单绒毛膜性双胎行射频消融减胎术后结局英文文献的Meta分析

Meta-analysis of English Literature in the Outcome of Postoperative Radiofrequency Ablation of Single Chorionic Twins

目的通过对文献进行荟萃分析评估双胎输血综合症(TTTS)与其他单绒毛膜性双胎妊娠并发症患者行射频消融减胎术后预后。方法检索1990年12月～2019年2月行射频消融减胎术的单绒毛膜性双胎妊娠的英文文献,检索数据库PubMed以及Web of Science。结果共纳入9篇回顾性研究,包括104例TTTS患者,341例其他手术指征患者。TTTS组术后保留胎儿存活率(62.23%)低于其他手术指征组(80.35%),差异具有统计学意义(RR=0.85,95%CI:0.74～0.98,P=0.03)。两组胎膜早破发生率分别为3.36%和3.23%,差异具有统计学意义(RR=6.10,95%CI:1.05～35.44,P=0.04)。其余早产率、胎死宫内率均无统计学差异。结论射频消融术治疗单绒毛膜性双胎具有一定安全性和有效性,TTTS患者术后保留胎儿存活率较低,胎膜早破风险略高,应根据临床条件选择合适的治疗方案。

Objective To evaluate the prognosis of patients with twin-transfusion syndrome(TTTS)and other patients with monochorionic twin pregnancy complications undergoing radiofrequency ablation after fetal reduction by meta-analysis of the literature.Methods The English literature of single chorionic twin pregnancy with radiofrequency ablation and fetus reduction from December 1990 to February 2019 was searched.The database was PubMed and Web of Science.Results A total of 9 retrospective studies were included,including 104 patients with TTTS and 341 patients with other surgical indications.The survival rate of the fetus in the TTTS group(62.23%)was lower than that in the other surgical indication group(80.35%),the difference was statistically significant(RR=0.85,95%CI:0.74~0.98,P=0.03).The incidence of premature rupture of membranes was 3.36%and 3.23%,respectively,the difference was statistically significant(RR=6.10,95%CI:1.05~35.44,P=0.04).There was no significant difference in the rate of preterm birth rate and intrauterine fetal death.Conclusion Radiofrequency ablation is safe and effective in the treatment of monochorionic twins.Patients with TTTS have a lower survival rate and a slightly higher risk of premature rupture of membranes.The appropriate treatment plan should be selected according to clinical conditions.