胎儿镜下胎盘血管交通支凝固术治疗双胎输血综合-第三军医大学学报.DOCVIP

胎儿镜下胎盘血管交通支凝固术治疗双胎输血综合征6例临床分析 李俊男1，梁志清1，陈功立1，管唯靓1，陈诚1，余美佳1，常青1，葛晓冬2，张晓航3，蔡萍4（第三军医大学西南医院：1妇产科，2病理科，3超声科，4放射科，重庆400038） 摘要：目的 双胎输血综合征（TTTS）是影响单绒毛膜双胎围生期结局的主要原因，我们报道胎儿镜下胎盘血管交通支凝固术（选择性或非选择性）治疗TTTS对围生结局的影响。方法 6例TTTS接受胎儿镜下胎盘血管交通支凝固术治疗，在实时超声引导下，直径3mm胎儿镜经孕妇腹壁进入羊水过多的受血儿羊膜腔，在胎儿镜下找到胎盘血管交通支，采用Nd:YAG激光光纤或双极电凝凝固血管交通支。结果 6位母亲均能耐受手术过程没有严重的并发症发生。1例双胎于34＋5周分娩，双胎均存活，目前随访婴儿发育良好，无神经系统等后遗症；1例双胎治疗后继续妊娠，随访双胎儿情况良好；另4例因不同原因而放弃妊娠行引产术。结论 胎儿镜下胎盘血管交通支凝固术治疗TTTS能提高围生儿的存活率，减少存活儿神经系统的发病率。 关键词：双胎输血综合征；单绒毛膜双胎；胎儿镜下胎盘血管交通支凝固术 Retrospective analysis of fetoscopic photocoagulation of communicating placental vessels of Twin-twin transfusion syndrome Li Jun-nan1, Liang Zhi-qing1, Chen Gong-li1, Guan Wei-jing1, Chen Cheng1, Yu Mei-jia1, Chang Qing1, Ge Xiao-dong2, Zhang Xiao-hang3, Cai Ping4 (1.Department of Obstetrics and Gynecology, 2.Department of Pathology, 3.Department of Ultrasound, 4.Department of Radiology ,The Affiliated Southwest Hospital of the Third Military Medical University, ChongQing, 400038, China) Abstract:Objective Twin-twin transfusion syndrome (TTTS) is the major reason which affects perinatal outcomes in monochorionic twin pregnancies. A novel technique for fetoscopic photocoagulation of communicating placental vessels in TTTS (selective or non-selective) is described.Methods Six TTTS underwent fetoscopic photocoagulation of communicating vessels. Under direct real-time sonographic guidance, a 3-mm-diameter fetoscope was percutaneously inserted through the maternal abdominal wall into the amniotic cavity of the recipient twin. A combination of ultrasonographic and fetoscopic vision was used to identify the crossing vessels which were systematically coagulated using Nd:YAG laser fiber or bipolar electrocoagulation. Results All 6 mothers tolerated the procedure without major complications.The first patient in this series was deliveried at 34w+5d and the two infants are well without neurological sequela. The patient 2 is following up and the two fetuses are well. The other four pregnancies