University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany.
University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany.
Best Pract Res Clin Obstet Gynaecol. 2019 Jul;58:55-65. doi: 10.1016/j.bpobgyn.2018.12.011. Epub 2019 Jan 5.
Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects 10-15% of monochorionic multiple pregnancies. Communicating placental vessels on the chorionic plate between the donor and recipient twin are responsible for the imbalance of blood flow. There is evidence for the superiority of fetoscopic laser ablation over serial amnioreductions regarding survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I is still debated. The "Solomon" technique showed a significant reduction in recurrent TTTS and post laser twin anemia-polycythemia sequence (TAPS) in comparison to the selective laser method without improvement in perinatal mortality or neonatal morbidity. Survival rates after fetoscopic laser surgery have significantly increased over the last 25 years. High volume centers report up to 70% double survival and at least one survivor in >90%. Long-term neurodevelopmental impairment occurs in about 10% of children after laser surgery. In this review we discuss the optimal management, innovations in laser technique, long-term neurodevelopmental outcome, and future aspects of TTTS treatment.
双胎输血综合征（TTTS）是一种严重的并发症，影响 10-15%的单绒毛膜多胎妊娠。胎盘绒毛板上供体和受体双胞胎之间的连通胎盘血管负责血液流动的不平衡。有证据表明，在 TTTS Ⅱ-Ⅳ期，胎儿镜激光消融术在存活率和神经结局方面优于连续羊膜减少术。然而，Ⅰ期的最佳治疗方法仍存在争议。与选择性激光方法相比，“所罗门”技术在复发性 TTTS 和激光后双胞胎贫血-多血症序列（TAPS）方面显著减少，而围产期死亡率或新生儿发病率没有改善。过去 25 年来，胎儿镜激光手术后的存活率显著提高。大容量中心报告的双胎存活率高达 70%，90%以上至少有一个存活。激光手术后约有 10%的儿童出现长期神经发育障碍。在这篇综述中，我们讨论了最佳治疗方法、激光技术的创新、长期神经发育结局以及 TTTS 治疗的未来方面。
