De Lia J E, Kuhlmann R S, Harstad T W, Cruikshank D P
Department of Obstetrics and Gynecology, Medical College of Wisconsin, WI 53226-3512, USA.
Am J Obstet Gynecol. 1995 Apr;172(4 Pt 1):1202-8; discussion 1208-11. doi: 10.1016/0002-9378(95)91480-3.
We undertook a pilot study to determine the feasibility and efficacy of fetoscopic laser occlusion of chorioangiopagous vessels in severe previable twin-twin transfusion syndrome.
A total of 35 patients were referred to the investigators with ultrasonographic findings consistent with twin-twin transfusion syndrome, posterior placental implantation, gestational age < 25 weeks, and clinical hydramnios. Placental vessel occlusion was performed with a rigid 2.9 x 3.85 mm dual-channel fetoscope and neodymium:yttrium-aluminum-garnet laser light.
Of the original 35 patients, 5 were eliminated preoperatively and 4 intraoperatively for various factors. The 26 treated patients had a mean gestational age of 20.8 weeks (range 18 to 24) and a mean fundal height of 36.1 cm (range 29 to 44). One patient has surviving triplets, 8 have surviving twins, 9 have a single survivor (2 neonatal and 7 fetal deaths occurred in this group), and 8 have no survivors (all had pregnancy loss within 3 weeks of treatment). The cases with survivors were delivered for obstetric indications at a mean of 32.2 weeks (range 26 to 37), having gained a mean of 11.7 weeks (range 6 to 17) in utero. Fifty-three percent (28/53) of the fetuses survived with 96% (27/28) developing normally at a mean age of 35.8 months (range 1 to 68). Thirty-three of 35 placentas were monochorionic with chorioangiopagous vessels on gross and microscopic evaluation.
Fetoscopic laser occlusion of chorioangiopagous vessels is technically feasible and improves the course and outcome of severe twin-twin transfusion syndrome in previable fetuses.
我们开展了一项前瞻性研究，以确定在严重的可存活前双胎输血综合征中行胎儿镜下激光封堵绒毛膜血管的可行性和疗效。
共有35例患者因超声检查结果符合双胎输血综合征、胎盘后置、孕周<25周及临床羊水过多而被转诊至研究人员处。使用2.9×3.85mm的硬质双通道胎儿镜及钕:钇铝石榴石激光进行胎盘血管封堵。
在最初的35例患者中，5例因各种因素在术前被排除，4例在术中被排除。26例接受治疗的患者平均孕周为20.8周（范围18至24周），平均宫高为36.1cm（范围29至44cm）。1例患者有存活的三胞胎，8例有存活的双胞胎，9例有单胎存活（该组发生2例新生儿死亡和7例胎儿死亡），8例无存活者（均在治疗后3周内发生妊娠丢失）。有存活者的病例因产科指征平均在32.2周（范围26至37周）分娩，在子宫内平均孕周增加了11.7周（范围6至17周）。53%（28/53）的胎儿存活，其中96%（27/28）在平均35.8个月（范围1至68个月）时发育正常。35个胎盘中有33个为单绒毛膜，在大体和显微镜检查下可见绒毛膜血管。
胎儿镜下激光封堵绒毛膜血管在技术上是可行的，并改善了严重的可存活前双胎输血综合征的病程及结局。
