Moise Kenneth J, Dorman Karen, Lamvu Georgine, Saade George R, Fisk Nicholas M, Dickinson Jan E, Wilson R D, Gagnon Alain, Belfort Michael A, O'Shaughnessy Richard O, Chitkara Usha, Hassan Sonia S, Johnson Anthony, Sciscione Anthony, Skupski Daniel
Department of Obstetrics and Gynecology of the University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):701-7. doi: 10.1016/j.ajog.2005.01.067.
Left untreated, severe twin-to-twin transfusion syndrome (TTTS) presenting in the early second trimester of pregnancy is often associated with significant maternal morbidity and almost universal perinatal loss. Removal of excessive amounts of amniotic fluid through serial amniocenteses (amnioreduction) has been the mainstay of therapy. We sought to compare amnioreduction to intentional perforation of the intervening twin membrane (septostomy).
Pregnant women with TTTS before 24 weeks' gestation were randomly assigned to serial amnioreduction or septostomy. A single puncture technique under ultrasound guidance was used for the septostomy. The primary outcome measure was survival to neonatal discharge, and was assessed based on the number of pregnancies or the number of fetuses as appropriate.
The study was terminated at the planned interim analysis stage after 73 women were enrolled. This was because the rate of survival of at least 1 infant was similar in the amnioreduction group compared to the septostomy group (78% vs 80% of pregnancies, respectively; RR=0.94, 95%CI 0.55-1.61; P=.82). Patient undergoing septostomy were more likely to require a single procedure for treatment (64% vs 46%; P=.04).
Although overall perinatal survival is not enhanced, septostomy offers the advantage of often requiring a single procedure compared to serial amnioreduction in the treatment of severe twin-to-twin transfusion syndrome.
妊娠中期早期出现的未经治疗的严重双胎输血综合征（TTTS）通常与显著的母体发病率相关，且几乎所有围产儿都会死亡。通过连续羊膜腔穿刺术（羊水减量）去除过量羊水一直是主要治疗方法。我们试图比较羊水减量与介入双胎膜的故意穿孔术（造口术）。
妊娠24周前患有TTTS的孕妇被随机分配接受连续羊水减量或造口术。造口术采用超声引导下的单穿刺技术。主要结局指标是新生儿出院时的存活率，并根据妊娠数或胎儿数进行适当评估。
在纳入73名女性后，该研究在计划的中期分析阶段终止。这是因为羊水减量组与造口术组中至少有1名婴儿存活的比例相似（分别为妊娠数的78%和80%；RR = 0.94，95%CI 0.55 - 1.61；P = 0.82）。接受造口术的患者更有可能只需一次手术即可治疗（64%对46%；P = 0.04）。
虽然总体围产儿存活率没有提高，但在治疗严重双胎输血综合征时，与连续羊水减量相比，造口术的优势在于通常只需一次手术。
