Abstract：
BACKGROUND: Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research was to clarify the effectiveness and safety of this technique.
METHODS: A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021).
RESULTS: A total of forty-one articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPSs), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. However, preterm premature rupture of membranes (P-PROMs) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) occurred in 36 out of 122 pregnancies (29.5%). In BPS, IFL was successfully performed in all cases with no significant fetal-maternal complications. The rates of P-PROM and PTB were, respectively, 3.2% and 12.5%. All PCA IFL-treated cases resulted in successful pregnancy outcomes; no cases of P-PROM were reported, but the rate of PTB reached a peak of 60% due to complications such as severe fetal growth restriction and fetal Doppler abnormalities. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); P-PROM occurred in 2 cases (18.2%), whereas the rate of PTB was 87.5%. In ER, no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies.
CONCLUSIONS: Our analysis suggests that IFL is a safe and feasible technique for the management of different fetal conditions. However, the overall risk of PTB, and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT IFL-treated cases. This information could aid in decision-making during prenatal counseling. However, final perinatal outcome depends on the severity of the disease itself.
METHODS: A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021).
RESULTS: A total of forty-one articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPSs), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. However, preterm premature rupture of membranes (P-PROMs) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) occurred in 36 out of 122 pregnancies (29.5%). In BPS, IFL was successfully performed in all cases with no significant fetal-maternal complications. The rates of P-PROM and PTB were, respectively, 3.2% and 12.5%. All PCA IFL-treated cases resulted in successful pregnancy outcomes; no cases of P-PROM were reported, but the rate of PTB reached a peak of 60% due to complications such as severe fetal growth restriction and fetal Doppler abnormalities. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); P-PROM occurred in 2 cases (18.2%), whereas the rate of PTB was 87.5%. In ER, no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies.
CONCLUSIONS: Our analysis suggests that IFL is a safe and feasible technique for the management of different fetal conditions. However, the overall risk of PTB, and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT IFL-treated cases. This information could aid in decision-making during prenatal counseling. However, final perinatal outcome depends on the severity of the disease itself.
摘要：
背景：在过去的几年中，胎儿内激光（IFL）疗法已越来越多地用于各种产前疾病的管理。我们研究的目的是阐明该技术的有效性和安全性。
方法：使用MEDLINE/PubMed进行了20年（2001-2021年）的文献系统回顾。
结果：文献检索共选取41篇文献，包括194例双胎反向动脉灌注（TRAP）序列，56例支气管肺隔离症（BPS），5例胎盘绒毛膜血管瘤（PCA），骶尾部畸胎瘤(SCT)11例,和103例使用IFL管理的胚胎减少（ER）。在TRAP序列中,在所有情况下，无心双胞胎的灌注均成功中断。胎膜早破（p-PROM）发生在79例妊娠中的6例（7.5％），122例孕妇中有36例（29.5%）早产（PTB）。在BPS中，所有病例均成功进行了IFL，无明显并发症。p-PROM和PTB的发生率分别为3.2％和12.5％。所有经PCAIFL治疗的病例均成功妊娠；未报告p-PROM病例，但是由于胎儿并发症，PTB的发生率达到了60％的峰值。在SCT案例中，4例(36.4%)血流完全停止;2例(18.2%)发生p-PROM,PTB发生率为87.5%。在ER中，文献中没有描述术中或主要的母体并发症。最初的三羊膜和二羊膜三胎妊娠的流产率和PTB率不同。
结论：我们的分析表明，IFL是处理不同胎儿状况的可行技术。然而,PTB的总体风险及其相关的发病率和死亡率，范围从12.5%的BPS到87.5%的SCT。这可以帮助在产前咨询期间做出决策。然而，最终的围产期结果取决于疾病本身的严重程度。
方法：使用MEDLINE/PubMed进行了20年（2001-2021年）的文献系统回顾。
结果：文献检索共选取41篇文献，包括194例双胎反向动脉灌注（TRAP）序列，56例支气管肺隔离症（BPS），5例胎盘绒毛膜血管瘤（PCA），骶尾部畸胎瘤(SCT)11例,和103例使用IFL管理的胚胎减少（ER）。在TRAP序列中,在所有情况下，无心双胞胎的灌注均成功中断。胎膜早破（p-PROM）发生在79例妊娠中的6例（7.5％），122例孕妇中有36例（29.5%）早产（PTB）。在BPS中，所有病例均成功进行了IFL，无明显并发症。p-PROM和PTB的发生率分别为3.2％和12.5％。所有经PCAIFL治疗的病例均成功妊娠；未报告p-PROM病例，但是由于胎儿并发症，PTB的发生率达到了60％的峰值。在SCT案例中，4例(36.4%)血流完全停止;2例(18.2%)发生p-PROM,PTB发生率为87.5%。在ER中，文献中没有描述术中或主要的母体并发症。最初的三羊膜和二羊膜三胎妊娠的流产率和PTB率不同。
结论：我们的分析表明，IFL是处理不同胎儿状况的可行技术。然而,PTB的总体风险及其相关的发病率和死亡率，范围从12.5%的BPS到87.5%的SCT。这可以帮助在产前咨询期间做出决策。然而，最终的围产期结果取决于疾病本身的严重程度。
