对单绒毛膜双胎中异常胎儿行脐带双极电凝减胎术的研究

摘要

Objective To summarize our preliminary experience of selective fetieide with bipolar coagulation in complicated monochorionie twins(MCT),and discuss the clinical application of feticide in discordant MCT.Methods Three MCT with one twin anomaly.in which 2 had severe twin-twin transfusion syndrome(TTTS),stage Ⅳ ,and 1 had acardiac twin,were identified in the second trimester of pregnancy.To terminate the abnormal twin and isolate the co-twin's circulation completely.selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy.After each invasive procedure,serial monitoring was performed,including procedural complications,Doppler of fetal middle cerebral artery and umbilical artery.Pregnancies were followed up every 2 weeks for fetal growth until delivery.After birth the placentas and the terminated fetuses were examined.Result Cord occlusion was successfully accomplished in all 3 targeted fetuses,at 21,22 and 24 weeks of gestation respectively.One case with TTTS was complicated with rupture of the membrane in the terminated fetus at the 7th day after the procedure.and a healthy baby was born at 32 weeks.The other case with TTTS delivered a boy by cesarean section at 38 weeks.The third case with TRAP is at 35 weeks of gestations and under regular follow-up.Monochorionicity was confirmed by placental examination after delivery.and the effects of bipolar coagulation were observed at the,cord of terminated fetuses.Conclusions Umbilical cord occlusion witll bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly.The outcome of normal fetus can be favorable.%目的 探讨脐带双极电凝法对单绒毛膜双胎中异常胎儿进行选择性减胎术的临床应用价值.方法 选择2007年2-3月中山大学附属第一医院妇产科胎儿医学中心收治的3例一胎异常的单绒毛膜双胎孕妇,其中2例为双胎输血综合征,1例双胎之一为无心畸形,在超声和胎儿镜的引导下应用双极电凝法阻断异常胎儿的脐带血流,以减灭异常胎儿.术后超声连续监测存活胎儿的大脑中动脉和脐动脉的血流频谱,并随访其发育以及母-胎手术并发症.分娩时检查胎儿及胎盘.结果 3例孕妇分别在孕21、22和24周时,应用脐带双极电凝法成功阻断异常胎儿的脐带血流.已经分娩的两例中,1例在减胎术后7 d,死胎发生胎膜破裂,孕32周剖宫产娩出一健康男婴;另1例孕38周剖宫产娩出一健康男婴.2个新生儿1分钟和5分钟Apgar评分均为10分.两例孕妇产后经胎盘病理检查确认为单绒毛膜双胎,死胎脐带可见明显的电凝痕迹.例3目前孕35周,随访结果正常.结论 脐带双极电凝减胎术是适用于单绒毛膜双胎的有效减胎手段,有助于改善正常胎儿的妊娠结局.