 董理 LI Gen-xia;LI Meng-yu;ZHANG Jun-ya;XIE Ming-hun;LI Jiao;FENG Fan;DONG Li(Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院产科,河南郑州450052 [2]郑州大学第三附属医院超声科,河南郑州450052

出　　处：《中国实用妇科与产科杂志》2024年第2期230-234,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：河南省医学科技攻关计划联合共建项目(2018020196)。

摘　　要：目的探讨不同单绒毛膜双羊膜囊双胎妊娠(MCDA)特有并发症行射频消融减胎术(RFA)后的妊娠结局。方法回顾性纳入2015年7月至2021年12月在郑州大学第三附属医院行RFA并已分娩的99例MCDA孕妇。根据MCDA并发症类型分为:双胎输血综合征(TTTS)组(25例),选择性胎儿宫内生长受限(sIUGR)组(23例),双胎反向动脉灌注序列征(TRAPs)组(22例),双胎之一胎发育异常(DA)组(29例)。根据手术孕周分为:≤16孕周组(9例),>16~<26孕周组(70例),≥26孕周组(20例)。采用单因素方差分析及χ^(2)检验或Fisher精确概率法比较组间临床特征及妊娠结局的差异,采用log-rank检验进行生存分析。结果99例孕妇减胎术后保留胎儿存活率为79.8%,未足月胎膜早破率为21.2%,总早产率为40.4%,三项指标在各组间的差异均无统计学意义(P>0.05)。TRAPs组手术孕周[(20.33±4.57)周]明显小于sIUGR组[(23.70±2.92)周]及DA组[(22.65±4.37)周],差异有统计学意义(P<0.05)。≥26孕周组消融周期及手术时长大于另外两组,差异有统计学意义(P<0.05)。结论MCDA不同并发症RFA后取得的妊娠结局相似。随手术孕周的增大,手术时长及消融周期均增加,但不同手术孕周的孕妇分娩孕周相似。Objective To investigate the pregnancy outcomes of specific complications of monochorionic diamniotic twins(MCDA)after radiofrequency ablation reduction(RFA).Methods A total of 99 pregnant women with monochorionic diamniotic twins who had delivered after RFA reduction in the Third Affiliated Hospital of Zhengzhou University from July 2015 to December 2021 were retrospectively included.According to the type of MCDA complications,they were divided into TTTS group(25 cases),sIUGR group(23 cases),TRAPs group(22 cases)and DA group(abnormal development of one twin)(29 cases).According to the gestational age at operation,the patients were divided into:≤16 weeks group(9 cases),>16 to<26 weeks group(70 cases),≥26 weeks group(20 cases).Univariate analysis of variance and χ^(2)-test or Fisher exact probability method were used to compare the differences in clinical features and pregnancy outcomes among groups.Log-rank test was used for survival analysis.Results The survival rate of fetal preservation was 79.8%,the incidence of premature rupture of membranes before term was 21.2%,and the total preterm birth rate was 40.4%.There was no statistically significant difference between the three indicators among the groups(P>0.05).The gestational age at operation of TRAPs group[(20.33±4.57)weeks]was significantly smaller than that of sIUGR group[(23.70±2.92)weeks]and DA group[(22.65±4.37)weeks](P<0.05).The ablation period and operation time of≥26 weeks group were greater than the other two groups(P<0.05).Conclusions The pregnancy outcomes are similar after reducing the fetus in monochorionic diamniotic twins.With the increase of gestational age at operation,both the duration of operation and the ablation period increase,but the gestational age at delivery is similar in women with different gestational age at operation.

关 键 词：射频消融减胎术 单绒毛膜双羊膜囊双胎妊娠 并发症 手术孕周 

分 类 号：R714.7[医药卫生—妇产科学]