Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University Southern California, Los Angeles, CA 90027, USA.
Placenta. 2010 Jul;31(7):611-4. doi: 10.1016/j.placenta.2010.04.006. Epub 2010 May 6.
The goal of fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS) is to ablate all placental vascular communications, thereby separating the fetal circulatory systems. We sought to ascertain the frequency and clinical implications of residual vascular communications (RVC) post preferential sequential selective laser photocoagulation of communicating vessels (SQLPCV).
TTTS placentas treated via preferential SQLPCV were examined. Patency of vascular communications was assessed via water and/or milk injections. Cases with intrauterine fetal demise or placental disruption were excluded. Outcomes with and without RVC were compared.
One hundred seventy-four TTTS patients were treated during the study period. Dual survival at birth was 76% (133/174). Of the 133 dual survivors, 105 (79%) submitted an intact placenta. Five of these 105 placentas had RVC (4.8%). Comparison of RVC versus non-RVC cases revealed the following: gestational age at delivery 28.7(6.5) vs. 33.4(3.3) weeks (p=0.178); recipient birth weight 1287(1061) vs. 1973(610) grams (p=0.020); donor birth weight 1429(1369) vs. 1653(715) grams (p=0.518); donor central/eccentric placental cord insertion 80% vs. 17% (p=0.006). One case required a second laser surgery to complete the laser ablation; this placenta did not have RVC after delivery. Otherwise there were no cases of persistent TTTS. One of the 5 RVC cases (20%) exhibited neonatal findings consistent with twin anemia-polycythemia sequence (TAPS), while none of the non-RVC cases had TAPS (p=0.005).
The rate of RVC was less than 5% among gestations with dual survivors post preferential SQLPCV treatment for TTTS.
双胎输血综合征（TTTS）胎儿镜激光手术的目的是消融所有胎盘血管交通支，从而使胎儿循环系统分离。我们旨在确定优先序贯选择性激光血管交通支凝固术（SQLPCV）后残余血管交通支（RVC）的频率及其临床意义。
对接受优先 SQLPCV 治疗的 TTTS 胎盘进行检查。通过水和/或牛奶注射评估血管交通的通畅性。排除宫内胎儿死亡或胎盘破裂的病例。比较有和无 RVC 的结局。
在研究期间，174 例 TTTS 患者接受了治疗。双胎存活分娩率为 76%（133/174）。在 133 例双存活儿中，105 例（79%）胎盘完整。这 105 例胎盘中有 5 例存在 RVC（4.8%）。RVC 与非 RVC 病例的比较结果如下：分娩时的胎龄 28.7(6.5) 与 33.4(3.3) 周（p=0.178）；受者出生体重 1287(1061) 与 1973(610) 克（p=0.020）；供者出生体重 1429(1369) 与 1653(715) 克（p=0.518）；供者中央/偏心胎盘脐带插入 80%与 17%（p=0.006）。有 1 例需要进行第二次激光手术以完成激光消融；该胎盘分娩后无 RVC。否则，没有持续性 TTTS 的病例。5 例 RVC 中有 1 例（20%）存在新生儿表现与双胎贫血-红细胞增多序列（TAPS）一致，而非 RVC 病例无一例出现 TAPS（p=0.005）。
在 TTTS 接受优先 SQLPCV 治疗后的双胎存活儿中，RVC 的发生率低于 5%。
