[1]吕艳红,郭 红,贺媛媛,等.双胎输血综合征临床研究进展[J].陕西医学杂志,2023,52(11):1612-1616.[doi:DOI:10.3969/j.issn.1000-7377.2023.11.035]
　LYU Yanhong,GUO Hong,HE Yuanyuan,et al.Clinical research progress of twin-twin transfusion syndrome[J].,2023,52(11):1612-1616.[doi:DOI:10.3969/j.issn.1000-7377.2023.11.035]
点击复制

双胎输血综合征临床研究进展
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
52
期数:
2023年11期
页码:
1612-1616
栏目:
综 述
出版日期:
2023-11-05

文章信息/Info

Title:
Clinical research progress of twin-twin transfusion syndrome
作者:
吕艳红1; 郭 红2; 贺媛媛1; 白 璐1; 陈必良2; 刘朵朵2
(1.空军军医大学西京医院,陕西 西安710032; 2.西安市人民医院 西安市第四医院,陕西 西安710100)
Author(s):
LYU Yanhong; GUO Hong; HE Yuanyuan; BAI Lu; CHEN Biliang; LIU Duoduo
(Xijing Hospital of Air Force Medical University,Xi'an 710032,China)
关键词:
双胎输血综合征;  诊断;  治疗;  并发症;  胎儿镜检查;  胎盘血管交通支凝固术
Keywords:
Twin-to-twin transfusion syndrome;  Diagnosis;  Therapy;  Complications;  Fetoscopy;  Placental vascular communicating branch coagulation surgery
分类号:
R 714.25
DOI:
DOI:10.3969/j.issn.1000-7377.2023.11.035
文献标志码:
A
摘要:
双胎输血综合征(TTTS)是单绒毛膜双胎妊娠中的一种较为常见且严重的并发症,其发生率约为10%～15%,若不进行及时有效的干预将导致严重的并发症。目前,临床治疗TTTS的最常见方法为胎儿镜下胎盘血管交通支凝固术,大大提高了这类患者的预后,但仍会造成胎死宫内、胎膜早破及早产等术后常见并发症,并对胎儿的预后造成影响,因而需要通过改善手术方式、手术技巧、重视术后管理等方式来减少术后并发症的发生,同时需加强新生儿的出生后的长期随访,关注术后远期并发症。现就TTTS临床诊断、治疗、术后并发症预防、术后管理以及长期随访等予以总结,旨在为临床TTTS诊疗方面提供参考。
Abstract:
Twin-to-twin transfusion syndrome(TTTS)is a common and serious complication in singleton chorionic twin pregnancy,its incidence rate is about 10% to 15%,It may cause serious complications if we don't take effective interventions in time.At present,the most common treatment for TTTS is coagulation of placental vascular communicating branch under fetoscopy,which greatly improves the prognosis of such patients.However,it still can cause complications such as intrauterine fetal death,premature rupture of membranes and premature delivery,which affect the prognosis of the fetus.Therefore,it is necessary to reduce the occurrence of postoperative complications by improving the operation methods,operation skills,postoperative management and other methods.At the same time,it is also important to take the long-term follow-up of the fetus of such patients after operation.This article summarizes the clinical diagnosis,treatment,prevention of postoperative complications,postoperative management,and long-term follow-up of TTTS,aiming to provide reference for the diagnosis and treatment of TTTS in clinical practice.

参考文献/References:

[1] Benirschke K,Masliah E.The placenta in multiple pregnancy:Outstanding issues[J].Reprod Fertil Dev,2001,13(7):615-622.
[2] 刘 星,侯林妤,王 敏.药物干预对单绒毛膜双羊膜囊双胎合并选择性胎儿生长受限孕妇新生儿预后的影响[J].陕西医学杂志,2022,51(12):1573-1576.
[3] Mackie FL,Whittle R,Morris RK,et al.Diagn progn res first trimester ultrasound measurements and maternal serum biomarkers as prognostic factors in monochorionic twins:A cohort study[J].Diagn Progn Res,2019,9(3):9-18.
[4] 苏 莉,杨文婷.产前系统胎儿超声检查筛查胎儿心脏异常中的应用[J].影像研究与医学应用,2021,5(22):205-206,208.
[5] Quintero RA,Morales WJ,Allen MH,et al.Staging of twin-twin transfusion syndrome[J].J Perinatol,1999,19(1):550-555.
[6] Dekoninck P,Deprest J,Lewi P,et al.Gestational age-specific reference ranges for amniotic fluid assessment in monochorionic diamniotic twin pregnancies[J].Ultrasound Obstet Gynecol,2013,41(1):649-652.
[7] Michelfelder E,Gottliebson W,Border W,et al.Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome:Relation to quintero stage[J].Ultrasound Obstet Gynecol,2007,30(1):965-971.
[8] Rychik J,Tian Z,Bebbington M,et al.The twin-twin transfusion syndrome:Spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease[J].Am J Obstet Gynecol,2007,197(1):391-398.
[9] 中国妇幼保健协会双胎妊娠专业委员会.双胎输血综合征诊治及保健指南(2020)[J].中国实用妇科与产科杂志,2020,8(36):714-721.
[10] 吕艳红,刘朵朵,贺媛媛,等.胎儿镜诊治87例次临床观察[J].陕西医学杂志,2020,49(9):1102-1105,1109.
[11] Ruano R,Rodo C,Peiro JL,et al.Fetoscopic laser ablation of the placental anastomoses in twin twin transfusion syndrome using the“solomon technique”[J].Ultrasound Obstet Gynecol,2013,42(4):434-439.
[12] Emery SP,Hasley SK,Catov JM,et al.North American Fetal Therapy Network:Intervention vs expectant management for stage Ⅰ twin-twin transfusion syndrome[J].Am J Obstet Gynecol,2016,215(3):1-7.
[13] Stirnemann J,Slaghekke F,Khalek N,et al.Intrauterine fetoscopic laser surgery versus expectant management in stage Ⅰ twin-to-twin transfusion syndrome:An international randomized trial[J].Am J Obstet Gynecol,2021,224(5):521-528.
[14] Dickinson JE,Evans SF.The progression of disease stage in twin-twin transfusion syndrome[J].J Matern Fetal Neonatal Med,2004,16(1):95-101.
[15] Sileo FG,Dantonio F,Benlioglu C,et al.Perinatal outcomes of twin pregnancies complicated by late twin-twin transfusion syndrome:A systematic review and meta-analysis[J].Acta Obstet Gynecol Scand,2021,100(5):832-842.
[16] Slaghekke F,Kist WJ,Oepkes D,et al.Twin anemia-polycythemia sequence:Diagnostic criteria,classification,perinatal management and outcome[J].Fetal Diagn Ther,2010,27(4):181-190.
[17] Lewi L,Jani J,Blickstein I,et al.The outcome of monochorionic diamniotic twin gestations in the era of invasive fetal therapy:A prospective cohort study[J].Am J Obstet Gynecol,2008,199(1):514-518.
[18] Yamamoto M,Murr L,Robyr R,et al.Incidence and impact of perioperative complications in 175 fetoscopy-guided laser coagulations of chorionic plate anastomoses in fetofetal transfusion syndrome before 26 weeks of gestation[J].Am J Obstet Gynecol,2005,193(3):1110-1116.
[19] Malshe A,Snowise S,Mann LK,et al.Preterm delivery after fetoscopic laser surgery for twin-twin transfusion syndrome:Etiology and risk factors[J].Ultrasound Obstetrics Gynecol,2017,49(5):612-616.
[20] Slaghekke F,Lopriore E,Lewi L,et al.Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome:An open-label randomised controlled trial[J].Lancet,2014,383(1):2144-2151.
[21] Slaghekke F,Lewi L,Middeldorp JM,et al.Residual anastomosesintwin-twintransfusionsyndromeafterlaser:The Solomonrandomized trial[J].Am J Obstet Gynecol,2014,211(1):1-7.
[22] Walsh CA,Auliffe FM.Recurrent twin-twin transfusion syndrome after selective fetoscopic laser photocoagulation:A systematic review of the literature[J].Ultrasound Obstet Gynecol,2012,40:506-512.
[23] Donepudi R,Akkermans J,Mann L,et al.Impact of cannula size on recurrent twin-twin transfusion syndrome and twin anemia-polycythemia sequence after fetoscopic laser surgery[J].Ultrasound Obstet Gynecol,2018,52(1):744-749.
[24] Cavicchioni O,Yamamoto M,Robyr R,et al.Intrauterine fetal demise following laser treatment in twin-to-twin transfusion syndrome[J].BJOG,2006,113(5):590-594.
[25] Delabaere A,Leduc F,Reboul Q,et al.Prediction of neonatal outcome of TTTS by fetal heart and Doppler ultrasound parameters before and after laser treatment[J].Prenat Diagn,2016,36(13):1199-1205.
[26] Eixarch E,Valsky D,Deprest J,et al.Preoperative prediction of the individualized risk of early fetal death after laser therapy in twin-to-twin transfusion syndrome[J].Prenat Diagn,2013,33(11):1033-1038.
[27] Delabaere A,Leduc F,Reboul Q,et al.Factors associated to early intrauterine fetal demise after laser for TTTS by preoperative fetal heart and doppler ultrasound[J].Prenatal Diagnosis,2018,38(1):523-530.
[28] 刘新秀,刘子建,王慧芳,等.胎儿镜下激光凝固胎盘吻合血管术治疗双胎输血综合征33例临床分析[J].中华妇产科杂志,2012,47(8):587-591.
[29] Papanna R,Habli M,Baschat AA,et al.Cerclage for cervical shortening at fetoscopic laser photocoagulation in twin-twin transfusion syndrome[J].Am J Obstet Gynecol,2012,206(5):1-7.
[30] 刘嘉欣,尹少尉,刘彩霞,等.子宫颈缩短的双胎输血综合征患者胎儿镜术中同时行子宫颈环扎术对妊娠结局的影响[J].中国实用妇科与产科杂志,2021,2(37):215-218.
[31] Fox NS,Gupta S,Lam-Rachlin J,et al.Cervical pessary and vaginal progesterone in twin pregnancies with a short cervix[J].Obstet Gynecol,2016,127(4):625-630.
[32] Stirnemann J,Djaafri F Kim A,et al.Preterm premature rupture of membranes is a collateral effect of improvement in perinatal outcomes following fetoscopic coagulation of chorionic vessels for twin-twin transfusion syndrome:A retrospective observational study of 1092 cases[J],BJOG,2018,125(1):1154-1162.
[33] Chmait RH,Chon AH,Korst LM,et al.Risks of preterm premature rupture of membranes and preterm birth post fetoscopy based on location of trocar insertion site[J].Am J Perinatol,2018,35(8):801-808.
[34] Lopriore E,Oepkes D,Walther FJ.Neonatal morbidity in twin-twin transfusion syndrome[J].Early Hum Dev,2011,87(9):595-599.
[35] Gijtenbeek M,Shirzada MR,Harkel ADJ,et al.Congenital heart defects in monochorionic twins:A systematic review and meta-analysis[J].J Clin Med,2019,8(6):902-911.
[36] Manning N,Archer N.Cardiac manifestations of twin-to-twin transfusion syndrome[J].Twin Res Human Genet,2016,19(3):246-254.
[37] Boom J,Battin M,Hornung T.Twin-twin transfusion syndrome,coarctation of the aorta and hypoplastic aortic arch:A case series report[J].J Paediatr Child Health,2010,46(3):76-79.
[38] Hillman SC,Morris RK,Kilby MD.Co-twin prognosis after single fetal death:A systematic review and meta-analysis[J].Obstet Gynecol,2011,118(4):928-940.
[39] Klink JM,Koopman HM,Zwet EW,et al.Cerebral injury and neurodevelopmental impairment after amnioreduction versus laser surgery in twin-twin transfusion syndrome:A systematic review and meta-analysis[J].Fetal Diagn Ther,2013,33(2):81-89.
[40] Spruijt M,Steggerda S,Rath M,et al.Cerebral injury in twin-twin transfusion syndrome treated with fetoscopic laser surgery[J].Obstet Gynecol,2012,120(1):15-20.
[41] Rossi AC,Vanderbilt D,Chmait RH.Neurodevelopmental outcomes after laser therapy for twin-twin transfusion syndrome:A systematic review and meta-analysis[J].Obstet Gynecol,2011,118(5):1145-1150.
[42] Marjolijn S,Spruijt A,Enrico L,et al.Twin-twin transfusion syndrome in the era of fetoscopic laser surgery:Antenatal management,neonatal outcome and beyond[J].Expert Review of Hematology,2020,13(3):259-267.
[43] Klink JM,Koopman HM,Rijken M,et al.Long-term neurodevelopmental outcome in survivors of twin-to-twin transfusion syndrome[J].Twin Res Human Genet,2016,19(3):255-261.
[44] 尹少尉,孟伊琳,贾宝龙,等.胎儿镜激光治疗后双胎输血综合征活产儿神经发育预后分析[J].中国实用妇科与产科杂志,2020,2(36):154-158.
[45] 种月先,李雪莉,杨丽红,等.推拿联合艾灸对脾肾两虚型早产高危儿中医症候积分、发育商、智力水平及运动功能的影响[J].陕西中医,2023,44(5):659-662.

相似文献/References:

[1]王双龙,于 美,吕 镔,等.声脉冲辐射力成像定量评估兔肝缺血再灌注损伤实验研究*[J].陕西医学杂志,2020,49(2):140.
　WANG Shuanglong,YU Mei,LV Bin,et al.Quantitative assessment of hepatic ischemia reperfusion injury with acoustic radiation force impulse in rabbit[J].,2020,49(11):140.
[2]陈 爽.不同彩色多普勒超声检查方式在异位妊娠早期诊断中的应用研究[J].陕西医学杂志,2020,49(2):154.
　CHEN Shuang..Application of different color Doppler ultrasonography in early diagnosis of ectopic pregnancy[J].,2020,49(11):154.
[3]刘永收,张 媛,秦 梅,等.手环血氧仪在阻塞性睡眠呼吸暂停低通气综合征诊断中的应用[J].陕西医学杂志,2020,49(2):176.
　LIU Yongshou,ZHANG Yuan,QIN Mei,et al.Application of wearable reflex oximeter in the diagnosis of obstructive sleep apnea-hypopnea syndrome[J].,2020,49(11):176.
[4]宋亚邛,胡海燕△.VEGF、TGF-β1、CA19-9、CA242和DKK1联合检测对早期胰腺癌临床诊断价值研究*[J].陕西医学杂志,2020,49(2):237.
　SONG Yaqiong,HU Haiyan..Clinical value analysis of combined examination of VEGF,TGF-β1,CA19-9,CA242 and DKK1 in patients with early pancreatic cancer[J].,2020,49(11):237.
[5]郭晓波,蔺 京,来春艳,等.新型冠状病毒与实时荧光RT-PCR核酸检测*[J].陕西医学杂志,2020,49(3):264.
[6]王 琪,卢朝祥△,陈晓峰,等.预测6月龄以下骶尾部畸胎瘤良恶性的列线图建立研究[J].陕西医学杂志,2020,49(3):313.
　WANG Qi,LU Chaoxiang,CHEN Xiaofeng,et al.Establishment of anomogram for predicting benign and malignant sacrococcygeal teratomas below 6 months[J].,2020,49(11):313.
[7]王迎春,孔延亮,蔚文祥,等.家庭聚集性新型冠状病毒肺炎患者初次就诊临床检验与CT特征分析[J].陕西医学杂志,2020,49(4):392.
　WANG Yingchun,KONG Yanliang,WEI Wenxiang,et al.Laboratory examination and CT features of family aggregative corona virus disease 2019 patients at first visit[J].,2020,49(11):392.
[8]杨自华,郭平学,王西辉,等.miRNA-244与miRNA-328在胆管癌患者血清中的表达及意义*[J].陕西医学杂志,2020,49(5):549.
　YANG Zihua,GUO Pingxue,WANG Xihui,et al.Expression and significance of miRNA-244 and miRNA-328 in serum of patients with cholangiocarcinoma[J].,2020,49(11):549.
[9]王双龙,吕 镔△,李 龙,等.超声造影参数成像在甲状腺微小乳头状癌鉴别诊断中的应用价值*[J].陕西医学杂志,2020,49(5):599.
　WANG Shuanglong,LV Bin,LI Long,et al.The value of parametric imaging of contrast-enhanced ultrasound in differential diagnosis of papillary thyroidmicrocarcinoma[J].,2020,49(11):599.
[10]权浩浩,于小勇,程小红,等.血清抗M型磷脂酶A2受体抗体检测在膜性肾病诊断中的价值研究*[J].陕西医学杂志,2020,49(6):755.[doi:DOI:10.3969/j.issn.10007377.2020.06.029]

备注/Memo

备注/Memo:
基金项目:国家自然科学基金资助项目(81972440); 陕西省重点研发计划项目(2018SF-075)
更新日期/Last Update: 2023-11-06