Fetoscopic laser photocoagulation for amniotic fluid discordance bordering on twin-twin transfusion syndrome: Feasibility, perinatal and long-term outcomes
Fetoscopic laser photocoagulation for amniotic fluid discordance bordering on twin-twin transfusion syndrome: Feasibility, perinatal and long-term outcomes
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DOI：
10.1111/jog.13349
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发表时间：
2017-08-01
影响因子：
1.6
通讯作者：
Sago, Haruhiko
中科院分区：
文献类型：
--
作者：
Ozawa, Katsusuke;Sugibayashi, Rika;Sago, Haruhiko
目的探讨胎儿镜下激光光凝（FLP）治疗羊水不一致（AFD）合并双胎输血综合征（TTTS）伴脐动脉舒张末速度（AREDV）缺失或逆转的可行性和安全性，并评估围生期和远期预后。方法对妊娠20+0 ~ 25+6周的孕妇（UMIN000004165）进行前瞻性干预研究。除TTTS外，与TTTS相邻的AFD定义为一对双胞胎中3cm的羊水最大垂直袋（MVP）和7cm的羊水最大垂直袋（MVP）。在6个月和3岁时评估神经发育结果。结果2010年9月至2011年7月，6例患者均无并发症。所有病例均需要羊膜输注，平均手术时间为70min。选择性宫内生长限制9例，生长不协调率为25%。供体和受体双胞胎的存活率分别为27.3%（3/11）和100%（11/11）。存活的捐赠双胞胎和11个接受捐赠的双胞胎中，没有一个在6个月大时出现偏瘫。另外一个接受受体的双胞胎在3岁时发育迟缓。结论胎儿镜下激光光凝治疗靠近TTTS并UA AREDV的AFD是可行的，无并发症，但经常导致供体双胞胎死亡，受体双胞胎存活率高，尽管在某些情况下会出现神经发育异常。对于接近TTTS的AFD， FLP似乎不是一个有希望的治疗选择。
AimThis study investigated the feasibility and safety of fetoscopic laser photocoagulation (FLP) for amniotic fluid discordance (AFD) bordering on twin-twin transfusion syndrome (TTTS) with an absent or reverse end-diastolic velocity (AREDV) in the umbilical artery (UA), and evaluated the perinatal and long-term outcomes.MethodsA prospective intervention study was performed between 20+0 and 25+6weeks of gestation (UMIN000004165). AFD bordering on TTTS was defined as maximum vertical pocket (MVP) of amniotic fluid in one twin's sac 3cm and amniotic fluid MVP in the other twin's sac 7cm excluding TTTS. Neurodevelopmental outcome was evaluated at 6months and at 3years of age.ResultsEleven women were treated without complications between September 2010 and July 2011. In all cases amnioinfusion was required, with a median surgical time of 70min. There were nine cases of selective intrauterine growth restriction in which the growth discordant rate was >25%. The survival rates of the donor and recipient twins were 27.3% (3/11) and 100% (11/11), respectively. None of the surviving donor twins and two of the 11 recipient twins had hemiplegia at 6months of age. One additional recipient twin had developmental delay at 3years of age.ConclusionsFetoscopic laser photocoagulation for AFD bordering on TTTS with AREDV in the UA was feasible without complications but frequently resulted in donor twin death and a high survival rate of the recipient twin, albeit with neurodevelopmental abnormalities in some cases. FLP does not seem to be a promising treatment option for AFD bordering on TTTS.