Lecointre L, Sananès N, Weingertner A S, Gaudineau A, Akladios C, Cavillon V, Langer B, Favre R
Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
Pôle de gynécologie-obstétrique, département d'échographie et de médecine fœtale, CMCO-HUS, 19, rue Louis-Pasteur, 67300 Schiltigheim/Strasbourg, France; Pôle de gynécologie-obstétrique, département d'obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Inserm, UMR-S 1121, « Biomatériaux et Bioingénierie », 11, rue Humann, 67085 Strasbourg cedex, France.
J Gynecol Obstet Hum Reprod. 2017 Feb;46(2):175-181. doi: 10.1016/j.jogoh.2016.10.004. Epub 2017 Jan 30.
To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100.
Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014.
There were 49 stage I, 88 stage II, 55 stage III and eight stage IV. Median gestation at time of laser was 20.1±3.0 weeks' gestation (WG) whereas median gestation at delivery was 31.6±5.4 WG. Overall perinatal survival rate was 68.0% and 84.0% have one or more surviving twins. Preterm premature rupture of membranes occurred in 39 cases with and the median gestational age for this complication was 28.8±4.6 SA. Predictive factors to have at least one living birth were Quintero stage and gestational age at delivery. In the most recent period, there were significantly more TTTS Quintero stage I treated with laser, more coagulation by the Solomon technique and a larger number of coagulated vessels.
The neonatal survival of TTTS is improved by fetoscopic laser coagulation, preferely by using Solomon tecnhique. The use of active management of stage I is currently on research.
报告采用激光消融手术治疗双胎输血综合征（TTTS）的术前数据、手术特点、并发症及围产期结局，分析新生儿存活的预测因素，并将最近100例病例与之前的100例进行比较。
对2004年1月至2014年12月间连续接受胎儿镜激光凝固治疗的200例TTTS病例进行单中心观察性队列研究。
有49例I期、88例II期、55例III期和8例IV期。激光治疗时的中位孕周为20.1±3.0周，而分娩时的中位孕周为31.6±5.4周。总体围产期存活率为68.0%，84.0%有一个或多个存活双胎。39例发生早产胎膜早破，该并发症的中位孕龄为28.8±4.6周。至少有一个活产的预测因素是Quintero分期和分娩时的孕周。在最近一段时间，接受激光治疗的I期TTTS病例显著增多，采用所罗门技术进行的凝固更多，凝固的血管数量也更多。
胎儿镜激光凝固术可提高TTTS的新生儿存活率，最好采用所罗门技术。目前正在研究对I期进行积极管理的应用。
