Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome
Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome
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DOI：
10.1056/nejmoa032597
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发表时间：
2004-07-08
影响因子：
158.5
通讯作者：
Ville, Y
中科院分区：
文献类型：
--
作者：
Senat, MV;Deprest, J;Ville, Y
背景资料：单绒毛膜双胎妊娠合并妊娠中期严重的双胎间输血综合征可通过连续减胎术（去除大量羊水）或选择性胎镜下激光凝固绒毛膜板上的交通血管来治疗。我们进行了一项随机试验，以比较这两种treatment.Methods的疗效和安全性：妊娠26周前的重度双胎输血综合征的孕妇被随机分配到激光治疗或bronchoderuction。我们评估了至少一对双胞胎的围产期存活率根据妊娠次数或胎儿或婴儿的数量（如适用），评估6个月时至少一个双胞胎的存活率和6个月时无神经系统并发症的存活率（预先规定的主要结局）。该研究提前结束，72名女性被分配到激光组，70名女性被分配到羊水减少组，因为计划的中期分析表明激光组具有显着的益处。与减胎术组相比，激光组至少有一个双胞胎存活到28天（76%对56%;两个胎儿死亡的相对风险为0.63; 95%置信区间为0.25 - 0.93; P=0.009）和6个月（P=0.002）的可能性更高。激光治疗组的婴儿囊性脑室周围白质软化的发生率也较低（6%对14%，P=0.02），并且在6个月大时更有可能没有神经系统并发症（52%对31%，P=0.003）。内镜下激光凝固术是一种比连续减容术更有效的治疗严重双胎畸形的一线治疗方法。妊娠26周前诊断的双胞胎输血综合征。
Background: Monochorionic twin pregnancies complicated by severe twin-to-twin transfusion syndrome at midgestation can be treated by either serial amnioreduction (removal of large volumes of amniotic fluid) or selective fetoscopic laser coagulation of the communicating vessels on the chorionic plate. We conducted a randomized trial to compare the efficacy and safety of these two treatments.Methods: Pregnant women with severe twin-to-twin transfusion syndrome before 26 weeks of gestation were randomly assigned to laser therapy or amnioreduction. We assessed perinatal survival of at least one twin (a prespecified primary outcome), survival of at least one twin at six months of age, and survival without neurologic complications at six months of age on the basis of the number of pregnancies or the number of fetuses or infants, as appropriate.Results: The study was concluded early, after 72 women had been assigned to the laser group and 70 to the amnioreduction group, because a planned interim analysis demonstrated a significant benefit in the laser group. As compared with the amnioreduction group, the laser group had a higher likelihood of the survival of at least one twin to 28 days of age (76 percent vs. 56 percent; relative risk of the death of both fetuses, 0.63; 95 percent confidence interval, 0.25 to 0.93; P=0.009) and 6 months of age (P=0.002). Infants in the laser group also had a lower incidence of cystic periventricular leukomalacia (6 percent vs. 14 percent, P=0.02) and were more likely to be free of neurologic complications at six months of age (52 percent vs. 31 percent, P=0.003).Conclusions: Endoscopic laser coagulation of anastomoses is a more effective first-line treatment than serial amnioreduction for severe twin-to-twin transfusion syndrome diagnosed before 26 weeks of gestation.