两种胎儿镜下激光凝固术治疗双胎输血综合征的疗效比较

A Comparative Study of Curative Effect after Two Kinds of Fetoscopy Laser Photocoagulation of TTTS

目的:探讨两种胎儿镜下激光凝固术(FLP)治疗双胎输血综合征(TTTS)的效果。方法:回顾性分析2014年6月至2022年5月于陆军军医大学第一附属医院行FLP治疗的TTTS 112例患者的临床资料,根据不同手术方式,纳入病例被分为选择性吻合血管激光凝固术组(SLPCV组,57例)和所罗门术组(Solomon组,55例)。评估两种FLP的手术情况、妊娠结局及术后并发症。结果:两组手术孕周、手术时长、术中出血量以及住院天数差异均无统计学意义(P>0.05);两组至少一胎存活、双胎存活、单胎存活、早产≤30孕周、早产>30孕周和流产率的比较,差异均无统计学意义(P>0.05)。SLPCV组与Solomon组术后并发症包括胎膜早破、胎盘早剥、羊膜腔感染以及术后双胎死亡,总体发生率相近(89.47%vs.89.09%),两组的并发症中胎膜早破发生率最高(分别为77.19%、80.00%)。结论:两种FLP治疗对改善TTTS妊娠结局均具有良好的效果,正确识别参与病理机制的胎盘血管交通支,优化手术流程以避免交通支遗漏,远期疗效还需要进一步探讨。

Objective:To investigate the effects of two kinds of fetoscopy laser photocoagulation(FLP)in the treatment of twin-to-twin transfusion syndrome(TTTS).Methods:The clinical data of 112 patients who received FLP for TTTS in the First Affiliated Hospital of The Army Medical University from June 2014 to May 2022 were retrospectively analyzed.According to different surgical methods,the included patients were divided into selective anastomosis vascular laser coagulation group(SLPCV group,57 cases)and Solomon group(55 cases).The operation,pregnancy outcome,and postoperative complications of the two FLPS were evaluated.Results:There were no significant differences in gestational weeks,operation duration,intraoperative blood loss,and hospital days between the two groups(P>0.05):There were no significant differences in the rates of at least one birth survival,twin birth survival,single birth survival,preterm birth≤30 weeks,preterm birth>30 weeks and abortion between the two groups(P>0.05).Postoperative complications including premature rupture of membranes,placental abruption,amniotic cavity infection,and postoperative twin death were similar in SLPCV group and Solomon group(89.47%vs.89.09%),with the highest incidence of premature rupture of membranes in both groups(77.19%and 80.00%,respectively).Conclusions:Both FLP treatments have a good effect on the pregnancy outcome of TTTS.The correct identification of placental vascular communication branches involved in the pathological mechanism and the optimization of surgical procedures to avoid the absence of communication branches need to be further discussed for long-term efficacy.