经阴道两种减胎术的比较研究

Comparative Analysis of Two Methods of Transvaginal Multifetal Pregnancy Reduction

目的 :对比分析胸心搏动区注射和卵黄囊抽吸进行选择性减胎手术的治疗效果。 方法 :选择多胎妊娠患者共 2 3例 ,采取胸心搏动区注射 10 %KCl( 8例 )和卵黄囊抽吸 ( 15例 )进行多胎妊娠选择性减胎手术 ,观察平均穿刺数、平均减胎操作时间、减胎失败率、流产发生率、感染发生率等。 结果 :卵黄囊抽吸的平均减胎时间 ( 2 .8± 0 .7)min ,明显少于胸心搏动区注射的 ( 5 .11± 1.35 )min(P <0 .0 5 ) ;卵黄囊抽吸和胸心搏动区注射感染发生率分别为6 .7%和 37.5 % (P >0 .0 5 ) ,但胸心搏动区注射感染发生率有高于卵黄囊抽吸的趋势 ;而在平均穿刺次数、减胎失败率、流产发生率方面 ,两种方法差异无显著性 (P >0 .0 5 )。 结论 :卵黄囊抽吸和胸心搏动区注射减胎术均是安全可靠的减胎方法 ,但卵黄囊抽吸减胎术具有操作时间短、感染发生率低等优点 ,适用于妊娠 6 0d内的多胎妊娠患者。

Objective: To make a comparartively analysis of the effects of 10% KCl injection into the fatal cardiac area and yolk sac aspiration on multifetal pregnancy reduction. Methods: Twenty three patients with multifetus were selected in the investigation. Eight of the patients accepted 10% KCl injection into the fatal cardiac area, and 15 of them received yolk sac aspiration. The average number of punctures, average time of reduction operation, failure rate of operation, abortion rate, and infection rate were observed. Results: The average time of reduction operation[ ( 2.8 ± 0.7 ) min] of aspiration was significantly lower than that of 10% KCl injection [( 5.11 ± 1.35 ) min]( P < 0.05 ). The infection rate of yolk sac aspiration was 6.7 %, lower than that of 10% KCl injection ( 37.5 %)( P > 0.05 ). Cardic area injection showed a higher infection rate, and no significant difference was observed in the average number of punctures, failure rate of operation and abortion rate( P > 0.05 ). Conclusion: Although both yolk sac aspiration and cardiac area injection were safe and reliable methods for multifetal pregnancy reduction, the former is worth recommending for its shorter operation time heeded and lower infection rate, especially for the multifetal patients within 60 gestation days.