Slaghekke F, Favre R, Peeters S H P, Middeldorp J M, Weingertner A S, van Zwet E W, Klumper F J, Oepkes D, Lopriore E
Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Ultrasound Obstet Gynecol. 2014 Sep;44(3):304-10. doi: 10.1002/uog.13382. Epub 2014 Aug 4.
To evaluate the effectiveness of laser treatment for antenatally detected twin anemia-polycythemia sequence (TAPS) compared with intrauterine transfusion or expectant management.
All monochorionic twin pregnancies with TAPS managed between 2005 and 2013 in two European fetal therapy centers were evaluated. The outcomes of TAPS cases treated primarily with laser surgery were compared with the outcomes of cases managed expectantly or treated with intrauterine transfusion.
In this retrospective study 52 cases of TAPS were detected antenatally and were managed with either laser surgery (n=8; 15%) or intrauterine blood transfusion (n=17; 33%) or expectantly (n=27; 52%). Perinatal survival in the laser group was 94% (15/16) vs 85% (29/34) in the intrauterine-transfusion group and 83% (45/54) in the expectant-management group (P=0.30). The rates of severe neonatal morbidity in liveborn neonates in the laser, intrauterine-transfusion and expectant-management groups were 7% (1/15), 38% (12/32) and 24% (12/50), respectively (P=0.17). There was a significant reduction in respiratory distress syndrome in cases treated by laser. No severe postnatal hematological complications were detected in the laser group compared with 72% (23/32) in the intrauterine-transfusion group and 52% (26/50) in the expectant-management group (P<0.01). Median time between diagnosis and birth was 11 weeks in the laser group compared to 5 weeks after intrauterine transfusion and 8 weeks after expectant management (P<0.01). After injection of colored dye no residual anastomoses were found in the laser group.
Laser surgery for TAPS appears to improve perinatal outcome by prolonging pregnancy and reducing respiratory distress syndrome. Larger, adequately controlled studies are needed to reach firm conclusions on the optimal management of TAPS.
评估激光治疗产前诊断的双胎输血综合征（TAPS）与宫内输血或期待治疗相比的有效性。
对2005年至2013年期间在两个欧洲胎儿治疗中心管理的所有患有TAPS的单绒毛膜双胎妊娠进行评估。将主要接受激光手术治疗的TAPS病例的结局与期待治疗或宫内输血治疗的病例结局进行比较。
在这项回顾性研究中，产前检测出52例TAPS病例，分别接受激光手术治疗（n = 8；15%）、宫内输血治疗（n = 17；33%）或期待治疗（n = 27；52%）。激光治疗组的围产期存活率为94%（15/16），宫内输血组为85%（29/34），期待治疗组为83%（45/54）（P = 0.30）。激光治疗组、宫内输血组和期待治疗组活产新生儿的严重新生儿发病率分别为7%（1/15）、38%（12/32）和24%（12/50）（P = 0.17）。激光治疗的病例中呼吸窘迫综合征显著减少。与宫内输血组的72%（23/32）和期待治疗组的52%（26/50）相比，激光治疗组未检测到严重的产后血液学并发症（P<0.01）。激光治疗组诊断至出生之间的中位时间为11周，而宫内输血后为5周，期待治疗后为8周（P<0.01）。注射彩色染料后，激光治疗组未发现残留吻合支。
TAPS的激光手术似乎通过延长孕周和减少呼吸窘迫综合征来改善围产期结局。需要进行更大规模、充分对照的研究，以就TAPS的最佳管理得出确切结论。
