Baylor College of Medicine and Texas Children's Hospital, Department of Obstetics and Gynecology, Division of Maternal-Fetal Medicine, Houston, TX, USA; Faculdade de Medicina da Universidade de Sao Paulo, Department of Obstetrics and Gynecology, Sao Paulo, SP, Brazil.
Ultrasound Obstet Gynecol. 2013 Oct;42(4):434-9. doi: 10.1002/uog.12492. Epub 2013 Sep 2.
To document perinatal outcomes following use of the 'Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS).
Between January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls).
Of the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group.
Use of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique.
记录在严重双胎输血综合征（TTTS）的胎盘吻合选择性光凝中使用“所罗门技术”的围产结局。
2010 年 1 月至 2012 年 7 月，在四个不同中心进行了胎儿镜激光消融术治疗严重 TTTS 的 102 例单绒毛膜双胎妊娠的连续数据被收集。我们比较了使用所罗门技术进行选择性激光凝固的患者（病例组）和未进行该手术的患者（对照组）的结果。
在检查的 102 例妊娠中，有 26 例（25.5%）采用了所罗门技术，76 例（74.5%）未采用。在 204 例胎儿中，有 139 例（68.1%）存活至 30 天龄。82 例（80.4%）妊娠至少有一胎存活，57 例（55.9%）妊娠双胎存活。与对照组相比，所罗门技术组的双胎存活率明显更高（84.6%比 46.1%；P<0.01），新生儿总存活率也更高（45/52（86.5%）比 94/152（61.8%）；P<0.01）。多变量分析显示，使用所罗门技术与双胎存活率独立相关（调整优势比（aOR），11.35（95%置信区间，3.11-53.14）；P=0.0007）和新生儿总存活率独立相关（aOR，4.65（95%置信区间，1.59-13.62）；P=0.005）。在 Solomon 技术组中，未发生复发性 TTTS 或双胎贫血-多血症序列（TAPS）。
胎盘吻合选择性光凝后使用 Solomon 技术似乎可以提高双胎存活率，并可能降低复发性 TTTS 和 TAPS 的风险。我们的数据支持进行随机对照试验来评估 Solomon 技术的有效性的想法。
