Abstract：
Complete coagulation of the vascular equator (as in the Solomon technique) has been suggested to reduce postoperative complications such as twin anemia polycythemia syndrome and the recurrence of twin-twin transfusion syndrome following fetoscopic laser coagulation of chorionic vessels for twin-twin transfusion syndrome.
We aimed to evaluate the benefit of this technique on perinatal outcomes compared with selective ablation of anastomoses.
We conducted a monocentric retrospective study comparing selective laser coagulation of anastomoses to the Solomon technique from January 2006 to August 2020. To adjust for potential confounders, the cases operated by selective surgery were matched to the cases operated with the Solomon technique according to the gestational age at laser therapy, placental localization, and Quintero stage using propensity score matching.
With a total of 994 cases, 399 matched pairs were included in the analysis. Compared with selective ablation, the Solomon technique was associated with significantly improved survival: the overall twin survival at delivery and discharge was 72% vs 79% (P=.003) and 69% vs 75% (P=.006), respectively; the double twin survival rate at discharge was 55% vs 65% (P=.02), respectively, and the rate of intrauterine death dropped from 18% to 12% (P=.003), respectively. The Solomon technique significantly reduced the rate of twin anemia polycythemia syndrome (10% vs 4%; P=.02), leading to fewer secondary rescue procedures (13% vs 7.3%; P=.01). However, the Solomon technique was associated with an increased risk of preterm rupture of membranes, especially at early gestational ages (3.8% vs 11%; P<.001 for preterm rupture of membranes <24 weeks). Among the survivors at delivery, both the groups had similar gestational ages at birth. Both neonatal mortality and severe neurologic morbidity were similar in both the groups. However, an increased risk of bronchopulmonary dysplasia was found in the Solomon group (4.5% vs 12%; P<.001).
Although the risk of preterm premature rupture of membranes has increased, the introduction of the Solomon technique has significantly improved perinatal outcomes in pregnancies affected with twin-twin transfusion syndrome.
We aimed to evaluate the benefit of this technique on perinatal outcomes compared with selective ablation of anastomoses.
We conducted a monocentric retrospective study comparing selective laser coagulation of anastomoses to the Solomon technique from January 2006 to August 2020. To adjust for potential confounders, the cases operated by selective surgery were matched to the cases operated with the Solomon technique according to the gestational age at laser therapy, placental localization, and Quintero stage using propensity score matching.
With a total of 994 cases, 399 matched pairs were included in the analysis. Compared with selective ablation, the Solomon technique was associated with significantly improved survival: the overall twin survival at delivery and discharge was 72% vs 79% (P=.003) and 69% vs 75% (P=.006), respectively; the double twin survival rate at discharge was 55% vs 65% (P=.02), respectively, and the rate of intrauterine death dropped from 18% to 12% (P=.003), respectively. The Solomon technique significantly reduced the rate of twin anemia polycythemia syndrome (10% vs 4%; P=.02), leading to fewer secondary rescue procedures (13% vs 7.3%; P=.01). However, the Solomon technique was associated with an increased risk of preterm rupture of membranes, especially at early gestational ages (3.8% vs 11%; P<.001 for preterm rupture of membranes <24 weeks). Among the survivors at delivery, both the groups had similar gestational ages at birth. Both neonatal mortality and severe neurologic morbidity were similar in both the groups. However, an increased risk of bronchopulmonary dysplasia was found in the Solomon group (4.5% vs 12%; P<.001).
Although the risk of preterm premature rupture of membranes has increased, the introduction of the Solomon technique has significantly improved perinatal outcomes in pregnancies affected with twin-twin transfusion syndrome.
摘要：
已建议完全凝固血管赤道（如所罗门技术）以减少术后并发症，例如双胎贫血红细胞增多症综合征和胎儿镜激光凝固绒毛膜血管后双胎输血综合征的复发。
我们的目的是评估该技术与选择性切除吻合相比对围产期结局的益处。
从2006年1月至2020年8月，我们进行了一项单中心回顾性研究，比较了吻合的选择性激光凝固术和所罗门技术。为了适应潜在的混杂因素，根据激光治疗的胎龄，选择性手术的病例与所罗门技术的病例相匹配，胎盘定位，和Quintero阶段使用倾向得分匹配。
共994例，399对匹配的配对包括在分析中。与选择性消融相比，所罗门技术与显著提高生存率相关:分娩和出院时的总体双胎生存率分别为72%和79%(P=.003)和69%和75%(P=.006),出院时双胎存活率分别为55%和65%(P=0.02)，分别,宫内死亡率从18%下降到12%(P=0.003),分别。所罗门技术显着降低了双胎贫血红细胞增多症综合征的发生率（10％vs4％；P=0.02），导致次要救援程序减少（13%vs7.3%；P=0.01）。然而,所罗门技术与胎膜早破的风险增加有关,尤其是在胎龄早期（3.8%vs11%；胎膜早破<24周，P<.001）。在分娩时的幸存者中，两组出生时的胎龄相似.两组的新生儿死亡率和严重的神经系统发病率相似。然而,所罗门组支气管肺发育不良的风险增加(4.5%vs12%;P<.001).
虽然早产胎膜早破的风险增加，Solomon技术的引入显著改善了双胎-双胎输血综合征孕妇的围产期结局.
我们的目的是评估该技术与选择性切除吻合相比对围产期结局的益处。
从2006年1月至2020年8月，我们进行了一项单中心回顾性研究，比较了吻合的选择性激光凝固术和所罗门技术。为了适应潜在的混杂因素，根据激光治疗的胎龄，选择性手术的病例与所罗门技术的病例相匹配，胎盘定位，和Quintero阶段使用倾向得分匹配。
共994例，399对匹配的配对包括在分析中。与选择性消融相比，所罗门技术与显著提高生存率相关:分娩和出院时的总体双胎生存率分别为72%和79%(P=.003)和69%和75%(P=.006),出院时双胎存活率分别为55%和65%(P=0.02)，分别,宫内死亡率从18%下降到12%(P=0.003),分别。所罗门技术显着降低了双胎贫血红细胞增多症综合征的发生率（10％vs4％；P=0.02），导致次要救援程序减少（13%vs7.3%；P=0.01）。然而,所罗门技术与胎膜早破的风险增加有关,尤其是在胎龄早期（3.8%vs11%；胎膜早破<24周，P<.001）。在分娩时的幸存者中，两组出生时的胎龄相似.两组的新生儿死亡率和严重的神经系统发病率相似。然而,所罗门组支气管肺发育不良的风险增加(4.5%vs12%;P<.001).
虽然早产胎膜早破的风险增加，Solomon技术的引入显著改善了双胎-双胎输血综合征孕妇的围产期结局.
