射频消融选择性减胎术在复杂性单绒毛膜多胎妊娠中的临床应用
发布时间：2018-08-25 18:26
【摘要】：目的探讨射频消融(Radiofrency ablation,RFA)选择性减胎术治疗复杂性单绒毛膜多胎妊娠的安全性及有效性,分析影响妊娠结局的因素。方法回顾性分析2011年7月22日至2017年3月16日在山东大学附属省立医院接受射频消融选择性减胎术治疗且已分娩的复杂性单绒毛膜多胎妊娠病例的临床资料。记录孕妇年龄、孕次、受孕方式、减胎指征、手术时的孕周、穿刺情况、手术所需的循环数、母儿并发症、分娩孕周、分娩方式、新生儿体重及随访保留胎儿生后生长发育等情况。保留胎儿存活率为接受射频消融选择性减胎患者中保留胎儿存活者所占的比例。分析影响妊娠结局的相关因素。采用卡方检验和Fisher确切概率法分析多个样本率之间的差异,采用Kruskal-Wallis H秩和检验分析不符合方差分析条件的多组计量数据之间的差异。结果从2011年07月22日到2017年3月16日,共有71例复杂性多胎病例接受了RFA减胎治疗。其中,含单绒毛膜双胎的三胎及以上妊娠要求减少胎儿数量者20例(28.2%),单绒毛膜双胎一胎儿畸形者21例(29.6%),单绒双胎妊娠出现双胎输血综合征(twin to twin transfusion syndrome,TTTS)20例(28.1%),严重的选择性宫内生长受限(selective intrauterine growth restriction,sIUGR)7例(9.9%),双胎反向动脉灌注序列征(twin reversed arterial perfusion sequence,TRAP)3例(4.2%)。平均手术孕周为(20.4±3.5)周(14.7～27.7周)。穿刺成功率100%(71/71)。57例1个循环即完全阻断血流,11例需2个循环,3例需3个循环。所有手术在技术上都是成功的。术后12例患者流产,其中9例于孕28周前发生胎膜早破流产(7例发生于术后2周内),1例患者术后5天因高热、宫缩过频流产,2例患者因宫缩难以抑制流产;5例不明原因胎死宫内(保留胎儿均于术后24小时内胎心消失);共17例患者保留胎儿死亡。54例患者其保留胎儿存活,保留胎儿存活率为76.1%。平均分娩孕周为(36.6±2.9)周(29.1～41.1周),新生儿平均出生体重(2633±601)g(1250～3750g),34周前早产率为20.4%(11/54),37周前早产率为40.7%(22/54)。术后随访未发现视网膜病变、颅内出血、坏死性小肠结肠炎及严重的神经系统后遗症等。不同手术指征组间保留胎儿存活率、平均分娩孕周、新生儿平均体重、流产率、胎死宫内率及37周前早产率均无统计学差异,P值均0.05;34周前早产率之间的差异具有统计学意义,P值0.05,其中多胎妊娠减少胎儿数目组、TTTS组及TRAP组保留胎儿34周前早产率明显高于单绒毛膜双胎一胎儿畸形组及sIUGR组。手术时的孕周与妊娠结局间并无相关性。手术循环次数与保留胎儿存活率、平均分娩孕周、新生儿平均体重、流产率、34周前早产率、37周前早产率间无相关性,P值均0.05;但与胎死宫内率有相关性,P值0.05,随着循环次数增加,胎死宫内率逐渐增高。结论射频消融选择性减胎术是治疗复杂性单绒多胎妊娠的一种安全、有效的方法。手术指征会影响保留胎儿34周前早产率,循环次数会影响保留胎儿胎死宫内率。
[Abstract]:Objective To investigate the safety and efficacy of selective reduction of fetus with radiofrequency ablation (RFA) in the treatment of complicated multiple single chorionic pregnancy and analyze the factors influencing pregnancy outcome. The clinical data of complicated single chorionic multifetal pregnancies were recorded, including the age of the pregnant woman, the number of pregnancies, the gestational age, the mode of conception, the indication of reduction, the gestational age at the time of operation, the puncture, the number of cycles needed for the operation, the complications of mother and infant, the gestational age of delivery, the mode of delivery, the weight of the newborn and the postnatal growth and development of the fetus. Survival rate was the proportion of those who retained fetal survival in patients undergoing selective reduction by radiofrequency ablation. Factors affecting pregnancy outcome were analyzed. Differences between multiple sample rates were analyzed by Chi-square test and Fisher exact probability method. Kruskal-Wallis H-rank sum test was used to analyze multigroup measurements that did not meet the criteria for analysis of variance. Results From July 22, 2011 to March 16, 2017, a total of 71 cases of complicated multiple pregnancy received RFA treatment. Among them, 20 cases (28.2%) of triplets with single chorionic twins and above required fewer fetuses, 21 cases (29.6%) of single chorionic twins with one fetal malformation, and single chorionic twins with twin transfusion syndrome. Twenty patients (28.1%) had twin to twin transfusion syndrome (TTTS), seven patients (9.9%) had severe selective intrauterine growth restriction (sIUGR), and three patients (4.2%) had twin reversed arterial perfusion sequence (TRAP). The mean gestational age was (20.4 (+3.5) weeks (14.7-27.7 weeks). The success rate of puncture was 100% (71/71). 57 cases (71/71). One cycle was completely blocked, 11 cases needed two cycles, and 3 cycles. The average gestational age was (36.6 2.9) weeks (29.1 41.1 weeks), and the average birth weight was (2633 601) g (12.1) g (12. The preterm birth rate was 20.4% (11/54) before 34 weeks and 40.7% (22/54) before 37 weeks. No retinopathy, intracranial hemorrhage, necrotizing enterocolitis and severe neurological sequelae were found during the follow-up. Fetal survival rate, mean gestational age, average neonatal weight, abortion rate, fetal death in uterus were maintained among the groups with different surgical indications. There was no significant difference in the preterm birth rate and the preterm birth rate before 37 weeks, P value was 0.05; the difference between preterm birth rate before 34 weeks was statistically significant, P value was 0.05. The preterm birth rate before 34 weeks in the group of multiple pregnancy reduction, TTTS group and TRAP group was significantly higher than that in the group of single chorionic twin-one fetal malformation and sIUGR group. There was no correlation between the number of operation cycles and fetal survival rate, mean gestational weeks, average neonatal weight, abortion rate, preterm delivery rate before 34 weeks, preterm delivery rate before 37 weeks, P value was 0.05, but it was correlated with the intrauterine rate of fetal death, P value was 0.05, with the increase of circulation times, the intrauterine rate of fetal death gradually increased. Fetal reduction is a safe and effective method for the treatment of complicated single-cashmere multiple pregnancy. The indication of operation will affect the premature delivery rate before 34 weeks of fetal retention, and the number of cycles will affect the intrauterine fetal death rate.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.23
本文编号：2203730
[Abstract]:Objective To investigate the safety and efficacy of selective reduction of fetus with radiofrequency ablation (RFA) in the treatment of complicated multiple single chorionic pregnancy and analyze the factors influencing pregnancy outcome. The clinical data of complicated single chorionic multifetal pregnancies were recorded, including the age of the pregnant woman, the number of pregnancies, the gestational age, the mode of conception, the indication of reduction, the gestational age at the time of operation, the puncture, the number of cycles needed for the operation, the complications of mother and infant, the gestational age of delivery, the mode of delivery, the weight of the newborn and the postnatal growth and development of the fetus. Survival rate was the proportion of those who retained fetal survival in patients undergoing selective reduction by radiofrequency ablation. Factors affecting pregnancy outcome were analyzed. Differences between multiple sample rates were analyzed by Chi-square test and Fisher exact probability method. Kruskal-Wallis H-rank sum test was used to analyze multigroup measurements that did not meet the criteria for analysis of variance. Results From July 22, 2011 to March 16, 2017, a total of 71 cases of complicated multiple pregnancy received RFA treatment. Among them, 20 cases (28.2%) of triplets with single chorionic twins and above required fewer fetuses, 21 cases (29.6%) of single chorionic twins with one fetal malformation, and single chorionic twins with twin transfusion syndrome. Twenty patients (28.1%) had twin to twin transfusion syndrome (TTTS), seven patients (9.9%) had severe selective intrauterine growth restriction (sIUGR), and three patients (4.2%) had twin reversed arterial perfusion sequence (TRAP). The mean gestational age was (20.4 (+3.5) weeks (14.7-27.7 weeks). The success rate of puncture was 100% (71/71). 57 cases (71/71). One cycle was completely blocked, 11 cases needed two cycles, and 3 cycles. The average gestational age was (36.6 2.9) weeks (29.1 41.1 weeks), and the average birth weight was (2633 601) g (12.1) g (12. The preterm birth rate was 20.4% (11/54) before 34 weeks and 40.7% (22/54) before 37 weeks. No retinopathy, intracranial hemorrhage, necrotizing enterocolitis and severe neurological sequelae were found during the follow-up. Fetal survival rate, mean gestational age, average neonatal weight, abortion rate, fetal death in uterus were maintained among the groups with different surgical indications. There was no significant difference in the preterm birth rate and the preterm birth rate before 37 weeks, P value was 0.05; the difference between preterm birth rate before 34 weeks was statistically significant, P value was 0.05. The preterm birth rate before 34 weeks in the group of multiple pregnancy reduction, TTTS group and TRAP group was significantly higher than that in the group of single chorionic twin-one fetal malformation and sIUGR group. There was no correlation between the number of operation cycles and fetal survival rate, mean gestational weeks, average neonatal weight, abortion rate, preterm delivery rate before 34 weeks, preterm delivery rate before 37 weeks, P value was 0.05, but it was correlated with the intrauterine rate of fetal death, P value was 0.05, with the increase of circulation times, the intrauterine rate of fetal death gradually increased. Fetal reduction is a safe and effective method for the treatment of complicated single-cashmere multiple pregnancy. The indication of operation will affect the premature delivery rate before 34 weeks of fetal retention, and the number of cycles will affect the intrauterine fetal death rate.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.23
【参考文献】
相关期刊论文 前1条
1 孙路明;周奋翮;邹刚;杨颖俊;周艳;孙琦;段涛;;射频消融减胎技术治疗34例单绒毛膜性双胎妊娠并发症的妊娠结局[J];中华围产医学杂志;2014年06期
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