Duy Anh N, Duy An N, Huyen Thuong P T, Thu Ha N T, Sim N T, Sy Hung H, Manh Tri N, Duc Lam N, Tuan Dat D, Ville Y, Manh Ha N, Minh Duc N
Department of Fetal Intervention, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.
Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam.
Clin Ter. 2022 May 25;173(3):265-273. doi: 10.7417/CT.2022.2430.
Twin-twin transfusion syndrome (TTTS) is a severe prenatal complication of monochorionic diamniotic twins (MCDA). If left untreated, TTTS is associated with a high risk of neonatal death and neurological complications. Various treatment methods for TTTS have been proposed, but fetoscopic laser surgery (FLS) is currently the primary treatment for TTTS in global fetal medicine centers. The objective of this study was to evaluate the outcome of TTTS following FLS treatment at Hanoi Obstetrics and Gynecology Hospital (HOGH), a new fetal medicine center in Vietnam.
A prospective study of a series of 33 consecutive TTTS cases prior to 26 weeks of gestation subjected to FLS at HOGH in Vie-tnam between September 2019 to July 2021. Neonates were monitored for at least six months after birth.
The survival rate of at least one fetus reached 84.85%. No short-term neurological complications have been reported upon follow-up of the newborn up to six months after birth. There were three stillbirth cases (9.09%), one case of preterm ruptured membra-nes (PROM) (3.03%) after seven days of surgery and three cases of recurrent TTTS after surgery using the Solomon technique (25%). No maternal complications were observed. The mean gestational age at birth was 33.76 ± 4.52 weeks, with a mean interval of 12.24 ± 6.67 weeks between intervention and delivery. Nine cases (30%) were born prematurely before 32 weeks. Additionally, 60% of recipients and nearly 90% of donors weighed less than 2500 grams.
FLS leads to high survival rates for fetuses with TTTS. FLS seems to be an effective therapeutic option for TTTS before 26 weeks of gestation.
双胎输血综合征（TTTS）是单绒毛膜双羊膜囊双胎（MCDA）严重的产前并发症。若不治疗，TTTS与新生儿死亡及神经系统并发症的高风险相关。已提出多种治疗TTTS的方法，但胎儿镜激光手术（FLS）是目前全球胎儿医学中心治疗TTTS的主要方法。本研究的目的是评估越南一家新的胎儿医学中心——河内妇产科医院（HOGH）采用FLS治疗TTTS的效果。
对2019年9月至2021年7月在越南HOGH接受FLS治疗的33例妊娠26周前的连续TTTS病例进行前瞻性研究。新生儿出生后至少监测六个月。
至少一个胎儿的存活率达到84.85%。对新生儿出生后六个月的随访未报告短期神经系统并发症。有3例死产病例（9.09%），1例术后7天发生早产胎膜破裂（PROM）（3.03%），3例采用所罗门技术术后发生复发性TTTS（25%）。未观察到母体并发症。出生时的平均孕周为33.76±4.52周，干预与分娩之间的平均间隔为12.24±6.67周。9例（30%）在32周前早产。此外，60%的受血儿和近90%的供血儿体重低于2500克。
FLS可使TTTS胎儿获得较高的存活率。FLS似乎是妊娠26周前治疗TTTS的有效治疗选择。
