双胎输血综合征胎儿镜术前宫颈长度与妊娠结局的研究

Correlation Between Pregnancy Outcomes and Cervical Length Before Laser Surgery for Twin-twin Transfusion Syndrome

目的探讨双胎输血综合征（twin-twin transfusion syndrome,TTTS）患者胎儿镜下胎盘交通血管激光凝固术（fetoscopic laser occlusion of chorioangiopagous vessels,FLOC）前后宫颈长度的变化及妊娠结局。方法回顾性分析2009年3月~2014年10月44例TTTS胎儿镜下胎盘交通血管激光凝固术的临床资料,根据术前经阴道超声测量的宫颈长度,分为2组,A组宫颈长度〈2.5 cm 11例,B组宫颈长度≥2.5 cm 33例,比较2组28周前自然流产率,不同孕周早产率及胎儿镜术前后宫颈长度的变化。结果 A组分娩孕周（28.0±6.0）周,明显小于B组分娩孕周（32.0±4.5）周（t=-2.345,P=0.027）。A组术后孕28周前自然流产率54.5%（6/11）,B组18.2%（6/33）,2组比较无统计学差异（χ~2=3.819,P=0.051）。胎儿镜术前后宫颈长度变化A组[中位数0.21 cm（-0.95~1.99 cm）]与B组[中位数0.30 cm（-1.00~3.00 cm）]差异无统计学意义（Z=-0.597,P=0.556）。术前宫颈长度（2.84±0.79）cm,术后复测宫颈长度（2.65±1.05）cm,术前后差异无统计学意义（t=0.919,P=0.361）。根据术后分娩孕周是否大于28孕周分为术后流产组和术后未流产组2组,前者术前测量的宫颈长度（2.38±0.94）cm,明显短于后者（3.01±0.67）cm（t=-2.481,P=0.017）。结论 TTTS术前超声测量宫颈长度是必要的,术前宫颈长度〈2.5 cm者术后分娩孕周明显小于宫颈长度≥2.5 cm者;胎儿镜手术对宫颈长度变化无影响;术后孕28周前流产者术前宫颈长度明显短于术后未流产者。

Objective To study changes of cervical length and pregnancy outcomes in twin-twin transfusion syndrome（ TTTS） patients before and after fetoscopic laser occlusion of chorioangiopagous vessels（ FLOC）. Methods A retrospective analysis was made on 44 patients with TTTS treated with FLOC. According to the cervical length detected by abdominal ultrasound measurement,the patients were divided into 2 groups（ A group： cervical length 〈2. 5 cm,11 patients; B group： cervical length ≥2. 5 cm,33 patients）. The spontaneous abortion ratio before 28 weeks,premature birth ratio and cervical length changes before and after FLOC surgery were compared between the two groups. Results Significant difference was noted in gestational age between the A group（ 28. 0 ± 6. 0 weeks） and the B group（ 32. 0 ± 4. 5 weeks）（ t =- 2. 345,P = 0. 027）. No statistical significance was seen in spontaneous abortion ratio before 28 weeks between the A group（ 54. 5%,6 /11） and the B group（ 18. 2%,6 /33）（ χ~2= 3. 819,P =0. 051）. No statistical significance was noted between the A group（ median： 0. 21 cm,range：- 0. 95- 1. 99 cm） and the B group（ median： 0. 30 cm,range：- 1. 00- 3. 00 cm） in cervical length changes before and after surgery（ Z =- 0. 597,P = 0. 556）. No changes of cervical length before（ 2. 84 ± 0. 79 cm） and after surgery（ 2. 65 ± 1. 05 cm） were obviously detected（ t = 0. 919,P =0. 361）. The patients with abortion（ less than 28 pregnancy weeks） after surgery showed significantly shorter cervical length than patients without abortion after surgery [（ 2. 38 ± 0. 94） cm vs.（ 3. 01 ± 0. 67） cm; t =- 2. 481,P = 0. 017]. Conclusions For TTTS patients it is essential to measure cervical length before FLOC. Gestational age is significantly lower in patients with cervical length〈 2. 5 cm as compared to patients with cervical length ≥2. 5 cm. FLOC has not affect cervical length. Patients with abortion before 28 pregnancy weeks after surgery showed significantly shorter cervical length than patients without abortion after surgery.