Yin Shaowei, Zhang Zhitao, Li Na, Liu Caixia
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China; Email:
Zhonghua Fu Chan Ke Za Zhi. 2015 May;50(5):329-33.
To analyze the clinical outcome and impact factors of twin-to-twin transfusion syndrome (TTTS) with anterior placenta treated by fetoscopic selective laser coagulation of placental vessels (SLCPV).
Ten cases of TTTS with anterior placenta and 8 cases with posterior placenta were treated by SLCPV in Shengjing Hospital from July 2011 to April 2014. Clinical data were analyzed retrospectively. Some cases were at Quintero stage II or higher stage, others were at Quintero stage I but with cardiovascular score ≥ 5 according to the scoring system of Children's Hospital of Philadelphia. The anterior placenta cases were treated by curve fetoscopy and the posterior placenta cases were treated by straight fetoscopy.
(1) Of all the 18 cases, the mean gestational age at SLCPV was 24.1 weeks (17(+5) to 27(+4) weeks). There were 2 cases at Quintero stage I, 4 at stage II and 12 at stage III. The mean gestational age of anterior placenta cases at SLCPV was 25.2 weeks (22 to 27(+4) weeks), with 2 cases at Quintero stage I, 2 cases at stage II and 6 at stage III; 5 cases had preterm prelabour rupture of the membranes (PPROM) and 1 case had maternal intestinal obstruction after the operation; the average operation time was 40 minutes. Of the posterior placenta cases, the mean gestational age at SLCPV was 22.7 weeks (17(+5) to 27(+4) weeks); 2 cases were at Quintero stage II and 6 cases at stage III. PPROM happened in one case; one case had maternal enterobacter cloacae septicemia; the average operation time was 28 minutes. All the 18 cases could tolerate the operations. There was no intraoperative complication. (2) One anterior placenta case had maternal intestinal obstruction and miscarriage; and one posterior placenta case had enterobacter cloacae septicemia. Karyotype analyses of the all the twins were normal. (3) 17 cases delivered already, including all the 10 anterior placenta cases and 7 posterior placenta cases. One infant had corpus callosum agenesis, but its co-twin was normal. The average gestational age at delivery for anterior placenta cases was 32.6 weeks (24 to 37(+1) weeks), an was 28.2 weeks (25(+6) to 36(+2) weeks) for posterior placenta cases. The fetuses survival rate was 13/17 (one case was still in pregnancy) for at least one twin, and 10/17 for both twins. Both twins survival rates were 5/10, 5/7 for anterior placenta cases and posterior placenta cases, respectively. At least one twin survival rates were 8/10, 5/7 for the two groups respectively.
SLCPV is suitable for the treatment of TTTS, no matter the placenta is on the anterior wall or posterior wall. The treatment had good outcomes, but more PPROM happened in the anterior placenta cases, which may be associated with operation time and the range of operation.
分析胎盘前置的双胎输血综合征（TTTS）行胎儿镜下选择性胎盘血管激光凝固术（SLCPV）的临床结局及影响因素。
回顾性分析2011年7月至2014年4月在盛京医院采用SLCPV治疗的10例胎盘前置及8例胎盘后置的TTTS患者的临床资料。部分病例处于QuinteroⅡ期或更高分期，其他病例处于QuinteroⅠ期但根据费城儿童医院评分系统心血管评分≥5分。胎盘前置病例采用弯形胎儿镜治疗，胎盘后置病例采用直形胎儿镜治疗。
（1）18例患者中，SLCPV时的平均孕周为24.1周（17⁺⁵至27⁺⁴周）。QuinteroⅠ期2例，Ⅱ期4例，Ⅲ期12例。胎盘前置病例SLCPV时的平均孕周为25.2周（22至27⁺⁴周），QuinteroⅠ期2例，Ⅱ期2例，Ⅲ期6例；5例发生早产胎膜早破（PPROM），1例术后发生母体肠梗阻；平均手术时间为40分钟。胎盘后置病例SLCPV时的平均孕周为22.7周（17⁺⁵至27⁺⁴周）；Ⅱ期2例，Ⅲ期6例。1例发生PPROM；1例发生母体阴沟肠杆菌败血症；平均手术时间为28分钟。18例患者均能耐受手术。术中无并发症发生。（2）1例胎盘前置病例发生母体肠梗阻及流产；1例胎盘后置病例发生阴沟肠杆菌败血症。所有双胎的染色体核型分析均正常。（3）17例已分娩，包括全部10例胎盘前置病例和7例胎盘后置病例。1例婴儿胼胝体发育不全，但其双胎正常。胎盘前置病例的平均分娩孕周为32.6周（24至37⁺¹周），胎盘后置病例为28.2周（25⁺⁶至36⁺²周）。至少1个胎儿的存活率为13/17（1例仍在妊娠中），双胎均存活的比例为10/17。胎盘前置病例和胎盘后置病例双胎均存活的比例分别为5/10、5/7。两组至少1个胎儿存活的比例分别为8/10、5/7。
SLCPV适用于治疗TTTS，无论胎盘位于前壁还是后壁。该治疗效果良好，但胎盘前置病例中PPROM发生率更高，这可能与手术时间及手术范围有关。
