Crombleholme Timothy M
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Semin Pediatr Surg. 2003 Aug;12(3):175-81. doi: 10.1016/s1055-8586(03)00028-3.
The twin-twin transfusion syndrome (TTTS) is the most common serious complication of monochorionic twin gestations, affecting between 4% and 35% of monochorionic twin pregnancies each year in the United States. The TTTS accounts for 17% of all perinatal mortality associated with twin gestations. Standard therapy in the United States has most commonly been serial amnioreduction, which appears to improve the overall outcome. Intertwin microseptostomy similarly improves outcome but has no survival advantage over serial amnioreduction. Survivors of TTTS treated by serial amnioreduction have an 18% to 26% incidence of sonographically detectable brain abnormalities. Selective fetoscopic laser photocoagulation of chorioangiopagus has emerged as an alternative treatment strategy in TTTS with at least comparable if not superior survival to serial amnioreduction. The superiority of fetoscopic laser treatment of TTTS remains unproven and is the subject of a National Institutes of Health (NIH)-sponsored prospective randomized clinical trial comparing aggressive serial amnioreduction with selective fetoscopic laser photocoagulation for severe TTTS.
双胎输血综合征（TTTS）是单绒毛膜双胎妊娠最常见的严重并发症，在美国每年影响4%至35%的单绒毛膜双胎妊娠。TTTS占所有双胎妊娠相关围产期死亡率的17%。美国的标准治疗方法最常见的是连续羊膜腔穿刺减压术，这似乎能改善总体结局。双胎间微隔膜造口术同样能改善结局，但与连续羊膜腔穿刺减压术相比没有生存优势。接受连续羊膜腔穿刺减压术治疗的TTTS幸存者中，超声可检测到的脑异常发生率为18%至26%。胎儿镜下激光凝固胎盘吻合血管已成为TTTS的一种替代治疗策略，其生存率至少与连续羊膜腔穿刺减压术相当，甚至可能更高。胎儿镜激光治疗TTTS的优越性尚未得到证实，这是美国国立卫生研究院（NIH）赞助的一项前瞻性随机临床试验的主题，该试验比较了积极的连续羊膜腔穿刺减压术与选择性胎儿镜激光凝固术治疗严重TTTS的效果。
