Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
Ultrasound Obstet Gynecol. 2012 Nov;40(5):506-12. doi: 10.1002/uog.11105.
Selective fetoscopic laser photocoagulation (SFLP) is now the treatment of choice for twin-twin transfusion syndrome (TTTS). The incidence of recurrent TTTS following SFLP has been inconsistently reported across different studies. We performed a systematic review of TTTS recurrence following SFLP.
PubMed and MEDLINE online databases were searched for articles published between 2000 and August 2011, using combinations of the terms 'twin-twin transfusion', 'TTTS', 'laser', 'recur' and 'outcome'. Citations identified in the primary search were screened for eligibility. Studies reporting outcomes from selective SFLP for TTTS in twin pregnancies, which addressed specifically the issue of TTTS recurrence, were included. The primary outcome was rate of TTTS recurrence. Secondary outcomes were therapeutic preference and fetal outcomes in cases of recurrent TTTS.
The primary search identified 22 eligible studies that are included in this review (n = 2447 twin pregnancies). Two studies included a minority of non-selective procedures. The published incidence of recurrent TTTS ranged from 0 to 16%. Clinical management was reported in 65.7% (71/108) cases, with repeat SFLP the most commonly performed secondary intervention. Only three studies provided comprehensive outcome data for cases of recurrent TTTS. The overall rate of neurologically-intact survival was 44% (23/52). The data were inadequate to determine the effects of secondary therapeutic approach, placental location or gestational age on perinatal outcome in cases of recurrent TTTS.
The published rate of TTTS recurrence following SFLP in monochorionic twin pregnancies ranges from 0 to 16%. Although limited follow-up data suggest that recurrence is associated with significant perinatal mortality and morbidity, further study is needed. Currently, there are insufficient data available to guide recommendations for clinical management of TTTS recurrence. Future studies on SFLP for TTTS must include details on recurrence rates and provide outcome data specific to the recurrent subset.
选择性胎儿镜激光凝固术（SFLP）现已成为治疗双胎输血综合征（TTTS）的首选方法。但不同研究对 SFLP 后 TTTS 复发的报道并不一致。我们对 SFLP 后 TTTS 复发进行了系统回顾。
检索 2000 年至 2011 年 8 月期间在 PubMed 和 MEDLINE 在线数据库发表的文章，使用“twin-twin transfusion”、“TTTS”、“laser”、“recur”和“outcome”等术语的组合进行检索。对初步检索中确定的引文进行筛选，以确定其是否符合纳入标准。纳入的研究均为报告了选择性 SFLP 治疗 TTTS 的双胎妊娠结果，且特别关注 TTTS 复发问题。主要结局为 TTTS 复发率。次要结局为 TTTS 复发时的治疗选择和胎儿结局。
初步检索共确定了 22 项符合纳入标准的研究（共纳入 2447 例双胎妊娠）。其中 2 项研究中包含少数非选择性手术。已发表的 TTTS 复发率范围为 0 至 16%。65.7%（71/108）的病例报告了临床处理方法，最常进行的二次干预为重复 SFLP。只有 3 项研究提供了关于 TTTS 复发病例的综合结局数据。总的神经完整存活率为 44%（23/52）。数据不足，无法确定二次治疗方法、胎盘位置或孕龄对 TTTS 复发患者围产儿结局的影响。
单绒毛膜双胎妊娠 SFLP 后 TTTS 的报道复发率范围为 0 至 16%。尽管有限的随访数据表明复发与围产儿死亡率和发病率显著相关，但仍需进一步研究。目前，尚无足够的数据可用于指导 TTTS 复发的临床管理建议。未来关于 TTTS 的 SFLP 研究必须包括复发率的详细信息，并提供特定于复发组的结局数据。
