Robyr Romaine, Lewi Liesbeth, Salomon Laurent J, Yamamoto Masami, Bernard Jean-Pierre, Deprest Jan, Ville Yves
Department of Obstetrics and Gynecology, Paris-Ouest University, CHI Poissy-St-Germain, France.
Am J Obstet Gynecol. 2006 Mar;194(3):796-803. doi: 10.1016/j.ajog.2005.08.069.
This study was undertaken to report on the prevalence and management of late complications in twin-to-twin transfusion syndrome (TTTS) treated by laser therapy when both twins are alive 1 week after surgery.
A total of 151 consecutive TTTS cases were treated by selective fetoscopic laser therapy. Cases in which both twins were alive 1 week after surgery were followed up with ultrasound and Doppler examination, including middle-cerebral artery peak systolic velocity measurement (MCA-PSV).
In the 151 cases treated with laser, both twins were still alive 7 days after the procedure in 101 cases. Intrauterine death of 1 and both twins occurred in 7 and 1 cases, respectively. Recurrence of TTTS with the polyhydramnios-oligohydramnios sequence occurred in 14 (14%) cases. In another 13 (13%) cases, amniotic fluid remained normal in both sacs, but MCA-PSV increased above 1.5 MoM in 1 twin and decreased concomitantly below 0.8 MoM in the co-twin. This was related to anemia and polycythemia, respectively, and resulted from unidirectional feto-fetal blood transfusion, mainly from former recipients into former donors. Late complications were managed accordingly by repeat laser, amnioreduction, cord coagulation, intrauterine blood transfusion, or elective delivery.
MCA-PSV Doppler measurements are useful in the follow-up of double survivors to detect and manage late complications after selective laser therapy.
本研究旨在报告激光治疗双胎输血综合征（TTTS）后1周，两个胎儿均存活时晚期并发症的发生率及处理情况。
共151例连续的TTTS病例接受了选择性胎儿镜激光治疗。对术后1周两个胎儿均存活的病例进行超声和多普勒检查随访，包括测量大脑中动脉收缩期峰值流速（MCA-PSV）。
在接受激光治疗的151例病例中，术后7天两个胎儿均存活的有101例。分别有7例和1例出现单胎宫内死亡及双胎均死亡。14例（14%）出现TTTS伴羊水过多-过少序列复发。另外13例（13%）羊膜囊内羊水均正常，但1个胎儿的MCA-PSV升高超过1.5倍中位数（MoM），而其双胎的MCA-PSV相应降低至低于0.8 MoM。这分别与贫血和红细胞增多症有关，是由单向胎儿-胎儿输血导致的，主要是从前受血儿输向前供血儿。晚期并发症相应地通过再次激光治疗、羊水减量、脐带凝固、宫内输血或选择性分娩进行处理。
MCA-PSV多普勒测量有助于对双胎存活者进行随访，以检测和处理选择性激光治疗后的晚期并发症。
