Program in Fetal Medicine, Alpert Medical School of Brown University, Providence, RI, USA.
Prenat Diagn. 2010 Apr;30(4):314-9. doi: 10.1002/pd.2454.
Survival (> or =1 twin) after laser surgery for patients with twin-to-twin transfusion syndrome (TTTS) ranges from 65 to 93%. However, most studies are noncontrolled and retrospective, and have included a limited number of patients. The aim of this study was to perform a systematic review of outcomes after laser surgery in patients with TTTS.
We conducted database and manual searches of reference lists and pertinent journals published between 1995 and 2009 that report outcomes of laser surgery in patients with TTTS. Two authors performed the search independently of each other. There exist only two randomized controlled trials, each with fewer than 80 patients having undergone laser surgery. Uncontrolled and retrospective series were therefore considered as well. Studies had to report sufficient information on inclusive dates, stage distribution, overall neonatal survival, and neonatal survival of at least one twin. Of the 486 studies identified, we considered 19 studies.
For each series, 95% confidence intervals (CI) were calculated. Survival was plotted against the date of publication, number of patients/series, gestational age at delivery, and proportion of advanced cases. Univariate analysis was performed to detect significant differences. Our meta-analysis, which included 1484 patients, shows 81.2% survival of at least one twin (CI: 79.1-83.2%). The average survival of at least one twin for the entire population remained within the CI of all but one series. Neither case load, nor stage distribution, nor chronological date of the study affected the survival.
A systematic review of endoscopic laser surgery performed in patients with TTTS failed to show a significant impact of high caseloads, disease severity distribution, or improvements in technique.
患有双胎输血综合征（TTTS）的患者接受激光手术后的存活率（>=1 对双胞胎）为 65%至 93%。然而，大多数研究是非对照和回顾性的，并且纳入的患者数量有限。本研究旨在对 TTTS 患者激光手术后的结局进行系统评价。
我们对 1995 年至 2009 年期间发表的报告 TTTS 患者激光手术结局的数据库和参考文献列表进行了数据库和手动搜索。两位作者独立进行了搜索。仅存在两项随机对照试验，每项试验接受激光手术的患者均少于 80 例。因此，也考虑了非对照和回顾性系列研究。研究必须报告足够的信息，包括包含日期、分期分布、总体新生儿存活率以及至少一对双胞胎的新生儿存活率。在确定的 486 项研究中，我们考虑了 19 项研究。
为每个系列计算了 95%置信区间（CI）。根据发表日期、患者/系列数量、分娩时的胎龄和晚期病例的比例绘制存活率。进行了单变量分析以检测显著差异。我们的荟萃分析包括 1484 名患者，显示至少有一对双胞胎存活的比例为 81.2%（CI：79.1-83.2%）。整个人群中至少有一对双胞胎存活的平均水平在除一个系列之外的所有系列的 CI 范围内。病例量、疾病严重程度分布或技术改进均未对存活率产生显著影响。
对 TTTS 患者接受的内镜激光手术进行的系统评价未能显示高病例量、疾病严重程度分布或技术改进对存活率的显著影响。
