Akkermans Joost, de Vries Saskia M, Zhao Depeng, Peeters Suzanne H P, Klumper Frans J, Middeldorp Johanna M, Oepkes Dick, Slaghekke Femke, Lopriore Enrico
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
Placenta. 2017 Apr;52:71-76. doi: 10.1016/j.placenta.2017.02.023. Epub 2017 Feb 27.
The introduction of the Solomon technique for the treatment of twin-twin transfusion syndrome (TTTS) increased placental exposure to laser energy. This study aims to identify the impact of power and energy used in laser treatment on placental tissue and pregnancy outcome.
Pictures of all dye-injected placentas since the start of the Solomon trial were analyzed. Placental damage was scored using a grading system including visual scar depth and affected proportion of the vascular equator. Parameters analyzed included laser power and total energy, gestational age (GA) at laser, GA at birth, laser-to-delivery interval and preterm prelabor rupture of membranes (PPROM).
We included 122 cases in the analysis. More placental damage occurred more often in the Solomon group (42%) compared to the selective group (15%) (p < 0.001). In multivariate analysis, more placental damage was associated with higher laser energy (regression coefficient B 0.002) but not with higher power setting (regression coefficient B -0.442). More damage was associated with earlier GA at birth (regression coefficient B -0.167), higher incidence of PPROM <32 weeks (regression coefficient B 0.003) and a shorter laser-to-delivery interval (regression coefficient B -0.168).
Placental damage is positively associated with more laser energy but negatively associated with higher power setting. More placental damage was associated with a lower GA at birth, shorter laser-to-delivery interval and higher PPROM rate. Whether these results should lead to a change in surgical technique requires more research, both further ex-vivo experiments on human placentas and clinical studies.
所罗门技术用于治疗双胎输血综合征（TTTS）增加了胎盘对激光能量的暴露。本研究旨在确定激光治疗中使用的功率和能量对胎盘组织及妊娠结局的影响。
分析自所罗门试验开始以来所有注射染料的胎盘图片。使用包括视觉瘢痕深度和血管赤道受影响比例的分级系统对胎盘损伤进行评分。分析的参数包括激光功率、总能量、激光治疗时的孕周（GA）、出生时的GA、激光治疗至分娩间隔以及胎膜早破（PPROM）。
我们纳入了122例进行分析。与选择性组（15%）相比，所罗门组（42%）发生更多胎盘损伤的情况更常见（p < 0.001）。在多变量分析中，更多的胎盘损伤与更高的激光能量相关（回归系数B 0.002），但与更高的功率设置无关（回归系数B -0.442）。更多的损伤与出生时更早的GA相关（回归系数B -0.167）、<32周PPROM的更高发生率相关（回归系数B 0.003）以及更短的激光治疗至分娩间隔相关（回归系数B -0.168）。
胎盘损伤与更多的激光能量呈正相关，但与更高的功率设置呈负相关。更多的胎盘损伤与出生时更低的GA、更短的激光治疗至分娩间隔以及更高的PPROM发生率相关。这些结果是否应导致手术技术的改变需要更多研究，包括进一步对人类胎盘进行的体外实验和临床研究。
