双胎输血综合征24例临床分析

Clinical Analysis of 24 Twin to Twin Transfusion Syndrome(TTTS)

目的:探讨双胎输血综合征的临床诊断、治疗及预后。方法:回顾性分析2004～2006年收治的24例双胎输血综合征患者的临床资料,对诊断、治疗、分娩方式、新生儿预后等情况进行分析。结果:双胎输血综合征占单绒毛膜双胎的5.76%,其中明确分级18例(Ⅰ级8例,Ⅱ级1例,Ⅲ级5例,Ⅳ级1例,Ⅴ级3例)。Ⅲ～Ⅴ级平均终止孕周为29.8±5.2周,Ⅲ～Ⅴ级围生儿死亡率100%。24例患者11例行剖宫产术,5例行引产,8例自然临产分娩,共获18个预后良好新生儿。结论:诊断时分级越高,孕周越小,围生儿死亡率越高;尽早行彩色超声检查以明确分级有助于临床治疗和评估预后,并能改善新生儿预后。

Objective：To investigate the diagnosis,treatment and prognosis of twin to twin transfusion syndrome （TTTS）. Methods：24 cases of TTTS were studied retrospectively from Jan 2004 to Dec 2006 in our hospital. The diagnosis, treatment, delivery methods and neonatal prognosis were analyzed. Results：The incidence of TTTS was 5.76% in monochorionic twin pregnancies. Eighteen cases of 24 TTTS were staged （8 cases at stagel, 1 at stage Ⅱ, 5 at stage Ⅲ, 1 at stageⅣ, 3 at stageⅤ ）. The average delivery gestational week of stage Ⅲ～Ⅴ was 29.8±5.2 weeks, and the death rate of perineonate of stage Ⅲ～Ⅴ was 100%. Eleven cases of 24 TTTS deliveried by cesarean section, 5 were terminated by induction, and 8 were vaginal delivery. There were 18 nenatus on good prognosis. Conclusions：The higher stage and the lesser gestational week when diagnosis, the higher death rate of perineonate. To check by colour ultrasound as early as possible and staging of TTTS may be helpful to treatment and evaluate the prognosis, as well as to improve the fetal prognosis.