Ville Y, Hyett J, Hecher K, Nicolaides K
Harris Birthright Research Centre for Fetal Medicine, King's College School of Medicine, London, United Kingdom.
N Engl J Med. 1995 Jan 26;332(4):224-7. doi: 10.1056/NEJM199501263320404.
In monozygotic twin pregnancies, there are placental vascular communications between the two fetuses. In 15 percent of such pregnancies there is an imbalance in net blood flow between the twins, resulting in the twin-twin transfusion syndrome. The recipient twin may have severe hydramnios during the second trimester of pregnancy, and there is a high risk of perinatal death and cerebral palsy in survivors. This condition can now be treated by endoscopic coagulation of the vascular anastomoses responsible for fetofetal transfusion with a neodymium:yttrium-aluminum-garnet (Nd: YAG) laser.
We performed intrauterine surgery in 45 pregnant women carrying twins at 15 to 28 weeks of gestation (median, 21); in each case there was severe hydramnios in one fetus due to the twin-twin transfusion syndrome. With the use of local anesthesia and continuous ultrasound visualization, a rigid fetoscope 2 mm in diameter, housed in a 2.7-mm cannula, was introduced transabdominally into the amniotic cavity of the recipient twin. A systematic search was made for all vessels approaching or crossing the membrane between the twins, and these were coagulated with an Nd:YAG laser by means of a fiber in the side arm of the cannula.
Coagulation of the communicating vessels was successful in all cases. The total number of fetuses who survived to delivery was 48 (53 percent), and the number of pregnancies with at least 1 survivor was 32 (71 percent). Among the live-born infants, the median gestational age at delivery was 35 weeks (range, 25 to 40), and the median birth weight was 2098 g (range, 550 to 4252). The median interval between the endoscopic laser procedure and delivery was 14 weeks (range, 0 to 21). All the survivors were developing normally at a median age of 12 months (range, 2 to 24).
Our preliminary experience suggests that the twin-twin transfusion syndrome can be treated effectively by endoscopic laser coagulation of the communicating placental vessels.
在单卵双胎妊娠中，两个胎儿之间存在胎盘血管交通。在15%的此类妊娠中，双胎之间的净血流存在不平衡，导致双胎输血综合征。受血儿在妊娠中期可能出现严重羊水过多，幸存者围产期死亡和患脑瘫的风险很高。现在这种情况可以通过用钕：钇铝石榴石（Nd:YAG）激光对负责胎儿间输血的血管吻合口进行内镜凝固来治疗。
我们对45例妊娠15至28周（中位孕周为21周）的双胎孕妇进行了宫内手术；每例中，由于双胎输血综合征，一个胎儿出现严重羊水过多。在局部麻醉和持续超声监测下，将一根直径2mm、置于2.7mm套管内的硬式胎儿镜经腹插入受血儿的羊膜腔。系统检查所有接近或穿过双胎之间胎膜的血管，并用Nd:YAG激光通过套管侧臂内的光纤对这些血管进行凝固。
所有病例中交通血管的凝固均成功。存活至分娩的胎儿总数为48例（53%），至少有1名存活者的妊娠数为32例（71%）。在存活婴儿中，分娩时的中位孕周为35周（范围为25至40周），中位出生体重为2098g（范围为550至4252g）。内镜激光手术与分娩之间的中位间隔时间为14周（范围为0至21周）。所有幸存者在中位年龄12个月（范围为2至24个月）时发育正常。
我们的初步经验表明，通过内镜激光凝固胎盘交通血管可有效治疗双胎输血综合征。
