单绒毛膜/单羊膜囊（MC/MA）双胎不一致胎儿中的TRAP序列：两例接受胎儿镜激光手术治疗的病例
TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery.
作者信息
Tonni Gabriele, Grisolia Gianpaolo, Zampriolo Paolo, Prefumo Federico, Fichera Anna, Bonasoni Paola, Lefebvre Mathilde, Khung-Savatovsky Suonavy, Guimiot Fabien, Rosenblatt Jonathan, Araujo Júnior Edward
机构信息
a Department of Obstetric and Gynecology, Prenatal Diagnostic Service , Reggio Emilia , Italy.
b Azienda Socio Sanitaria Territoriale di Mantova, Department of Obstetrics and Gynecology , Carlo Poma Hospital , Mantova , Italy.
出版信息
Fetal Pediatr Pathol. 2018 Dec;37(6):433-447. doi: 10.1080/15513815.2018.1526240. Epub 2019 Jan 12.
INTRODUCTION
Ablation of the acardiac twin umbilical cord in the TRAP protects the normal donor twin.
MATERIALS AND METHODS
Two case descriptions, one of interstitial laser photocoagulation and one of laser umbilical cord occlusion (L-UCO) of the acardiac twin in monochorionic monoamniotic pregnancies are reported.
RESULTS
L-UCO in two pregnancies with TRAP syndrome in the second trimester resulted in intrauterine fetal death in both cases after 1 month. Case 1 had no detectable cause of fetal death. Case 2 had rupture of the amniotic sac causing anhydramnios and acute chorioamnionitis. A groove on the umbilical cord of the normal twin indicated a cord stricture due to cord entanglement.
CONCLUSION
Our experience confirms that the best timing and optimal treatment of MC/MA twins complicated by TRAP sequence still remains a controversial clinical issue. Cord entanglement may continue be a potential clinical risk factor for adverse perinatal outcome even after ablation therapy.
引言
在治疗无心双胎序列征（TRAP）时，消融无心双胎的脐带可保护正常的供血双胎。
材料与方法
报告了两例病例，其中一例为单绒毛膜单羊膜囊妊娠中无心双胎的间质激光光凝术，另一例为激光脐带闭塞术（L-UCO）。
结果
两例孕中期患有TRAP综合征的孕妇接受L-UCO治疗后，均在1个月后出现宫内胎儿死亡。病例1未发现胎儿死亡的可检测原因。病例2羊膜囊破裂导致羊水过少和急性绒毛膜羊膜炎。正常双胎脐带出现的凹槽表明因脐带缠绕导致脐带狭窄。
结论
我们的经验证实，对于合并TRAP序列征的单绒毛膜单羊膜囊双胎，最佳治疗时机和最佳治疗方法仍然是一个有争议的临床问题。即使在消融治疗后，脐带缠绕可能仍然是围产期不良结局的潜在临床危险因素。
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