荷兰对100例患有严重双胎输血综合征的孕妇进行胎儿镜激光手术。

Fetoscopic laser surgery in 100 pregnancies with severe twin-to-twin transfusion syndrome in the Netherlands.

作者信息

Middeldorp J M, Sueters M, Lopriore E, Klumper F J C M, Oepkes D, Devlieger R, Kanhai H H H, Vandenbussche F P H A

机构信息

Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands.

出版信息

Fetal Diagn Ther. 2007;22(3):190-4. doi: 10.1159/000098715. Epub 2007 Jan 16.

DOI:10.1159/000098715

PMID:17228157

Abstract

OBJECTIVE

In this prospective cohort study, we evaluated the initial results of fetoscopic laser surgery for severe second trimester twin-to-twin transfusion syndrome (TTTS) treated at our centre.

METHOD

A total of 100 consecutive pregnancies with severe second trimester TTTS treated at our centre with selective fetoscopic laser coagulation of vascular anastomoses on the placental surface between August 2000 and November 2004 were included in the study. Perinatal survival was analysed in relation to Quintero stage.

RESULTS

Median gestational age was 20 weeks at fetoscopy (range: 16-26) and 33 weeks at delivery (range: 18-40). Perinatal survival rate was 70% (139/200). The treatment resulted in at least one survivor at the age of 4 weeks in 81% of pregnancies. Perinatal survival was significantly higher when treatment was performed in the early Quintero stages (95% in stage 1, 76% in stage 2, 70% in stage 3, 50% in stage 4) (p = 0.02).

CONCLUSION

Results of fetoscopic laser surgery for TTTS in our centre are similar to those in specialised centres in other countries. Diagnosis and treatment in the early Quintero stages resulted in significantly higher perinatal survival.

摘要

目的

在这项前瞻性队列研究中，我们评估了在我们中心接受治疗的孕中期严重双胎输血综合征（TTTS）胎儿镜激光手术的初步结果。

方法

本研究纳入了2000年8月至2004年11月期间在我们中心接受胎盘表面血管吻合术选择性胎儿镜激光凝固治疗的100例连续孕中期严重TTTS妊娠。分析围产期生存率与Quintero分期的关系。

结果

胎儿镜检查时的中位孕周为20周（范围：16 - 26周），分娩时为33周（范围：18 - 40周）。围产期生存率为70%（139/200）。该治疗使81%的妊娠在4周龄时至少有一名存活者。在Quintero早期进行治疗时，围产期生存率显著更高（1期为95%，2期为76%，3期为70%，4期为50%）（p = 0.02）。