双胎输血综合征研究现状及进展

Updated Researches in Twin-twin Transfusion Syndrome

双胎输血综合征的诊断目前多采用Quintero诊断分级标准。但很多研究认为,应在其基础上加入胎儿心血管功能状况和胎盘血管有无动脉-动脉交通支存在的评估。双胎输血综合征治疗方法飞速发展,对严重病例现多同时采用系列羊水减量术、胎儿镜下激光凝结胎盘血管交通支术和羊膜中隔微型穿孔术3种方法以提高疗效。虽血管活性物质可能导致双胎输血综合征发病,但成功模拟的双胎输血综合征疾病进展模型显示,胎盘血管交通支在其病理生理机制中起关键作用。

The widely used Quintero staging system in the estimation of twin-twin transfusion syndrome （TTTS） is still controversial. A new staging system including fetal cardiac function assessment and placental A-A anastomosis detection is proposed. Alternatives for TTTS treatment include serial amnioreduction, septostomy, and selective fetoscopic laser photocoagulation. In severe TTTS cases, these methods can be used in combination for optimal effect. The etiology of TITS remains unknown, while vasoactive mediators may participate in the pathophysiology of TTTS. Mathematical models describing the onset and development of the four stages of TITS may contribute to the role of placental vascular connections in the pathogenesis of TITS.