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目的探讨射频消融(radiofrequency ablation,RFA)选择性减胎术和胎儿镜下选择性胎盘血管交通支凝结术(selective laser coagulation of placental vessels,SLCPV)两种不同方式治疗严重双胎输血综合征(twin-twin transfusion syndrome,TTTS)患者的临床结局。方法收集中国医科大学附属盛京医院2011年7月至2015年5月行RFA治疗(5例)、SLCPV治疗(15例)的Quintero分期Ⅲ~Ⅳ期TTTS患者的临床资料进行回顾性分析对比。结果 (1)RFA组手术孕周为22~26+1周,平均24.4周;平均手术时间15.6 min;SLCPV组手术孕周为17+5~27+4周,平均23.1周;平均手术时间30 min。RFA组无一例发生未足月胎膜早破(premature rupture of the membrane,PPROM),SLCPV组5例(P>0.05)。(2)SLCPV组患者有1例发生肠梗阻并最终发生流产;术后两组20例患者的胎儿染色体检测结果均未见异常。(3)RAF组患者分娩孕周为28~(+1)~36~(+1)周,平均32.2周,SLCPV分娩孕周为26~(+3)~37~(+1)周,平均30.3周。对新生儿定期随访发现:SLCPV组中1例胼胝体发育不良,而其同胞胎儿表现正常。至少一胎存活率全部20例患者为16/20,RAF组为5/5,SLCPV组为11/15(P>0.05)。结论 RAF选择性减胎术和胎儿镜SLCPV治疗严重双胎输血综合征均具有良好效果;射频消融手术是治疗严重双胎输血综合征一种可考虑的选择。
Objective To investigate the effects of selective ablation of radiofrequency ablation (RFA) and selective laser coagulation of placental vessels (SLCPV) in the treatment of severe twin transfusion syndrome -twin transfusion syndrome, TTTS). Methods A retrospective analysis was performed on the clinical data of patients with Quintero stage Ⅲ-Ⅳ TTTS treated with RFA (5 cases) and SLCPV (15 cases) at Shengjing Hospital affiliated to China Medical University from July 2011 to May 2015. The average gestational time was 15.6 min in the RFA group. The gestational weeks of the RFA group was 22-26 + 1 week (mean 24.4 weeks) min. There was no case of premature rupture of the membrane (PPROM) or SLCPV in RFA group (P> 0.05). (2) One case of intestinal obstruction occurred in SLCPV group and eventually abortion occurred. No result of fetal chromosome test was found in 20 cases in the two groups. (3) The gestational weeks of delivery in RAF group were 28 ~ (+1) ~ 36 ~ (+1) weeks, with an average of 32.2 weeks. The gestational weeks of SLCPV delivery were 26 ~ (+3) ~ 37 ~ 30.3 weeks. Regular follow-up of newborns found: SLCPV group, 1 case of corpus callosum dysplasia, while its siblings showed normal. The survival rate of at least one fetus was 16/20 in 20 patients, 5/5 in RAF group and 11/15 in SLCPV group (P> 0.05). Conclusion The selective ablation of RAF and fetus mirror SLCPV in the treatment of severe twin transfusion syndrome have good results. Radiofrequency ablation is a feasible option for the treatment of severe twin syphilis.