孕中期单绒毛膜双胎妊娠的选择性减胎:不同技术的系统评价  

Selective fetal reduction in monochorionic twin pregnancies during the second trimester:a systematic review of different techniques

作　　者：刘彦 姚丙帅 李磊 LIU Yan;YAO Bingshuai;LI Lei(Graduate Department,Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250117,China;Obstetrics and Gynecology Department,The Provincial Hospital Affiliated to Shandong First Medical University&Shandong Academy of Medical Sciences,Jinan 250021,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)研究生部,山东济南250117 [2]山东第一医科大学附属省立医院妇产科,山东济南250021

出　　处：《山东第一医科大学(山东省医学科学院)学报》2025年第1期58-64,共7页Journal of Shandong First Medical University & Shandong Academy of Medical Sciences

摘　　要：近年来,由于各种辅助生殖技术的发展,多胎妊娠的发生率迅速上升,多胎妊娠与死产风险和新生儿死亡风险也相应增加。多胎妊娠主要包括单绒毛膜双胎妊娠、双绒毛膜双胎妊娠,主要并发症包括双胎输血综合征、选择性胎儿生长受限、动脉反向灌注序列、贫血多血质序列征。有时必须考虑选择终止其中一个胎儿,以尽可能地减少对另一个胎儿的风险或增加胎儿存活的机会,选择终止受影响的胎儿对健康胎儿有利。目前有多种减胎技术在临床中应用使胎儿围生期、生存期延长,新生儿并发症(脑损伤和神经发育障碍)的发生率降低。分析比较射频消融术、微波消融术、脐带血管双极凝固、脐带血管双极凝固、高强度聚焦超声刀等选择性减胎后复杂单绒毛膜妊娠的围产儿结局。结果发现,不同减胎技术各有优点,并且各自的适应证不同。双胎并发症为选择性胎儿生长受限时,可优先考虑行射频消融术减胎治疗,且其Ⅱ型比Ⅲ型的存活率高;双胎并发症为动脉反向灌注序列时,可优先考虑微波消融治疗,且与降低早产风险有关。目前,高强度聚焦超声刀也在逐步应用于动脉反向灌注序列的治疗。由于脐带结扎所致的早产率与死亡率较高,正在逐步减少应用。In recent years,the development of various assisted reproductive technologies has led to a rapid increase in the incidence of multiple pregnancies,and the risk of stillbirth and neonatal mortality has also increased accordingly.Multiple pregnancies mainly include single chorionic twin pregnancies and double chorionic twin pregnancies.The main complications include twin to twin transfusion syndrome,selective fetal growth restriction,arterial reverse perfusion sequences and anemic polyvascular sequencing.Sometimes it is necessary to consider terminating one of the fetuses in order to minimize the risk to the other fetus or increase the chances of fetal survival.Choosing to terminate affected twins is beneficial for healthy fetuses.At present,there are various fetal reduction techniques applied in clinical practice,which prolong the perinatal and survival periods of fetuses,and reduce the incidence of neonatal complications(brain injury and neurodevelopmental disorders).By analyzing and comparing the perinatal outcomes of complex monochorionic pregnancies after selective fetal reduction using radiofrequency ablation,microwave ablation,bipolar coagulation of umbilical cord blood vessels,bipolar coagulation of umbilical cord blood vessels,and high-intensity focused ultrasound knife,it is found that different fetal reduction techniques have their own advantages and different indications.When the complication of twin pregnancy is selective fetal growth restriction,radiofrequency ablation for fetal reduction treatment can be prioritized,and the survival rate of selective fetal growth restriction typeⅡis higher than that of typeⅢ.When the complication of twin pregnancy is arterial reverse perfusion sequences,microwave ablation therapy can be prioritized and is associated with reducing the risk of premature birth.At present,high-intensity focused ultrasound knives are gradually being applied in the treatment of arterial reverse perfusion sequences.Due to the high rates of premature birth and mortality caused by umbilic

关 键 词：单绒毛膜双胎 射频消融术 微波消融术 脐带血管双极凝固 脐带结扎术 高强度聚焦超声刀 

分 类 号：R71[医药卫生—妇产科学]