Gil Guevara Enrique, Pazos Andrea, Gonzalez Otilia, Carretero Pilar, Molina Francisca S
The Center for Fetal, Cellular and Molecular Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Hospital of Granada (CHUG), Granada, Spain.
Int J Gynaecol Obstet. 2017 Jun;137(3):241-245. doi: 10.1002/ijgo.12143. Epub 2017 Mar 27.
To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis.
The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively.
There were 86 pregnancies exhibiting TTTS treated with fetoscopic laser surgery included in the study. The median length of pregnancy at the time of surgery was 21.1 weeks. Both twin fetuses and at least one fetus survived in 61 (71%) and 73 (85%) pregnancies, respectively. Among recipient fetuses, ductus venosus a-wave anomalies (P=0.026), shorter cervical length (P=0.044), and a greater than 25% discrepancy in the estimated weight of the twin fetuses (P=0.045) were associated with reduced survival.
Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual-fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1-week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus.
探讨激光手术治疗双胎输血综合征（TTTS）后的胎儿存活率及多普勒分析的影响。
本回顾性单中心研究纳入了2007年1月1日至2016年12月31日期间接受胎儿镜激光手术治疗的TTTS妊娠患者的数据。检查围产期结局，并分别比较存活和死亡的供血胎儿与受血胎儿之间的变量。
本研究纳入了86例接受胎儿镜激光手术治疗的TTTS妊娠患者。手术时的妊娠中位数为21.1周。双胎均存活和至少一个胎儿存活的妊娠分别为61例（71%）和73例（85%）。在受血胎儿中，静脉导管a波异常（P=0.026）、宫颈长度较短（P=0.044）以及双胎估计体重差异大于25%（P=0.045）与存活率降低有关。
在TTTS妊娠中，激光手术与显著的双胎存活相关。术前静脉导管异常与受血胎儿较低的存活率相关，术后1周的超声检查数据显示，与静脉导管正常化的受血胎儿相比，静脉导管持续异常的受血胎儿存活率较低。
