Murata Susumu, Takano Mayumi, Kagawa Yukiko, Sumie Masahiro, Nakata Masahiko
a Department of Obstetrics and Gynecology , Kawasaki Medical School , Okayama , Japan.
b Department of Obstetrics and Gynecology , Toho University Omori Medical Center , Tokyo , Japan.
J Matern Fetal Neonatal Med. 2018 May;31(9):1137-1141. doi: 10.1080/14767058.2017.1311309. Epub 2017 Apr 16.
Fetoscopic laser photocoagulation of vascular anastomoses (FLP) is the essential choice in twin-twin transfusion syndrome (TTTS). We proposed that the modified sequential selective laser photocoagulation of communicating vessels (modified SQLPCV) to clarify the perinatal outcomes in TTTS.
The modified SQLPCV was designed with the following order: 1, artery-to-artery anastomoses; 2, venous-to-venous anastomoses; 3, artery-to-venous anastomoses from donor to recipient; and 4, artery-to-venous anastomoses from recipient to donor. The perinatal outcomes were present in TTTS patients who underwent the modified SQLPCV.
A total of 203 women underwent modified SQLPCV. The mean pregnancy prolongation period was 83 days, and the mean gestational age at delivery was 33 weeks (range 23-40 weeks). There was a significantly lower rate of recipient fetal demise than donor fetal demise (4% vs. 13%; p < .01). The survival rate of zero and one were respectively 6% (13/203) and 19% (39/203). Two survivors were seen in 74% (151/203), and at least one survivor in 94% (190/203). Univariate and multivariate analysis showed that abnormal fetal Doppler measurements in donor were correlated with donor demise after surgery.
The modified SQLPCV represents satisfactory outcomes for fetuses complicating with TTTS.
胎儿镜下血管吻合术激光凝固（FLP）是双胎输血综合征（TTTS）的主要治疗选择。我们提出改良序贯选择性激光凝固交通血管（改良SQLPCV）以明确TTTS的围产期结局。
改良SQLPCV按以下顺序进行：1. 动脉-动脉吻合；2. 静脉-静脉吻合；3. 从供血儿到受血儿的动脉-静脉吻合；4. 从受血儿到供血儿的动脉-静脉吻合。对接受改良SQLPCV的TTTS患者的围产期结局进行分析。
共有203名女性接受了改良SQLPCV。平均妊娠延长时间为83天，平均分娩孕周为33周（范围23-40周）。受血儿胎儿死亡发生率显著低于供血儿胎儿死亡发生率（4%对13%；p<0.01）。一胎及无存活儿的存活率分别为6%（13/203）和19%（39/203）。74%（151/203）的患者有两名存活儿，94%（190/203）的患者至少有一名存活儿。单因素和多因素分析显示，供血儿异常胎儿多普勒测量结果与术后供血儿死亡相关。
改良SQLPCV对于合并TTTS的胎儿而言结局令人满意。
