Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'
Fetoscopic laser ablation of placental anastomoses in twin-twin transfusion syndrome using 'Solomon technique'
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DOI：
10.1002/uog.12492
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发表时间：
2013-10-01
影响因子：
7.1
通讯作者：
Belfort, M. A.
中科院分区：
文献类型：
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作者：
Ruano, R.;Rodo, C.;Belfort, M. A.
ObjectiveTo记录使用所罗门技术选择性光凝治疗重度双胎输血综合征（TTTS.MethodsBetween 2010年1月至2012年7月，收集了102例连续单绒毛膜双胎妊娠合并重度TTTS的资料，这些双胎妊娠在4个不同的中心接受了胎儿镜激光消融术。我们进行了选择性激光凝固使用的所罗门技术（病例）和那些进行选择性激光凝固没有这个程序（对照组）之间的结果进行了比较。ResultsOf 102妊娠检查，26（25.5%）进行了所罗门技术和76（74.5%）没有。在204只胎仔中，139只（68.1%）存活至30日龄。82例（80.4%）妊娠中至少有一对双胞胎存活，57例（55.9%）妊娠中双胞胎均存活。与对照组相比，Solomon技术组双胞胎的存活率明显更高（84.6 vs 46.1%; P < 0.01），总新生儿存活率更高（45/52（86.5%）vs 94/152（61.8%; P < 0.01）。多变量分析显示，使用所罗门技术与双胞胎存活率（校正比值比（aOR），11.35（95%CI，3.11-53.14）; P = 0.0007）和新生儿总存活率（aOR，4.65（95%CI，1.59-13.62）; P = 0.005）独立相关。有没有复发TTTS或双胞胎贫血，红细胞增多症序列（TAPS）在Solomon-technique group.ConclusionsUse的所罗门技术选择性激光凝固后的胎盘早剥似乎提高双胞胎的生存率，并可能降低复发TTTS和TAPS的风险。我们的数据支持进行随机对照试验的想法，以评估所罗门技术的有效性。Copyright（c）2013 ISUOG.出版社：John Wiley & Sons Ltd
ObjectiveTo document perinatal outcomes following use of the Solomon technique' in the selective photocoagulation of placental anastomoses for severe twin-twin transfusion syndrome (TTTS).MethodsBetween January 2010 and July 2012, data were collected from 102 consecutive monochorionic twin pregnancies complicated by severe TTTS that underwent fetoscopic laser ablation at four different centers. We compared outcomes between subjects that underwent selective laser coagulation using the Solomon technique (cases) and those that underwent selective laser coagulation without this procedure (controls).ResultsOf the 102 pregnancies examined, 26 (25.5%) underwent the Solomon technique and 76 (74.5%) did not. Of the 204 fetuses, 139 (68.1%) survived up to 30 days of age. At least one twin survived in 82 (80.4%) pregnancies and both twins survived in 57 (55.9%) pregnancies. When compared with the control group, the Solomon-technique group had a significantly higher survival rate for both twins (84.6 vs 46.1%; P < 0.01) and a higher overall neonatal survival rate (45/52 (86.5%) vs 94/152 (61.8%); P < 0.01). Use of the Solomon technique remained independently associated with dual twin survival (adjusted odds ratio (aOR), 11.35 (95% CI, 3.11-53.14); P = 0.0007) and overall neonatal survival rate (aOR, 4.65 (95% CI, 1.59-13.62); P = 0.005) on multivariable analysis. There were no cases of recurrent TTTS or twin anemia-polycythemia sequence (TAPS) in the Solomon-technique group.ConclusionsUse of the Solomon technique following selective laser coagulation of placental anastomoses appears to improve twin survival and may reduce the risk of recurrent TTTS and TAPS. Our data support the idea of performing a randomized controlled trial to evaluate the effectiveness of the Solomon technique. Copyright (c) 2013 ISUOG. Published by John Wiley & Sons Ltd.