Tsao KuoJen, Feldstein Vickie A, Albanese Craig T, Sandberg Per L, Lee Hanmin, Harrison Michael R, Farmer Diana L
Fetal Treatment Center, Department of Surgery, University of California, San Francisco 94143-0570, USA.
Am J Obstet Gynecol. 2002 Sep;187(3):635-40. doi: 10.1067/mob.2002.125242.
Acardiac/acephalic twinning is a rare anomaly in which a normal "pump" twin perfuses an acardiac twin, which results in twin reversed arterial perfusion sequence. A novel technique for selective reduction and obliteration of blood flow in the acardiac twin is described.
Thirteen consecutive cases of monochorionic twin gestation with twin reversed arterial perfusion sequence underwent selective reduction of the abnormal twin with the use of radiofrequency ablation. Under direct real-time sonographic guidance, a 3-mm (14-gauge) radiofrequency ablation needle was percutaneously inserted through the maternal abdominal wall into the intrauterine fetal abdomen at the level of the cord insertion site of the acardiac twin. Energy was applied until termination of blood flow to the acardiac fetus was documented by Doppler ultrasound scanning.
All 13 mothers tolerated the procedure without major complications. All 13 "pump" fetuses have been delivered. Twelve of 13 infants are alive and well. The first patient in this series was delivered at 24.4 weeks and the infant subsequently died from complications of prematurity. Average gestational age at intervention was 20.7 weeks, and the average gestational age at delivery was 36.2 weeks.
Radiofrequency ablation is a minimally invasive, percutaneous technique that can effectively obliterate blood supply to an acardiac twin to preserve and protect the pump twin.
无心/无头双胎妊娠是一种罕见的异常情况，即正常的“泵血”双胎为无心双胎灌注血液，从而导致双胎反向动脉灌注序列。本文描述了一种用于选择性减少并阻断无心双胎血流的新技术。
对13例连续的单绒毛膜双胎妊娠且伴有双胎反向动脉灌注序列的病例，采用射频消融术对异常双胎进行选择性减胎。在实时超声直接引导下，将一根3毫米（14号）的射频消融针经皮穿过孕妇腹壁，插入无心双胎脐带插入部位水平的子宫内胎儿腹部。施加能量，直至通过多普勒超声扫描证实无心胎儿的血流终止。
所有13位母亲均耐受该手术，无严重并发症。所有13例“泵血”胎儿均已分娩。13例婴儿中有12例存活且情况良好。该系列中的首例患者在24.4周时分娩，婴儿随后死于早产并发症。干预时的平均孕周为20.7周，分娩时的平均孕周为36.2周。
射频消融是一种微创的经皮技术，能够有效阻断无心双胎的血液供应，以保护“泵血”双胎。
