Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore.
Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore.
Singapore Med J. 2020 Oct;61(10):523-531. doi: 10.11622/smedj.2019107. Epub 2019 Sep 6.
Fetoscopic laser photocoagulation (FLP), a treatment option for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre. We previously reported on our experience of FLP from June 2011 to March 2014. This paper audits our fetal surgery performance since then.
15 consecutive patients who underwent FLP for Stage II-III TTTS before 26 weeks of gestation from June 2011 to January 2017 were retrospectively reviewed, consisting of five cases from our initial experience and ten subsequent cases. Perioperative, perinatal and neonatal outcomes were analysed.
Of 15 pregnancies, 10 (66.7%) and 5 (33.3%) were for Stage II and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort. Overall mean gestational ages at presentation, laser and delivery were comparable between the cohorts at 19.7 (15.4-24.3) weeks, 20.3 (16.3-25.0) weeks and 31.2 (27.6-37.0) weeks, respectively. 2 (13.3%) cases had intra-amniotic bleeding and 1 (6.7%) had iatrogenic septostomy. 1 (6.7%) case had persistent TTTS requiring repeat FLP, and another (6.7%) had preterm premature rupture of membranes at seven weeks post procedure. The overall perinatal survival rate was 21 (75.0%) out of 28 infants. One mother underwent termination of pregnancy for social reasons at 1.4 weeks post procedure. Double survival occurred in 8 (57.1%) out of 14 pregnancies, while 13 (92.9%) had at least one survivor.
FLP requires a highly specialised team and tertiary neonatal facility. Continual training improves maternal and perinatal outcomes, ensuring comparable standards with international centres.
胎儿镜激光凝固术（FLP）是治疗单绒毛膜双胎妊娠中双胎输血综合征（TTTS）的一种治疗选择，目前是我们中心的首选治疗方法。我们之前报告了 2011 年 6 月至 2014 年 3 月期间我们的 FLP 经验。本文审查了自那时以来我们的胎儿外科手术表现。
回顾性分析 2011 年 6 月至 2017 年 1 月期间因 26 周前 II-III 期 TTTS 接受 FLP 的 15 例连续患者，其中包括我们最初经验的 5 例和随后的 10 例。分析围手术期、围产期和新生儿结局。
15 例妊娠中，10 例（66.7%）和 5 例（33.3%）分别为 II 期和 III 期 TTTS，后一组在更早的 Quintero 阶段进行了 FLP。两组在就诊时、激光治疗时和分娩时的平均孕周分别为 19.7（15.4-24.3）周、20.3（16.3-25.0）周和 31.2（27.6-37.0）周。2 例（13.3%）有羊膜内出血，1 例（6.7%）有医源性中隔切开术。1 例（6.7%）患者 TTTS 持续存在，需要重复 FLP，另 1 例（6.7%）在术后 7 周出现早产胎膜早破。28 例婴儿中，21 例（75.0%）围产儿存活。1 例母亲因社会原因在术后 1.4 周终止妊娠。14 例妊娠中，8 例（57.1%）双胎存活，13 例（92.9%）至少有 1 例存活。
FLP 需要一个高度专业化的团队和三级新生儿设施。持续培训可改善母婴围产期结局，确保与国际中心具有可比标准。
