单绒毛膜性双胎行射频消融减胎术后结局英文文献的Meta分析(1)
摘要：目的 通过对文献进行荟萃分析评估双胎输血综合症(TTTS)与其他单绒毛膜性双胎妊娠并发症患者行射频消融减胎术后预后。方法 检索1990年12月～2019年2月行射频消融减胎术的单绒毛膜性双胎妊娠的英文文献，检索数据库PubMed以及Web of Science。结果 共纳入9篇回顾性研究，包括104例TTTS患者，341例其他手术指征患者。TTTS组术后保留胎儿存活率(62.23%)低于其他手术指征组(80.35%)，差异具有统计学意义(RR=0.85，95%CI：0.74～0.98，P=0.03)。两组胎膜早破发生率分别为3.36%和3.23%，差异具有统计学意义(RR=6.10，95%CI：1.05～35.44，P=0.04)。其余早产率、胎死宫内率均无统计学差异。结论 射频消融术治疗单绒毛膜性双胎具有一定安全性和有效性，TTTS患者术后保留胎儿存活率较低，胎膜早破风险略高，应根据临床条件选择合适的治疗方案。
关键词：双胎输血综合征;单绒毛膜性双胎妊娠;射频消融减胎术
, 百拇医药
中图分类号：R714 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.08.028
文章编号：1006-1959(2019)08-0097-04
Abstract：Objective To evaluate the prognosis of patients with twin-transfusion syndrome (TTTS) and other patients with monochorionic twin pregnancy complications undergoing radiofrequency ablation after fetal reduction by meta-analysis of the literature. Methods The English literature of single chorionic twin pregnancy with radiofrequency ablation and fetus reduction from December 1990 to February 2019 was searched. The database was PubMed and Web of Science. Results A total of 9 retrospective studies were included， including 104 patients with TTTS and 341 patients with other surgical indications. The survival rate of the fetus in the TTTS group (62.23%) was lower than that in the other surgical indication group (80.35%)，the difference was statistically significant (RR=0.85， 95%CI： 0.74～0.98， P=0.03). The incidence of premature rupture of membranes was 3.36% and 3.23%， respectively，the difference was statistically significant (RR=6.10，95%CI：1.05～35.44，P=0.04). There was no significant difference in the rate of preterm birth rate and intrauterine fetal death. Conclusion Radiofrequency ablation is safe and effective in the treatment of monochorionic twins. Patients with TTTS have a lower survival rate and a slightly higher risk of premature rupture of membranes. The appropriate treatment plan should be selected according to clinical conditions.
, 百拇医药
Key words：Twin-transfusion syndrome;Monochorionic twin pregnancy;Radiofrequency ablation
单绒毛膜性(monochorionic，MC)双胎可合并双胎输血综合征(twin-twin transfusion syndrome， TTTS)、双胎反向动脉灌注序列征、选择性胎儿宫内生长受限等特有并发症，围产期胎儿死亡率、早产率、流产率较双绒毛膜性双胎妊娠高[1]。研究表明，MC双胎妊娠中，一胎死亡后，正常胎儿发生神经系统发育障碍、胎死宫内、早产、流产的风险较高[2]。当一胎处于濒死边缘，危及正常胎儿生长发育时，可行选择性减胎术以减少对正常胎儿的影响，然而由于存在胎盘血管吻合支，以氯化钾减胎时，药物可能通过吻合支影响正常胎儿，因此只能采用脐带血流阻断技术进行减胎。射频消融术(radio frequency ablation， RFA)是其中一种，研究表明术后保留胎儿总存活率约为63.6%～88%[3，4]。TTTS是MC双胎妊娠严重并发症之一，若未进行干预处理，胎儿围产期死亡率较高[5]。研究表明，TTTS行RFA减胎术后保留胎儿总存活率71.4%，较其他双胎并发症低(80.06%)[6]。但也有研究中报道的TTTS组存活率较其他并发症组高。在一项荟萃分析中，结果表明TTTS组保留胎儿总存活率较低[7]。为了进一步探究TTTS组与其他并发癥组行RFA减胎术后临床结局的差异，我们对现有文献进行了荟萃分析，以评估TTTS行RFA减胎术后的预后情况。, http://www.100md.com(王晓丹 漆洪波)
关键词：双胎输血综合征;单绒毛膜性双胎妊娠;射频消融减胎术
, 百拇医药
中图分类号：R714 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.08.028
文章编号：1006-1959(2019)08-0097-04
Abstract：Objective To evaluate the prognosis of patients with twin-transfusion syndrome (TTTS) and other patients with monochorionic twin pregnancy complications undergoing radiofrequency ablation after fetal reduction by meta-analysis of the literature. Methods The English literature of single chorionic twin pregnancy with radiofrequency ablation and fetus reduction from December 1990 to February 2019 was searched. The database was PubMed and Web of Science. Results A total of 9 retrospective studies were included， including 104 patients with TTTS and 341 patients with other surgical indications. The survival rate of the fetus in the TTTS group (62.23%) was lower than that in the other surgical indication group (80.35%)，the difference was statistically significant (RR=0.85， 95%CI： 0.74～0.98， P=0.03). The incidence of premature rupture of membranes was 3.36% and 3.23%， respectively，the difference was statistically significant (RR=6.10，95%CI：1.05～35.44，P=0.04). There was no significant difference in the rate of preterm birth rate and intrauterine fetal death. Conclusion Radiofrequency ablation is safe and effective in the treatment of monochorionic twins. Patients with TTTS have a lower survival rate and a slightly higher risk of premature rupture of membranes. The appropriate treatment plan should be selected according to clinical conditions.
, 百拇医药
Key words：Twin-transfusion syndrome;Monochorionic twin pregnancy;Radiofrequency ablation
单绒毛膜性(monochorionic，MC)双胎可合并双胎输血综合征(twin-twin transfusion syndrome， TTTS)、双胎反向动脉灌注序列征、选择性胎儿宫内生长受限等特有并发症，围产期胎儿死亡率、早产率、流产率较双绒毛膜性双胎妊娠高[1]。研究表明，MC双胎妊娠中，一胎死亡后，正常胎儿发生神经系统发育障碍、胎死宫内、早产、流产的风险较高[2]。当一胎处于濒死边缘，危及正常胎儿生长发育时，可行选择性减胎术以减少对正常胎儿的影响，然而由于存在胎盘血管吻合支，以氯化钾减胎时，药物可能通过吻合支影响正常胎儿，因此只能采用脐带血流阻断技术进行减胎。射频消融术(radio frequency ablation， RFA)是其中一种，研究表明术后保留胎儿总存活率约为63.6%～88%[3，4]。TTTS是MC双胎妊娠严重并发症之一，若未进行干预处理，胎儿围产期死亡率较高[5]。研究表明，TTTS行RFA减胎术后保留胎儿总存活率71.4%，较其他双胎并发症低(80.06%)[6]。但也有研究中报道的TTTS组存活率较其他并发症组高。在一项荟萃分析中，结果表明TTTS组保留胎儿总存活率较低[7]。为了进一步探究TTTS组与其他并发癥组行RFA减胎术后临床结局的差异，我们对现有文献进行了荟萃分析，以评估TTTS行RFA减胎术后的预后情况。, http://www.100md.com(王晓丹 漆洪波)