双胎输血综合征胎盘血管铸型及深部动静脉吻合的形态学分析

Placental vascular casting molds of twin-to-twin transfusion syndrome and morphometric analysis of deep artery-to-vein anastomoses

目的建立单绒毛膜双羊膜囊（MCDA）双胎胎盘血管铸型，观察双胎输血综合征（yrrs）与胎盘形态的关系。方法收集2012年1月～2015年1月在南方医科大学附属佛山市妇幼保健院住院分娩的MCDA且无特殊并发症的患者的胎盘117例，其中23例TTTS者胎盘（TTTS组），94例非m’S者胎盘（非TTTS组）。采用改良的血管铸型方法，比较两组胎盘脐带插入、胎盘份额和胎盘表面血管吻合及深部动静脉吻合形态。结果与非TTTS组比较，TTTS组胎盘重量轻，脐带帆状附着胎盘、胎盘面积差异〉25％的发生率较高，差异均有统计学意义（P〈0．05）：TTTS组动脉一动脉（AA）吻合的胎盘数少于非TTTS组，AA吻合直径及血管总吻合直径小于非TTTS组，差异均有统计学意义（P〈0．05）；两组血管吻合总数、每个胎盘动脉-静脉（AV）吻合数、AV吻合的胎盘数、静脉一静脉（VV）吻合的胎盘数、VV吻合直径、胎盘表面AV吻合直径、深部AV吻合的胎盘数、深部AV吻合直径比较，差异均无统计学意义（P〉0．05）。结论rIYITrs胎盘脐带帆状插入率高、胎盘份额不平衡和缺乏AA吻合及AA吻合直径及总的血管吻合直径小。其AV吻合的胎盘数、吻合数量、血管直径与非TTTS胎盘无明显差异，推测AV吻合可能不是导致TTTS发生的根本原因，但可能助长了TTTS发病。

Objective To establish placental vascular casting molds of monochorionic diamniotic （MCDA） twin placen- tas so as to define the association between twin-to-twin transfusion syndrome （33TS） and morphology of placenta. Methods 117 MCDA placentas of paitients and without special complications from January 2012 to January 2015 in Foshan Maternal and Children Hospital, Southern Medical University were selected, 23 placentas of paitients with TITS as the TITS group, 94 placentas of paitients with non-TITS as the non-TTTS group. Placental vascular casting molds of MCDA were established. Placenta umbilical cord insertion, placenta share and placental vascular anastomosis, and deep arteriovenous anastomosis surface morphology of two groups were compared. Results Compared with the non- TITS group, the TITS group placentas showed lower weight of placenta, significantly higher frequencies of vclamentous cord insertion, placenta area differ〉25%, the differences were statistically significant （P 〈 0.05）. The number of artery- to-artery （AA） anastomoses of the TTTS group were less than that in the non-TTTS group, absence of AA anastomoses diameter and overall diameter in the TITS group were lower than those in the non-TTTS group, the differences were statistically significant （P 〈 0.05）. The total number of anastomoses, number of artery-to-vein （AV） in each placenta, number of AV anastomoses, presence of vein-to-vein （VV） anastomoses, diamete of the surface and deep AV anasto-moses, and diamete of deep VV anastomoses had no significant differences between two groups （P 〉 0.05）. Conclusion The placentas of patitnets with TITS shows significantly higher frequencies of velamentous cord insertion, uneven placental sharing, absence of AA anastomoses and lower anastomosic diameter of AA and overall anastomoses diameter, and there is no significant difference between the TTTS and non-TFYS patitnets on the prevalence, number, diamete of AV anastomoses. It is sug- gest that AV anastomoses can not be the main caurse of TTTS, but may contribute to the pathogenesis of TTTS.