Quincke 与 Diamond-Tip 针在双胎输血综合征胎盘激光手术中的应用比较。

Quincke versus Diamond-Tip Needles for Entry in Placental Laser Surgery for Twin-to-Twin Transfusion Syndrome.

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California, USA.

Midwest Fetal Care Center, Children's Minnesota, Minneapolis, Minnesota, USA,

出版信息

Fetal Diagn Ther. 2023;50(3):196-205. doi: 10.1159/000530548. Epub 2023 Apr 10.

DOI:10.1159/000530548

PMID:37037188

Abstract

INTRODUCTION

Chorioamniotic membrane separation (CAS), preterm prelabor rupture of membranes (PPROM), and preterm delivery (PTD) remain as major complications of fetoscopic laser photocoagulation (FLP) for twin-to-twin transfusion syndrome (TTTS). We sought to examine whether use of Quincke-tip needles for initial entry during FLP reduces the risk of these complications.

METHODS

This is a secondary analysis of prospectively collected data from patients that had FLP for TTTS at a single tertiary care center (2011-2021). We excluded patients for whom direct trocar entry was used. Patients for whom a Quincke-tip needle was used were compared to those for whom a diamond-tip needle was used during Seldinger entry. Demographics, ultrasound findings and operative characteristics were compared between groups. Postoperative outcomes and complications (including CAS, PPROM, and PTD) were also compared. Multivariate logistic regression models were fit to assess independent risk factors for complications.

RESULTS

386 patients met inclusion criteria; Quincke-tip needles were used in 81 (21.0%) cases, while diamond-tip needles were used in 305 (79.0%). Rates of CAS (11.1 vs. 9.5%, p = 0.67) and PPROM (44.4 vs. 41.0%, p = 0.57) were similar between groups. Patients in the Quincke-tip group delivered 1.5 weeks earlier than those in the diamond-tip group (30.5 vs. 32.0 weeks, p = 0.01). However, these patients were more likely to be delivered for maternal (35.9 vs. 19.0%) and fetal (23.1 vs. 15.3%) indications (p < 0.01). In multivariate analysis, needle type was not identified as an independent risk factor for PPROM. However, Quincke-tip needle use was associated with PTD less than 32 weeks (aOR 1.74, 95% CI: 1.02-2.97, p = 0.043).

CONCLUSION

Membrane complications following FLP were not associated with the needle type used for entry. Earlier delivery in the Quincke-tip group was likely attributable to higher rates of delivery for maternal and fetal indications, and not membrane complications. The needle chosen for entry is likely best determined by operator preference.

摘要

介绍

羊膜膜分离（CAS）、胎膜早破（PPROM）和早产（PTD）仍然是胎儿镜激光凝固术（FLP）治疗双胎输血综合征（TTTS）的主要并发症。我们试图研究在 FLP 中使用 Quincke 尖端针进行初始进入是否会降低这些并发症的风险。

方法

这是对在单一三级保健中心（2011-2021 年）接受 TTTS 的 FLP 的患者前瞻性收集数据的二次分析。我们排除了直接使用套管针进入的患者。使用 Quincke 尖端针的患者与使用钻石尖端针进行 Seldinger 进入的患者进行比较。对两组患者的人口统计学、超声检查结果和手术特征进行比较。还比较了术后结果和并发症（包括 CAS、PPROM 和 PTD）。使用多变量逻辑回归模型评估并发症的独立危险因素。

结果

386 名患者符合纳入标准；81 例（21.0%）使用 Quincke 尖端针，305 例（79.0%）使用钻石尖端针。CAS 发生率（11.1%比 9.5%，p=0.67）和 PPROM 发生率（44.4%比 41.0%，p=0.57）相似。Quincke 尖端组的患者比钻石尖端组的患者早分娩 1.5 周（30.5 周比 32.0 周，p=0.01）。然而，这些患者更有可能因母亲（35.9%比 19.0%）和胎儿（23.1%比 15.3%）的原因而分娩（p < 0.01）。多变量分析显示，针型不是 PPROM 的独立危险因素。然而，Quincke 尖端针的使用与 32 周以下的 PTD 相关（优势比 1.74，95%置信区间：1.02-2.97，p=0.043）。