胎儿镜下选择性胎盘血管交通支凝固术治疗双胎输血综合征48例临床分析

Clinical Analysis of 48 Cases of Twin-Twin Transfusion Syndrome Treated by Elective Laser Photocoagulation of Communicating Vessels under Fetoscopic Laser

目的:探讨胎儿镜下选择性血管交通支凝固术(SLPCV)治疗单绒毛膜双羊膜囊双胎并发双胎输血综合征(TTTS)的临床效果。方法:收集2016年9月至2018年8月空军军医大学第一附属医院(西京医院)产科收治并接受SLPCV治疗的48例TTTS患者的临床资料,按Quintero分期标准进行分期,并分析其术中、术后并发症,随访其妊娠结局及胎儿存活情况。结果:48例患者平均年龄为28.06±4.97岁,Quintero临床分期为Ⅰ期15例、Ⅱ期31例、Ⅲ期1例、Ⅳ期1例。48例行SLPCV术患者中位孕周为23.6周,平均手术时间为43.92±13.94分钟,术后总体胎死宫内发生率为17.71%(17/96),术后胎膜早破总发生率为18.75%(9/48)。48例患者中有19例患者(39.58%)因提前终止妊娠未进入围产期,29例患者(60.42%)进入围产期。胎儿总体存活率为40.63%(39/96),双胎存活率为37.50%(18/48),单胎存活率为12.50%(6/48),至少一胎存活率为50.00%(24/48)。受血儿平均出生体质量1989.72±542.76 g,供血儿平均出生体质量1534.7±600.24 g。37例患者术前、术后血常规中血红蛋白、红细胞计数及血细胞比容进行比较,差异均有统计学意义(P=0.000)。结论:SLPCV手术能够达到较高的TTTS胎儿存活率,且较安全可靠。但术后存在血液稀释情况。

Objective:To explore the clinical effect of elective laser photocoagulation of communicating vessels(SLPCV) under fetoscope in the treatment of twin-twin transfusion syndrome(TTTS).Methods:The clinical data of 48 patients with TTTS treated by SLPCV from September 2016 to August 2018 in Xijing Hospital of AFMU were collected and analyzed for intraoperative and postoperative complications,perinatal outcome and fetal survival rate.The clinical stage of TTTS was identified according to the Quintero staging system.Results:Patient status and stage:The average age of 48 patients was 28.06±4.97 year-old.According to the Quintero staging system,15 cases were in stage Ⅰ,31 cases were in stage Ⅱ,1 case was in stage Ⅲ and 1 case was in stage Ⅳ.Perioperative status and postoperative complications:The median gestational age of 48 SLPCV patients was 23.6 weeks,and the mean operative time was 43.92±13.94 minutes.The overall incidence of intrauterine fetal death was 17.71%(17/96),and the total incidence of premature rupture of membranes was 18.75%(9/48).Pregnancy outcome:19 of 48 patients(39.58%) failed to enter the perinatal period due to the early termination of pregnancy,while the rest 29 patients(60.42%) entered the perinatal period.The overall fetal survival rate was 40.63%(39/96),the twin infant survival rate was 37.50%(18/48),the single infant survival rate was 12.50%(6/48),and at least one fetal survival rate was 50.00%(24/48).The average birth weight of recipients was 1989.72±542.76 g,and that of donors was 1534.7±600.24 g.Blood dilution after TTTS:There were significant differences on hemoglobin,red blood cell count and hematocrit of 37 patients before and after TTTS(P=0.000).Conclusions:SLPCV surgery is a safe and reliable approach to achieve a higher survival rate of TTTS,but blood dilution exists after operation.