经腹胎儿颅内与胸腔内注射氯化钾减胎的临床效果

Clinical effect of fetal reduction by intracranial and intrathoracic KCl injection

目的:评估中孕早期多胎妊娠经腹胎儿颅内注射氯化钾(KCl)减胎的可行性和有效性。方法:回顾性分析北京大学第三医院生殖中心2006年1月至2019年12月363例经腹减胎患者的临床资料,根据减胎穿刺部位分为两组:颅内注射组(n=196)和胸腔内注射组(n=167),比较两组减胎过程及妊娠结局。结果:两组患者平均年龄、辅助生殖技术助孕前不孕症类型、妊娠方式、减胎指征、减胎前活胎数、减灭胎儿数目、保留胎儿数目比例差异均无统计学意义(P>0.05)。颅内注射组和胸腔内注射组穿刺次数≥2次发生率(12.1%vs.8.6%,P=0.249)及更换穿刺部位发生率(10.7%vs.6.4%,P=0.161)差异均无统计学意义。减胎术后1 d复查彩超,颅内注射组和胸腔内注射组减灭胎儿胎心复跳发生率[3.6%(8/224)vs.1.1%(2/187),P=0.188]、KCl使用量[(2.6±1.0)mL vs.(2.8±1.1)mL,P=0.079]、减胎术后4周内流产率(1.0%vs.0.6%,P=0.654),差异均无统计学意义。另外,两组减胎术后总流产率、早产率、剖宫产率、分娩孕周及新生儿出生体质量差异亦无统计学意义(P>0.05)。结论:颅内注射KCl减胎术可成为胸腔内注射KCl减胎术的有效替代方案。

Objective:To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester.Methods:The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively.According to the location of fetal reduction,they were divided into two groups:Intracranial injection group(n=196)and intrathoracic injection group(n=167).The process of fetal reduction and pregnancy outcome of the two groups were compared.Results:There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology,conception method,indication for fetal reduction,starting number of fetuses,reduced number of fetuses,and finishing number of fetuses(P>0.05).There was no significant difference between the two groups in the proportion of the number of puncture≥2 times(12.1%vs.8.6%,P=0.249)and the incidence of replacing puncture site(10.7%vs.6.4%,P=0.161).The next day after fetal reduction,color Doppler ultrasound was rechecked.In the intracranial injection group and intrathoracic injection group,the incidence of fetal heartbeat recovery[3.6%(8/224)vs.1.1%(2/187),P=0.188],the volumes of KCl used[(2.6±1.0)mL vs.(2.8±1.1)mL,P=0.079],and the abortion rate within 4 weeks after fetal reduction(1.0%vs.0.6%,P=0.654)were of no significant difference.In addition,there was no significant difference in the total abortion rate after fetal reduction,premature delivery rate,cesarean section rate,delivery gestational week and neonatal birth weight between the two groups(P>0.05).Conclusion:Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.