New fluorescence endoscope for use in twin-twin transfusion syndrome: In vivo visualization of placental blood vessels
New fluorescence endoscope for use in twin-twin transfusion syndrome: In vivo visualization of placental blood vessels
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DOI：
10.1016/j.medengphy.2010.11.006
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发表时间：
2011-04-01
影响因子：
2.2
通讯作者：
Chiba, Toshio
中科院分区：
文献类型：
--
作者：
Ishiyama, Akihiko;Kim, Keri;Chiba, Toshio
双胞胎输血综合征（TTTS）是一种双胞胎通过共用胎盘中的交通血管不成比例地共享血液的疾病，导致胎儿和围产期死亡率很高。进行胎儿镜激光光凝以中断这些交通血管;然而，由于胎儿镜获得的图像较差，小血管经常被遗漏。我们已经开发出一种荧光内窥镜，能够可视化非常小的血管，即使在羊水中，我们研究了其可行性在体内可视化胎盘血管。将吲哚菁绿色（ICG）分别以0.5、1.0和1.5 mg/kg单剂量注入孕兔母体循环，用内窥镜观察胎盘血管。注射ICG约10 min后15 s内检测到血管。0.5 mg/kg给药后绒毛间隙和脐血管之间的亮度差异显著小于1.0 mg/kg（p = 0.02）或1.5 mg/kg（p = 0.01）给药后。甚至检测到非常小的血管（直径0.2 mm）。总之，我们的新内窥镜成功地提供了体内胎盘血管的详细视图。结果是有希望的未来TTTS激光手术。(C)2010年，妇女平等问题国际研究所。由爱思唯尔有限公司出版。保留所有权利。
Twin-twin transfusion syndrome (TTTS) is a condition in which twins share blood disproportionately by the communicating vessels in the shared placenta, resulting in high fetal and perinatal mortality. Fetoscopic laser photocoagulation is performed to interrupt these communicating vessels; however, small vessels are often missed due to the poor image obtained with a fetoscope. We have developed a fluorescence endoscope capable of visualizing very small vessels, even in amniotic fluid, and we investigated its feasibility for in vivo visualization of placental vessels. Indocyanine green (ICG) was given at single doses of 0.5, 1.0, and 1.5 mg/kg, respectively, into the maternal circulation of pregnant rabbits, and the endoscope was used to identify the placental vessels. The vessels were detected within 15s after ICG injection for about 10 min. The brightness difference between the intervillous space and the umbilical vessels was significantly smaller after administration of 0.5 mg/kg than after 1.0 mg/kg (p = 0.02) or 1.5 mg/kg (p = 0.01). Even very small vessels (0.2 mm in diameter) were detected. In conclusion, our new endoscope successfully provided a detailed view of the placental vessels in vivo. The results are promising for future TTTS laser surgery. (C) 2010 IPEM. Published by Elsevier Ltd. All rights reserved.