摘要
目的探讨煊彩超声血管成像在术前辅助制定胎儿镜激光手术穿刺点选择策略中的应用价值。方法前瞻性分析2019年1月至2020年12月于中国医科大学附属盛京医院就诊并接受胎儿镜激光治疗的双胎输血综合征(TTTS)病例50例,其中术前使用煊彩超声辅助选择穿刺点的煊彩超声组25例,对照组25例,通过比较两组病例手术中血管交通支激光凝固操作的难易程度,探讨研究方案是否有效。结果煊彩超声组和对照组的容易型血管交通支平均占比分别为(68.13±21.43)%和(45.78±27.71)%(P=0.002);较难型分别为(23.38±17.30)%和(43.89±22.80)%(P=0.001);两组血管交通支的占比区别明显。激光手术时间分别为(5.76±1.20)min和(6.24±2.11)min(P=0.178);平均分娩孕周分别为(31.51±4.09)周和(31.39±5.14)周(P=0.930);双胎至少一胎生存率分别为88.00%和84.00%(P=0.270),双胎生存率分别为64.00%和52.00%(P=0.284);未足月胎膜早破(PPROM)发生率分别为12.00%和24.00%(P=0.044)。结论煊彩超声胎盘血管成像能够优化胎儿镜激光治疗TTTS的术前穿刺定位策略,并且没有造成额外的损伤和并发症。
Objective To explore the application value of HD-live flow silhouette in making strategies for puncture site selection preoperatively in fetoscopic laser surgery(FLS).Methods with TTTS who were treated with FLS in Shengjing Hospital of China Medical University from January 2019 to December2020.Among them,HD-live flow silhouette was used in 25 patients for puncture site selection,and the other 25 patients was regarded as controls.The difficulty of laser coagulation of blood vessel communicating branch was compared between the two groups,and the advantages and disadvantages of the two selection strategies were discussed.Results average proportion of easy-coagulated vessels in the two groups was(68.13±21.43)%and(45.78±27.71)%(P=0.002).The moderately difficult-coagulated vessels was(23.38±17.30)%and(43.89±22.80)%(P=0.001).There was significant difference between these two groups.The average time of laser operation was(5.76±1.20)minutes and(6.24±2.11)minutes(P=0.178).The average gestational weeks at delivery was(31.51±4.09)weeks and(31.39±5.14)weeks(P=0.930),the average survival rates of at least one twin were 88.00%and 84.00%(P=0.270),the average survival rates of two twins were 64.00%and 52.00%(P=0.284),and the incidence of PPROM was 12.00%and 24.00%(P=0.044).ConclusionHD-live flow silhouette can optimize the preoperative puncture positioning strategy of fetoscopic laser treatment for TTTS and does not cause additional damage or complications.
作者
尹少尉
廖姗姗
李洋洋
杨泽宇
刘彩霞
YIN Shao-wei;LIAO Shan-shan;LI Yang-yang;YANG Ze-yu;LIU Cai-xia(Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2021年第8期832-835,共4页
Chinese Journal of Practical Gynecology and Obstetrics
基金
国家重点研发计划《重大胎儿疾病宫内诊断和治疗新技术研发》:《复杂性双胎的产前诊断与宫内干预及预后评估》(2018YFC1002900,2018YFC1002902)
中国医科大学2019年度医疗新技术新项目(112-3111190311)。
关键词
双胎输血综合征
煊彩成像
胎儿镜激光手术
twin transfusion syndrome
HD-live flow silhouette
fetoscopic laser surgery
