胎儿期射频消融治疗双胎反向动脉灌注序列征（TRAP）：单中心经验

Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single-center experience.

作者信息

Livingston Jeffrey C, Lim Foong-Yen, Polzin William, Mason Jennifer, Crombleholme Timothy M

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH 45267-0526, USA.

出版信息

Am J Obstet Gynecol. 2007 Oct;197(4):399.e1-3. doi: 10.1016/j.ajog.2007.07.051.

DOI:10.1016/j.ajog.2007.07.051

PMID:17904976

Abstract

OBJECTIVE

The objective of the study was to review perinatal outcomes in pregnancies treated with intrafetal radiofrequency ablation (RFA) for twin reversed arterial perfusion (TRAP) sequence.

STUDY DESIGN

Perinatal outcome data from a quaternary care referral center were abstracted from a chart review of pregnancies with TRAP sequence treated in the midtrimester with umbilical cord RFA of the perfused twin.

RESULTS

Twenty-one pregnancies with TRAP sequence were evaluated. Two women had a pump twin demise prior to therapy, 1 with trisomy 21 declined treatment. Four of 20 were treated successfully with RFA but remain undelivered, and 1 was treated with fetoscopic cord coagulation. Twelve of 13 pump twins treated with RFA (94%) survived to 30 days of life. Mean preoperative cardiac combined cardiac output was 588 mL/kg and pump/twin ratio was 0.7 (range 0.4 to 1.1). The effect of RFA on postoperative cardiac output was variable (6-85%). The average gestational age at birth was 37 weeks (range 26-39 weeks).

CONCLUSION

Primary therapy with RFA is a successful modality for pregnancies complicated by TRAP sequence.

摘要

目的

本研究的目的是回顾经胎儿射频消融术（RFA）治疗双胎反向动脉灌注序列征（TRAP）的围产期结局。

研究设计

从一家四级医疗转诊中心的围产期结局数据中，提取了孕中期对灌注双胎进行脐带射频消融术治疗的TRAP序列征妊娠病例的病历回顾资料。

结果

对21例TRAP序列征妊娠进行了评估。两名女性在治疗前泵血双胎死亡，其中1例21三体综合征患者拒绝治疗。20例中有4例成功接受了射频消融术治疗但仍未分娩，1例接受了胎儿镜下脐带凝固术治疗。13例接受射频消融术治疗的泵血双胎中有12例（94%）存活至出生后30天。术前平均心脏联合心输出量为588 mL/kg，泵血双胎/双胎比例为0.7（范围0.4至1.1）。射频消融术对术后心输出量的影响各不相同（6% - 85%）。出生时的平均孕周为37周（范围26 - 39周）。