Centre for Women's & Children's Health, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Russells Hall Hospital, The Dudley Group NHS Foundation Trust, Dudley, UK.
Ultrasound Obstet Gynecol. 2015 Nov;46(5):526-33. doi: 10.1002/uog.14813.
To compare the Solomon and selective techniques for fetoscopic laser ablation (FLA) for the treatment of twin-twin transfusion syndrome (TTTS) in monochorionic-diamniotic twin pregnancies.
This was a systematic review conducted in accordance with the PRISMA statement. Electronic searches were performed for relevant citations published from inception to September 2014. Selected studies included pregnancies undergoing FLA for TTTS that reported on recurrence of TTTS, occurrence of twin anemia-polycythemia sequence (TAPS) or survival.
From 270 possible citations, three studies were included, two cohort studies and one randomized controlled trial (RCT), which directly compared the Solomon and selective techniques for FLA. The odds ratios (OR) of recurrent TTTS when using the Solomon vs the selective technique in the two cohort studies (n = 249) were 0.30 (95% CI, 0.00-4.46) and 0.45 (95% CI, 0.07-2.20). The RCT (n = 274) demonstrated a statistically significant reduction in risk of recurrent TTTS with the Solomon technique (OR, 0.21 (95% CI, 0.04-0.98); P = 0.03). The ORs for the development of TAPS following the Solomon and the selective techniques were 0.20 (95% CI, 0.00-2.46) and 0.61 (95% CI, 0.05-5.53) in the cohort studies and 0.16 (95% CI, 0.05-0.49) in the RCT, with statistically significant differences for the RCT only (P < 0.001). Observational evidence suggested overall better survival with the Solomon technique, which was statistically significant for survival of at least one twin. The RCT did not demonstrate a significant difference in survival between the two techniques, most probably owing to the small sample size and lack of power.
This systematic review of observational, comparative cohort and RCT data suggests a trend towards a reduction in TAPS and recurrent TTTS and an increase in twin survival, with no increase in the occurrence of complications or adverse events, when using the Solomon compared to the selective technique for the treatment of TTTS. These findings need to be confirmed by an appropriately-powered RCT with long-term neurological follow-up.
比较 Solomon 法和选择性法在治疗单绒毛膜双羊膜囊双胎妊娠胎儿镜激光凝固术（FLA）中的应用。
本系统评价根据 PRISMA 声明进行。电子检索自开始至 2014 年 9 月的相关文献。纳入的研究为 FLA 治疗 TTTS 后复发 TTTS、发生双胎贫血-多血症序列（TAPS）或存活的研究。
从 270 个可能的引用中，有 3 项研究入选，2 项队列研究和 1 项随机对照试验（RCT），直接比较了 Solomon 法和选择性法在 FLA 中的应用。2 项队列研究（n = 249）中 Solomon 法与选择性法相比，TTTS 复发的比值比（OR）为 0.30（95%CI，0.00-4.46）和 0.45（95%CI，0.07-2.20）。RCT（n = 274）显示 Solomon 法治疗 TTTS 的复发风险显著降低（OR，0.21（95%CI，0.04-0.98）；P = 0.03）。队列研究中 Solomon 法和选择性法发生 TAPS 的 OR 分别为 0.20（95%CI，0.00-2.46）和 0.61（95%CI，0.05-5.53），RCT 中为 0.16（95%CI，0.05-0.49），仅 RCT 具有统计学意义（P < 0.001）。观察性证据表明 Solomon 法总体上有更好的存活率，至少有一个胎儿存活的差异有统计学意义。RCT 没有显示两种技术之间的存活率有显著差异，最可能的原因是样本量小和缺乏效能。
本系统评价对观察性、比较性队列研究和 RCT 数据的综合分析表明，与选择性法相比，使用 Solomon 法治疗 TTTS 可降低 TAPS 和 TTTS 复发率，提高双胎存活率，且不增加并发症或不良事件的发生率。这些发现需要通过具有长期神经随访的大型 RCT 来证实。
