Residual anastomoses after fetoscopic laser surgery in twin-to-twin transfusion syndrome: Frequency, associated risks and outcome
Residual anastomoses after fetoscopic laser surgery in twin-to-twin transfusion syndrome: Frequency, associated risks and outcome
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DOI：
10.1016/j.placenta.2006.03.005
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发表时间：
2007-02-01
期刊：
影响因子：
3.8
通讯作者：
Vandenbussche, F. P. H. A.
中科院分区：
文献类型：
--
作者：
Lopriore, E.;Middeldorp, J. M.;Vandenbussche, F. P. H. A.
胎儿镜下激光凝固胎盘血管吻合口被认为是治疗严重双胎输血综合征的首选方法。胎儿镜激光手术的目的是完全分离双胎间的胎盘循环。激光凝血不完全可能导致血管吻合口残留。胎儿镜激光手术治疗双胎输血综合征中吻合口残留的发生率和临床意义尚未研究。在2002年6月至2005年12月期间，我们检查了所有接受过激光手术的胎盘，并使用彩色染料进行血管注射。研究了吻合口残留与不良结局和出生时双胞胎间血红蛋白差异的关系。不良结局定义为胎儿死亡、新生儿死亡或严重脑损伤。评价残留吻合口与胎盘定位（子宫前壁或子宫后壁）的关系。本研究共对52例激光治疗胎盘进行了研究。33%（17/52）胎盘吻合口残留。吻合口残留组和无吻合口残留组不良结局相似，分别为18%（6/34）和29% (20/70)（p = 0.23）。双胎间血红蛋白差异较大，65%（11/17）存在吻合口，20%（7/35）未存在吻合口，差异有统计学意义（p < 0.01）。胎盘前侧定位与吻合口残留发生率不相关。综上所述，在我们的机构中，三分之一的单绒毛膜胎盘在胎儿镜激光手术中出现了残留的吻合口。虽然在我们的研究中，残留的吻合口与不良结果无关，但它们通常与新生儿血液学并发症有关。(c) 2006 Elsevier Ltd.版权所有。
Fetoscopic laser coagulation of placental vascular anastomoses is considered to be the treatment of choice in severe twin-to-twin transfusion syndrome. The aim of fetoscopic laser surgery is to separate completely the inter-twin placental circulation. Incomplete laser coagulation may result in residual vascular anastomoses. The incidence and clinical implications of residual anastomoses in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery has not yet been studied. We examined all placentas treated with fetoscopic laser surgery and delivered at our center between June 2002 and December 2005 with vascular injection using colored dyes. Presence of residual anastomoses was studied in association with adverse outcome and inter-twin hemoglobin difference at birth. Adverse outcome was defined as fetal demise, neonatal death or severe cerebral injury. The relation between residual anastomoses and placental localization (anterior or posterior uterine wall) was evaluated. A total of 52 laser-treated placentas were studied. Residual anastomoses were detected in 33% (17/52) of placentas. Adverse outcome was similar in the groups with and without residual anastomoses, 18% (6/34) and 29% (20/70), respectively (p = 0.23). Large inter-twin hemoglobin differences (> 5 g/dL) were found in 65% (11/17) of cases with residual anastomoses and 20% (7/35) of cases without residual anastomoses (p < 0.01). Anterior placental localization was not associated with a more frequent presence of residual anastomoses. In conclusion, residual anastomoses at our institution are seen in one-third of monochorionic placentas treated with fetoscopic laser surgery. Although residual anastomoses in our study were not associated with adverse outcome, they were often associated with neonatal hematological complications. (c) 2006 Elsevier Ltd. All rights reserved.