不同宫颈长度严重双胎输血综合征孕妇SLCPV术后孕周及妊娠结局比较

Comparison of gestational weeks and pregnancy outcomes after SLCPV in pregnant women with severe cervical length and double transfusion syndrome

目的探究胎儿镜选择性胎盘血管交通支凝结术(selective laser coagulation of placental vessels,SLCPV)治疗严重双胎输血综合征(twin-twin transfusion syndrome,TTTS)孕妇的临床效果。方法选取2014年1月到2018年1月重庆三峡中心医院接受SLCPV术治疗的38例严重TTTS孕妇作为研究对象。观察孕妇SLCPV围术期情况,比较孕妇手术前后宫颈长度变化,分析宫颈长度与分娩孕周、28周内自然流产的关系。结果38例孕妇成功完成手术,手术时间(31.78±6.82)min,无出现术中和术后并发症。所有母体羊水平均减量(968.45±160.77)mL;羊水回输9例,灌注量均为500mL,胎儿手术前后大脑中动脉血流频谱无明显波动。术前宫颈长度<2.5cm孕妇分娩孕周[(28.12±5.65)周]明显短于术前宫颈长度≥2.5 cm孕妇[(32.53±5.13)周],其差异具有统计学意义(P<0.05)。宫颈长度与分娩孕周呈正相关(r=0.632,P=0.027)。28周前自然流产孕妇(n=9)术前平均宫颈长度[(2.33±0.73)cm]明显小于未流产孕妇(n=29)宫颈长度[(2.97±0.62)cm],其差异具有统计学意义(P<0.05)。结论SLCPV术治疗严重TTTS孕妇的术中和术后情况良好,手术对孕妇宫颈长度无明显影响,但宫颈长度与分娩孕周呈正相关,且28周前自然流产孕妇宫颈长度明显较短。

Objective To explore the clinical effect of selective laser coagulation of placental vessels(SLCPV)in the treatment of pregnant women with severe twin-twin transfusion syndrome(TTTS).Methods 38 patients with severe TTTS who underwent SLCPV from January 2014 to January 2018 in Chongqing Three Gorges Central Hospital were selected as subjects.The perioperative status of SLCPV was observed,the changes in cervical length between before and after operation were compared,and the relationship between cervical length and spontaneous abortion within 28 weeks of delivery was analyzed.Results The operation was successfully completed in 38 patients.The average operation time was(31.78±6.82)minutes.There were no intraoperative and postoperative complications.The level of amniotic fluid was reduced in 9 cases,and the perfusion volume was 500 mL.There was no significant fluctuation in the blood flow spectrum of middle cerebral artery before and after fetal operation.The average gestational week of delivery in patients with preoperative cervical length<2.5 cm[(28.12±5.65)weeks]was significantly shorter than that in patients with preoperative cervical length>2.5 cm[(32.53±5.13)weeks],with statistically significant differences between the two groups(P<0.05).Cervical length was positively correlated with gestational age(r=0.632,P=0.027).The mean preoperative cervical length of spontaneous abortion patients before 28 weeks[(n=9),(2.33±0.73)cm]was significantly shorter than that of non-abortion patients[(n=29),(2.97±0.62)cm],with statistically significant differences(P<0.05).Conclusions Severe TTTS patients treated by SLCPV are of good intraoperative and postoperative conditions.The surgery has no significant effect on the length of the cervix.The length of the cervix is positively correlated with the gestational age of delivery,and the length of the cervix in spontaneous abortion patients before 28 weeks is significantly shorter.