摘要
目的探讨双胎输血综合征的临床诊断、处理及妊娠结局。方法回顾性分析十五年间18例双胎输血综合征(TTTS组)和620例非双胎输血综合征双胎(非TTTS组)的临床资料,比较两组的妊娠并发症、妊娠合并症和妊娠结局。结果(1)双胎输血综合征占双胎妊娠总数的2.8%,占单绒毛膜双胎的8.1%;(2)明确分期14例,引产10例,要求保留胎儿7例(Ⅱ期1例、Ⅲ期5例、Ⅳ期1例);3例经腹羊水减量,其中2例转为Ⅴ期后引产,1例胎儿镜下激光凝固胎盘血管交通支,获两活婴;(3)TTTS组辅助生育受孕明显低于非TTTS组(11.1%比40.0%,P<0.05),胎盘早剥发生率明显高于非TTTS组(22.2%比1.3%,P<0.05);(4)TTTS组终止妊娠孕周、胎儿平均出生体重显著低于非TTTS组(P<0.01)。TTTS组胎儿死亡、畸形和窒息的发生率分别为41.7%、16.7%和33.3%,显著高于非TTTS组的6.4%、1.9%和7.0%(P<0.01)。结论(1)双胎输血综合征严重影响胎儿预后;(2)明确双胎输血综合征的分期有助于临床处理和评估预后;(3)胎儿镜下激光凝固胎盘血管交通支术治疗双胎输血综合征有较好的应用前景。
Objective To investigate the diagnosis, treatment and pregnancy outcomes of twin- twin transfusion syndrome（TTTS）. Methods Eighteen cases of TTTS（TTTS group） were studied retrospectively from Jan 1991 to Oct 2005 in our hospital, and 620 twin pregnancies unaffected by TTTS （control group） were compared. Results （1）The overall incidence of TTTS was 2.8% in all twin pregnancies, and 8.1% in monochorionic twin pregnancies. （2） Fourteen cases of TTTS were staged, and 10 were terminated. Seven cases opted to be managed （1 case at stage Ⅱ , 5 at stage Ⅲ and 1 at stage Ⅳ）. Transabdominal amnioreduction was performed in 3 cases, 2 of them progressed to stage Ⅴ and was terminated. One case was treated by fetoscopic laser coagulation and 2 neonates survived. （3）The ratio of conception by assisted reproductive techniques in TTTS group was lower （11.1% vs 40.0%, P〈0.05）, and the incidence of placenta abruption was higher than that of the control group （22.2% vs 1.3%, P〈0. 01）. The mean gestational age at delivery and birth weight was significantly lower in TTTS group （P〈0.01）. The incidence of perinatal death, fetal malformation and neonatal asphyxia was significantly higher than that of control group （41.7%, 16.7%, 33.3 % vs 6.4%, 1.9 %, 7.0 %, P〈0.01）. Conclusions （1） TTTS have severe harmful effects on the fetus. （2） Staging of TTTS may be helpful in predicting the fetal prognosis. （3） Fetoscopic laser coagulation of the placentan anastomoses is promising in TTTS management.
出处
《中华围产医学杂志》
CAS
2006年第3期145-149,共5页
Chinese Journal of Perinatal Medicine
关键词
双胎输血综合征
妊娠结局
Twin-twin transfusion syndrome
Pregnancy outcome
