PDF(Pubmed)
Abstract：
BACKGROUND: Our objective was to investigate outcomes in twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery (FLS) at <18 weeks vs ≥18 weeks, and to conduct subgroup analysis of TTTS with FLS at <16 weeks vs 16-18 weeks.
METHODS: PubMed, Scopus and Web of Science were searched systematically from inception until May 2023. Primary outcome was survival, and secondary outcomes included preterm premature rupture of membranes (PPROM), preterm birth and gestational age (GA) at delivery.
RESULTS: Nine studies encompassing 1691 TTTS pregnancies were included. TTTS stage III was significantly more common in TTTS pregnancies treated with FLS at <18 weeks (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.24-6.54), and procedure duration was shorter at <18 weeks (MD -5.27 minutes, 95% CI -9.19 to -1.34). GA at delivery was significantly earlier in TTTS pregnancies treated with FLS at <18 weeks (MD -3.12 weeks, 95% CI -6.11 to -0.13). There were no significant differences in outcomes, including PPROM, PPROM at <7 days post-FLS, preterm birth at <28 and <32 weeks, delivery at <7 days post-FLS, and survival outcomes, including fetal demise, live birth and neonatal survival. Similarly, TTTS stage III was more common in TTTS with FLS at <16 weeks than at 16-18 weeks (OR 2.95, 95% CI 1.62-5.35), with no significant differences in the aforementioned outcomes.
CONCLUSIONS: In early TTTS treated with FLS, outcomes were comparable between those treated at <18 weeks compared with ≥18 weeks except for GA at delivery, which was 3 weeks earlier. In the subset treated at <16 weeks vs 16-18 weeks, the procedure was feasible without an increased risk of very early preterm birth or perinatal mortality.
METHODS: PubMed, Scopus and Web of Science were searched systematically from inception until May 2023. Primary outcome was survival, and secondary outcomes included preterm premature rupture of membranes (PPROM), preterm birth and gestational age (GA) at delivery.
RESULTS: Nine studies encompassing 1691 TTTS pregnancies were included. TTTS stage III was significantly more common in TTTS pregnancies treated with FLS at <18 weeks (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.24-6.54), and procedure duration was shorter at <18 weeks (MD -5.27 minutes, 95% CI -9.19 to -1.34). GA at delivery was significantly earlier in TTTS pregnancies treated with FLS at <18 weeks (MD -3.12 weeks, 95% CI -6.11 to -0.13). There were no significant differences in outcomes, including PPROM, PPROM at <7 days post-FLS, preterm birth at <28 and <32 weeks, delivery at <7 days post-FLS, and survival outcomes, including fetal demise, live birth and neonatal survival. Similarly, TTTS stage III was more common in TTTS with FLS at <16 weeks than at 16-18 weeks (OR 2.95, 95% CI 1.62-5.35), with no significant differences in the aforementioned outcomes.
CONCLUSIONS: In early TTTS treated with FLS, outcomes were comparable between those treated at <18 weeks compared with ≥18 weeks except for GA at delivery, which was 3 weeks earlier. In the subset treated at <16 weeks vs 16-18 weeks, the procedure was feasible without an increased risk of very early preterm birth or perinatal mortality.
摘要：
背景：我们的目的是调查胎儿镜激光手术（FLS）治疗的双胎对双胎输血综合征（TTTS）在<18周与≥18周的结局，并在<16周与16-18周时对FLS的TTTS进行亚组分析。
方法：PubMed，Scopus和WebofScience从成立到2023年5月进行了系统搜索。主要结果是生存，次要结局包括早产胎膜早破（PPROM），早产和分娩时的胎龄（GA）。
结果：纳入了包括1691例TTTS妊娠的9项研究。在<18周时接受FLS治疗的TTTS妊娠中，TTTSIII期明显更常见（比值比[OR]2.84，95％置信区间[CI]1.24-6.54），和手术持续时间在<18周时较短(MD-5.27分钟，95%CI-9.19至-1.34）。在<18周接受FLS治疗的TTTS妊娠中，分娩时的GA明显更早（MD-3.12周，95%CI-6.11至-0.13）。结果没有显着差异，包括PPROM，FLS后<7天的PPROM，早产<28周和<32周，在FLS后<7天交货，和生存结果，包括胎儿死亡,活产和新生儿生存。同样，TTTSIII期在<16周时比在16-18周时更常见（OR2.95，95％CI1.62-5.35），上述结果没有显着差异。
结论：在FLS治疗的早期TTTS中，除了分娩时的GA外，<18周治疗的患者与≥18周治疗的患者之间的结局具有可比性，那是三周前.在<16周与16-18周治疗的亚组中，该手术是可行的,不会增加极早早产或围产期死亡的风险.
方法：PubMed，Scopus和WebofScience从成立到2023年5月进行了系统搜索。主要结果是生存，次要结局包括早产胎膜早破（PPROM），早产和分娩时的胎龄（GA）。
结果：纳入了包括1691例TTTS妊娠的9项研究。在<18周时接受FLS治疗的TTTS妊娠中，TTTSIII期明显更常见（比值比[OR]2.84，95％置信区间[CI]1.24-6.54），和手术持续时间在<18周时较短(MD-5.27分钟，95%CI-9.19至-1.34）。在<18周接受FLS治疗的TTTS妊娠中，分娩时的GA明显更早（MD-3.12周，95%CI-6.11至-0.13）。结果没有显着差异，包括PPROM，FLS后<7天的PPROM，早产<28周和<32周，在FLS后<7天交货，和生存结果，包括胎儿死亡,活产和新生儿生存。同样，TTTSIII期在<16周时比在16-18周时更常见（OR2.95，95％CI1.62-5.35），上述结果没有显着差异。
结论：在FLS治疗的早期TTTS中，除了分娩时的GA外，<18周治疗的患者与≥18周治疗的患者之间的结局具有可比性，那是三周前.在<16周与16-18周治疗的亚组中，该手术是可行的,不会增加极早早产或围产期死亡的风险.
