Deprest J A, Van Schoubroeck D, Van Ballaer P P, Flageole H, Van Assche F A, Vandenberghe K
Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium.
Ultrasound Obstet Gynecol. 1998 May;11(5):347-52. doi: 10.1046/j.1469-0705.1998.11050347.x.
Nd: YAG laser coagulation is used to treat severe twin-to-twin transfusion syndrome (TTS). Success of the technique depends on visualization of the placenta, the fetal membranes and the targeted vessels, as well as obtaining an optimal inclination angle for laser coagulation. In the rare case of an extensive anterior placenta, it may be difficult to achieve these conditions using the percutaneous approach. Here, we propose an alternative to the percutaneous procedure. Modifications involve an open access and the use of a flexible cannula and bent scope. An extraplacental area, usually at the fundus, is identified by B-mode and color Doppler imaging. A mini-laparotomy is made under general anesthesia. The viscera are retracted and the cannula is inserted under direct view and ultrasound control by the Seldinger technique. The curved fiberscope is passed through the flexible cannula, allowing adequate inspection of the placenta, and target vessels can be coagulated at an angle close to 90 degrees. After the procedure, the uterus is closed primarily to prevent postoperative leakage of amniotic fluid or hemorrhage. This technique has been successfully used in six patients with TTS and a completely anterior placenta, with a gestational age between 18.5 and 22.0 weeks. In all patients, the amniotic cavity was accessed without hemorrhage. The outcomes are similar to those published previously for laser coagulation. The mean interval from intervention until delivery was 10.5 weeks. All 12 fetuses were live born but four died from complications of extreme prematurity. No maternal complications occurred.
钇铝石榴石激光凝固术用于治疗严重的双胎输血综合征(TTS)。该技术的成功取决于胎盘、胎膜和目标血管的可视化，以及获得激光凝固的最佳倾斜角度。在前置胎盘广泛的罕见情况下，使用经皮途径可能难以达到这些条件。在此，我们提出一种经皮手术的替代方法。改进包括开放入路以及使用柔性套管和弯曲的内镜。通过B超和彩色多普勒成像确定胎盘外区域，通常在子宫底部。在全身麻醉下做一个小剖腹术。牵拉内脏，通过Seldinger技术在直视和超声引导下插入套管。弯曲的纤维内镜穿过柔性套管，可充分检查胎盘，目标血管可在接近90度的角度进行凝固。术后，子宫一期缝合以防止术后羊水渗漏或出血。该技术已成功应用于6例TTS合并完全前置胎盘的患者，孕周在18.5至22.0周之间。所有患者均成功进入羊膜腔且无出血。结果与之前发表的激光凝固术相似。从干预到分娩的平均间隔时间为10.5周。所有12例胎儿均存活，但4例死于极早产并发症。未发生母体并发症。
