Roberts D, Gates S, Kilby M, Neilson J P
Department of Obstetrics and Gynaecology, Liverpool Women's NHS Foundation Trust, Liverpool, UK.
Ultrasound Obstet Gynecol. 2008 Jun;31(6):701-11. doi: 10.1002/uog.5328.
We performed a Cochrane review to assess which of the treatments for twin-twin transfusion syndrome (TTTS) improves fetal, childhood and maternal outcomes. This article represents a version of the review which includes additional data to the published version. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2007) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, October 2007) for randomized and quasi-randomized studies of amnioreduction, laser coagulation and septostomy and compared their outcomes. We also searched conference proceedings and contacted the authors of published trials for clarification and additional data. No trials compared intervention with no intervention. Three studies (253 women) were included. Laser coagulation resulted in less overall death (48% vs. 59%; relative risk (RR), 0.81; 95% CI, 0.65-1.01 adjusted for clustering; two trials, 364 fetuses), perinatal death (26% vs. 44%; RR, 0.59; 95% CI, 0.40-0.87 adjusted for clustering; one trial, 284 fetuses) and neonatal death (8% vs. 26%; RR, 0.29; 95% CI, 0.14-0.61 adjusted for clustering; one trial, 284 fetuses) when compared with amnioreduction. There was no difference in perinatal outcome between amnioreduction and septostomy. More babies were alive without neurological abnormality at the age of 6 months in the laser group than in the amnioreduction group (52% vs. 31%; RR, 1.66; 95% CI, 1.17-2.35 adjusted for clustering; one trial). There was no difference in the proportion of babies alive at 6 months that had undergone treatment for major neurological abnormality between the laser coagulation and the amnioreduction groups (4% vs. 7%; RR, 0.58; 95% CI, 0.18-1.86 adjusted for clustering; one trial). The results suggest that endoscopic laser coagulation of anastomotic vessels should be considered in the treatment of all stages of TTTS to improve perinatal and neonatal outcome.
我们进行了一项Cochrane综述，以评估双胎输血综合征（TTTS）的哪种治疗方法能改善胎儿、儿童期及母体结局。本文是该综述的一个版本，其中包含了比已发表版本更多的数据。我们检索了Cochrane妊娠与分娩组试验注册库（2007年4月）以及Cochrane对照试验中央注册库（《Cochrane图书馆》，2007年10月），以查找羊膜腔穿刺减压术、激光凝固术和隔膜造口术的随机及半随机研究，并比较它们的结局。我们还检索了会议论文集，并联系已发表试验的作者以获取澄清信息和更多数据。没有试验将干预措施与不干预进行比较。纳入了三项研究（253名女性）。与羊膜腔穿刺减压术相比，激光凝固术导致的总体死亡（48%对59%；相对危险度（RR），0.81；95%可信区间（CI），0.65 - 1.01，经聚类调整；两项试验，364例胎儿）、围产期死亡（26%对44%；RR，0.59；95% CI，0.40 - 0.87，经聚类调整；一项试验，284例胎儿）和新生儿死亡（8%对26%；RR，0.29；95% CI，0.14 - 0.61，经聚类调整；一项试验，284例胎儿）更少。羊膜腔穿刺减压术和隔膜造口术的围产期结局没有差异。激光组6个月大时无神经异常存活的婴儿比羊膜腔穿刺减压术组更多（52%对31%；RR，1.66；95% CI，1.17 - 2.35，经聚类调整；一项试验）。激光凝固术组和羊膜腔穿刺减压术组中因重大神经异常接受治疗的6个月大存活婴儿比例没有差异（4%对7%；RR，0.58；95% CI，0.18 - 1.86，经聚类调整；一项试验）。结果表明，在TTTS各阶段的治疗中，应考虑采用内镜激光凝固吻合血管的方法，以改善围产期和新生儿结局。
