九例射频消融选择性减胎术的疗效及观察

doi:10.12280/gjfckx.20210138

摘要/Abstract

摘要：

目的: 探讨射频消融减胎术（radio frequency ablation,RFA）对复杂性多胎妊娠的疗效。方法: 回顾性分析2017年4月—2019年5月在武汉大学人民医院行RFA治疗的9例患者的临床资料,总结其临床疗效,包括流产、早产、足月产、活产、分娩方式和新生儿体质量等。结果: 9例患者中有2例是双绒毛膜三羊膜囊妊娠,有5例为单绒毛膜双羊膜囊双胎之一胎儿畸形行减胎术,1例为双胎输血综合征（twin-twin transfusion syndrome,TTTS）Ⅲ期减胎,1例为双胎之一选择性胎儿生长受限（selective fetal growth restriction,sFGR）Ⅱ型行选择性减胎术。9例患者均一次性RFA成功,手术成功率100%,均无手术并发症,仅1例于减胎术后2周流产,其余均获得活产。结论: RFA对复杂性多胎妊娠是一种安全有效且损伤小的宫内治疗方式,在临床上应该根据绒毛膜性及患者的意愿选择合适的减胎方式。

关键词: 导管消融术, 妊娠减少,多胎, 妊娠,多胎, 胎儿生长迟缓, 双胎输血综合征, 双生, 射频消融减胎术

Abstract:

Objective: To investigate the treatment effect of radio frequency ablation (RFA) on fetal reduction. Methods: The clinical data of 9 patients undergoing RFA for the fetal reduction in our hospital from April 2017 to May 2019 were retrospectively analyzed, including the average age of the patients, the number of pregnancies, the mode of pregnancy, the gestational weeks at the time of the fetal reduction, the indications of fetal reduction and the pregnancy outcome. The clinical efficacy was summarized, including abortion, premature delivery, full-term birth, live birth, mode of delivery, neonatal weight, etc. Results: Among the 9 cases, 2 cases were dichorionic triamniotic (DCTA) triplet pregnancies, 5 cases were monochorionic diamniotic (MCDA) twin conceived, which one of the twins underwent fetal reduction due to disorder fetal anomalies, 1 case was twin transfusion syndrome (TTTS), and 1 case was one of the twins with selective fetal growth restriction (sFGR) type Ⅱ. Nine pregnant women were operated successfully in a one-time RFA procedure. The procedure was technically successful in all cases. There were no operative complications. Only one case had miscarriage 2 weeks after the operation, and the rest gave birth to the newborns. Good pregnancy outcome was achieved and the clinical effect was significant. Conclusions: RFA is a safe, effective and minimally invasive intrauterine treatment for complicated multiple pregnancies, and the appropriate method of fetal reduction should be selected by chorionicity and patient′s willingness.

Key words: Catheter ablation, Pregnancy reduction,multifetal, Pregnancy,multiple, Fetal growth retardation, Fetofetal transfusion, Twins, Radio frequency ablation

彭良玉, 范翠芳, 杨菁. 九例射频消融选择性减胎术的疗效及观察[J]. 国际妇产科学杂志, 2021, 48(4): 395-398.

PENG Liang-yu, FAN Cui-fang, YANG Jing. Efficacy and Observation of Radiofrequency Ablation Selective Fetal Reduction in Nine Cases[J]. Journal of International Obstetrics and Gynecology, 2021, 48(4): 395-398.

图/表 2

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患者序号	孕周（周）	年龄（岁）	孕产次	手术原因	手术方式
例1	18⁺⁵	24	孕2产1	双绒毛膜三羊膜囊	羊水穿刺+RFA
例2	16⁺¹	31	孕5产1	双绒毛膜三羊膜囊,一胎颅骨缺损,脑膜脑膨出,促排卵	RFA
例3	25⁺⁰	29	孕1产0	sFGR Ⅱ型	RFA
例4	19⁺¹	31	孕3产1	单绒毛膜双羊膜囊,一胎左干支畸形	RFA
例5	24⁺⁴	30	孕1产0	TTTS Ⅲ期	RFA
例6	26⁺⁴	34	孕2产1	单绒毛膜双羊膜囊,一胎心脏室间隔缺损合并房间隔缺损畸形	羊水穿刺+RFA
例7	25⁺²	28	孕2产1	单绒毛膜双羊膜囊,一胎无心反向序列综合征	RFA
例8	24⁺²	33	孕3产1	单绒毛膜双羊膜囊,一胎法洛四联症	羊水穿刺+RFA
例9	20⁺³	37	孕2产1	单绒毛膜双羊膜囊,一胎开放性脊柱裂,双侧脑积水,小脑形态失常,后颅窝池消失,第三脑室扩张,透明隔腔未显示	羊水穿刺+RFA

患者序号	孕周（周）	年龄（岁）	孕产次	手术原因	手术方式
例1	18⁺⁵	24	孕2产1	双绒毛膜三羊膜囊	羊水穿刺+RFA
例2	16⁺¹	31	孕5产1	双绒毛膜三羊膜囊,一胎颅骨缺损,脑膜脑膨出,促排卵	RFA
例3	25⁺⁰	29	孕1产0	sFGR Ⅱ型	RFA
例4	19⁺¹	31	孕3产1	单绒毛膜双羊膜囊,一胎左干支畸形	RFA
例5	24⁺⁴	30	孕1产0	TTTS Ⅲ期	RFA
例6	26⁺⁴	34	孕2产1	单绒毛膜双羊膜囊,一胎心脏室间隔缺损合并房间隔缺损畸形	羊水穿刺+RFA
例7	25⁺²	28	孕2产1	单绒毛膜双羊膜囊,一胎无心反向序列综合征	RFA
例8	24⁺²	33	孕3产1	单绒毛膜双羊膜囊,一胎法洛四联症	羊水穿刺+RFA
例9	20⁺³	37	孕2产1	单绒毛膜双羊膜囊,一胎开放性脊柱裂,双侧脑积水,小脑形态失常,后颅窝池消失,第三脑室扩张,透明隔腔未显示	羊水穿刺+RFA

患者序号	减胎前后胎儿个数（个）	行减胎术孕周	分娩孕周（周）	获健康儿个数（个）	活产儿体质量（g）	分娩方式
例1	3→2	18⁺⁵	38⁺¹	2	2 750	剖宫产
					2 650
例2	3→2*	16⁺¹	34⁺²	1	2 100	阴道分娩
例3	2→1	25⁺⁰	33⁺⁰	1	2 330	剖宫产
例4	2→1	19⁺¹	21⁺⁰	0	-	流产
例5	2→1	24⁺⁴	37⁺⁰	1	2 700	阴道分娩
例6	2→1	26⁺⁴	34⁺⁶	1	2 200	阴道分娩
例7	2→1	25⁺²	39⁺⁰	1	2 450	阴道分娩
例8	2→1	24⁺²	36⁺⁰	1	2 600	阴道分娩
例9	2→1	20⁺³	37⁺¹	1	2 520	阴道分娩

患者序号	减胎前后胎儿个数（个）	行减胎术孕周	分娩孕周（周）	获健康儿个数（个）	活产儿体质量（g）	分娩方式
例1	3→2	18⁺⁵	38⁺¹	2	2 750	剖宫产
					2 650
例2	3→2*	16⁺¹	34⁺²	1	2 100	阴道分娩
例3	2→1	25⁺⁰	33⁺⁰	1	2 330	剖宫产
例4	2→1	19⁺¹	21⁺⁰	0	-	流产
例5	2→1	24⁺⁴	37⁺⁰	1	2 700	阴道分娩
例6	2→1	26⁺⁴	34⁺⁶	1	2 200	阴道分娩
例7	2→1	25⁺²	39⁺⁰	1	2 450	阴道分娩
例8	2→1	24⁺²	36⁺⁰	1	2 600	阴道分娩
例9	2→1	20⁺³	37⁺¹	1	2 520	阴道分娩