天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (1): 59-63.doi: 10.11958/20191789

• 临床研究 • 上一篇    下一篇

双胎输血综合征患者SLCPV与选择性RFA减胎术治疗后 孕周及妊娠结局对比观察

方有珍，陈蔓，罗清清，张东东   

  1. 作者单位：贵州省贵阳市妇幼保健院产科（邮编550001） 作者简介：方有珍（1979），女，本科，副主任医师，主要从事胎儿医学的研究
  • 收稿日期:2019-06-14 修回日期:2019-09-25 出版日期:2020-01-15 发布日期:2020-01-15
  • 通讯作者: 方有珍 E-mail:guoshua967564@163.com

A comparative study of gestational weeks and pregnancy outcomes between SLCPV and selective RFA in patients with twin transfusion syndrome

FANG You-zhen, CHEN Man, LUO Qing-qing, ZHANG Dong-dong   

  1. Department of Obstetrics, Guiyang Maternal and Child Health Hospital, Guiyang 550001, China
  • Received:2019-06-14 Revised:2019-09-25 Published:2020-01-15 Online:2020-01-15

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摘要： 目的 比较双胎输血综合征患者行选择性胎盘血管交通支凝结术（SLCPV）与选择性射频消融（RFA）减胎 术治疗后的孕周及妊娠结局差异。方法 选取2015年1月—2018年1月期间我院收治的双胎输血综合征患者80 例，根据手术方法将患者分为SLCPV组和RFA组（n=40），分别采用SLCPV和选择性RFA减胎术治疗。比较2组患者 手术时间、分娩孕周、妊娠结局、胎儿存活情况、新生儿体质量以及新生儿Apgar评分等指标。结果 SLCPV组手术 时间（28.74±4.59）min长于RFA组的（16.27±3.94）min（P＜0.05）。SLCPV组术后母体并发症发生率为10.0%（4/40）， RFA组未发生明显母体并发症，组间并发症发生率差异无统计学意义（P=0.116）。SLCPV组分娩率90.0%（36/40）与 RFA 组 100.0%（40/40）差异无统计学意义（P＞0.05），分娩孕周（30.15±2.41）周明显短于 RFA 组的（32.85±2.53）周 （P＜0.05）。2 组患者妊娠期糖尿病（GDM）与妊娠期高血压疾病（HDCP）发生率差异均无统计学意义（P＞0.05）。 SLCPV 组胎儿总存活率（55.00%）与 RFA 组（50.00%）差异无统计学意义（P＞0.05），至少一胎存活率（75.0%）低于 RFA组（100.0%，P＜0.05）。SLCPV组新生儿体质量和Apgar评分均明显低于RFA组（P＜0.05）。结论 双胎输血综 合征患者行SLCPV与选择性RFA减胎术均能取得较好的治疗效果。但RFA组能够更好地保证患者分娩和至少一胎 存活，且患者能够获得更长的分娩孕周，是一种值得推荐的治疗选择。

关键词: 双胎输血综合征, 选择性胎盘血管交通支凝结术, 选择性射频消融减胎术, 孕周, 妊娠结局

Abstract: Objective To compare the gestational weeks and pregnancy outcomes after selective laser coagulation of placental vessels (SLCPV) and selective radiofrequency ablation (RFA) in twin transfusion syndrome. Methods Eighty patients with twin transfusion syndrome admitted to our hospital from January 2015 to January 2018 were selected in this study. According to the surgical method, the patients were divided into SLCPV group and RFA group. SLCPV group was treated with SLCPV, and RFA group was treated with selective RFA fetal reduction. The gestational weeks, fetal status and pregnancy outcomes were observed in the two groups, and the therapeutic effects were compared between the two methods. Results The mean operation time was (28.74±4.59) min in SLCPV group, and which was significantly longer than that of RFA group (16.27 ± 3.94) min (P＜0.05). The incidence of maternal complications was 10.00% in SLCPV group, and no significant maternal complications were found in RFA group (P＞0.05). There were no significance in maternal complications between groups (P=0.116). The delivery rate was 90.00% (36/40) in SLCPV group and 100.00 (40/40) in RFA group (P＞0.05). The average gestational weeks of delivery were (30.15 ± 2.41) in SLCPV group, which were significantly shorter than those of RAF group (32.85±2.53, P＜0.05). There were no significant differences in the incidences of gestational diabetes mellitus (GDM) and pregnancy induced hypertension (HDCP) between the two groups (P＞0.05). There was no significant difference in the overall survival rate between the two groups (P＞0.05). The total survival rate of at least one fetus was 75.0% in SLCPV group, which was significantly lower than that of RFA group (P＜0.05). The body mass and Apgar score were significantly higher in RFA group than those in SLCPV group (P＜0.05). Conclusion SLCPV and selective RFA abortion can achieve better therapeutic effect for twin transfusion syndrome patients. However, RFA can better ensure the delivery and survival at least one fetus, and patients can obtain longer gestational weeks of delivery, which is a recommended treatment option.

Key words: twin transfusion syndrome, SLCPV, selective RFA reduction, week of pregnancy, pregnancy outcome