Szaflik Krzysztof, Nowak Patrycja, Bielak Adam, Maroszyńska Iwona, Respondek-Liberska Maria, Janiak Katarzyna, Czaj Marta, Wojtera Justyna, Krzeszowski Waldemar, Sobczuk Kamila
1 Klinika Ginekologii, Rozrodczości i Terapi Płodu Instytutu Centrum Zdrowia Matki Polki w todzi, Polska.
Ginekol Pol. 2013 Jan;84(1):24-31. doi: 10.17772/gp/1536.
Twin to twin transfusion syndrome occurs in 15% of monochorionic twin pregnancies. Untreated, TTTS has been reported to have a mortality of nearly 100%. Two main therapies include serial amnioreduction and fetoscopic laser coagulation for the vascular anastomoses.
The aim of the project was to investigate the optimal diagnostic and therapeutic procedure in pregnancies complicated by TTTS. Additionally the study was supposed to compare non-invasive and invasive methods of treatment and to show antenatal and postnatal follow - up to 4 months of age.
42 pregnant women with twin-to-twin transfusion syndrome were assigned to laser therapy using diode laser and 33 pregnant women underwent only several amnioreductions. Selected parameters characterizing the pregnancy were compared in both groups.
In the amnioreduction group, the perinatal survival rate seven days after the delivery was 31.8%. The survival rate of at least one twin was 39.4%. As compared to the amnioreduction group, in the laser group the survival rate of at least one twin was observed in 31 cases (31/42) and it was equal to 74%. Neurological complications in the amninoreduction group were observed in 19% (4/21) of cases, in the laser group and in 5% (2/40) of neonates at 4 months of age.
Currently the preferred and only method that addresses the cause of the disease is the endoscopic laser coagulation of anastomoses. Comparison of the two treatments shows better outcomes with higher survival rates and minor neurological defects in cases treated with laser coagulation.
双胎输血综合征发生于15%的单绒毛膜双胎妊娠中。据报道，未经治疗的双胎输血综合征死亡率近100%。两种主要治疗方法包括反复羊水减量术和胎儿镜下激光凝固血管吻合支。
本项目旨在研究双胎输血综合征合并妊娠的最佳诊断和治疗方法。此外，该研究还应比较非侵入性和侵入性治疗方法，并展示直至4月龄的产前和产后随访情况。
42例双胎输血综合征孕妇被分配接受二极管激光治疗，33例孕妇仅接受了几次羊水减量术。对两组中表征妊娠情况的选定参数进行比较。
在羊水减量术组，产后7天围产儿存活率为31.8%。至少一个胎儿的存活率为39.4%。与羊水减量术组相比，激光治疗组有31例（31/42）观察到至少一个胎儿存活，存活率为74%。羊水减量术组19%（4/21）的病例出现神经并发症，激光治疗组在4月龄时新生儿的神经并发症发生率为5%（2/40）。
目前，解决该疾病病因的首选且唯一方法是内镜下激光凝固吻合支。两种治疗方法的比较显示，激光凝固治疗的病例存活率更高，神经缺陷更少，治疗效果更好。
