双胎无心反向灌注序列的超声应用及治疗进展

Ultrasound Application and Treatment Progress of Twin Fetal Heartless Reverse Perfusion Sequence

目的总结双胎反向动脉灌注序列征(TRAPS)的自然病程,探讨TRAPS的产前治疗进展。方法回顾性分析2012年1月—2018年8月在该院产前超声检查诊断为TRAPS的16例胎儿的超声表现及妊娠结局。结果16例TRAPS纳入研究,TRAPS超声表现:①寄生胎畸形类型:16例寄生胎中14例表现为无形无心型(可见躯干和下肢),1例表现为有头无心型(空洞脑、无心脏遗迹),1例表现为有头有心(有头、有心脏遗迹、未见胎心搏动)。②寄生胎伴发畸形:16例无心畸胎儿皮肤水肿8例,颈部水囊瘤5例,单脐动脉3例,脐膨出2例,均见脐动脉血流反向进入腹腔。③泵血儿超声表现:16例泵血儿合并心脏畸形3例(1例为心脏室间隔缺损、共同动脉干;2例为室间隔缺损)。该院16例TRAPS的结局为正常分娩4例,自然流产3例,引产9例。结论产前超声可以明确诊断TRAPS,对临床是否干预治疗及干预时机的选择有重要价值,宫内干预可以有效阻断胎盘内的血管吻合支,改善泵血胎的预后。

Objective To summarize the natural course of double-arterial arterial perfusion sequence(TRAPS)and to explore the progress of TRAPS in prenatal treatment.Methods The ultrasound findings and pregnancy outcomes of 16 fetuses diagnosed as TRAPS in the hospital from January 2012 to August 2018 were retrospectively analyzed.Results 16 cases of TRAPS were included in the study.TRAPS ultrasound showed:1.parasitic malformation type:14 cases of 16 cases of parasitic fetus showed invisible and non-cardiac type(visible trunk and lower limb),and 1 case showed headless and non-cardiac type(empty brain,no heart remnant),and one case showed a head and heart(with head,heart remnant,no fetal heartbeat).2.parasitic fetal malformation:16 cases of non-cardiac fetal skin edema in 8 cases,neck water cyst tumor in 5 cases,single umbilical artery in 3 cases,umbilical bulge in 2 cases,all see umbilical artery blood flow reverse into the abdominal cavity.3.Ultrasound performance of pumping blood:16 cases of pumping blood combined with cardiac malformation in 3 cases(1 case of ventricular septal defect,common artery trunk;2 cases of ventricular septal defect).The outcome of 16 cases of TRAPS in the hospital was 4 cases of normal delivery,3 cases of spontaneous abortion,and 9 cases of induced labor.Conclusion Prenatal ultrasound can clearly diagnose TRAPS,which is of great value for clinical intervention and the timing of intervention.Interuterine intervention can effectively block the vascular anastomosis in the placenta and improve the prognosis of the pumped fetus.