METHODS: Outcomes were retrospective analyzed after use of a standard lens fetoscope of 2 mm (sheath 6.63 mm2 or 11.27 mm2 for anterior placenta) and a flexible fetoscope of 1 mm or 1.2 mm (sheath 2.65 mm2 or 3.34 mm2) in two German centers of fetal surgery, performed during 2006-2019.
RESULTS: Neonatal outcome of 247 TTTS patients were analyzed including the rates of double and single fetal survival. The survival of at least one fetus was 97.2 % in the group with the ultrathin technique (n=154) compared to 88.3 % (n=93) in the group with the standard lens fetoscope (p=0.008). Survival of both fetuses was not different between groups (81.0 vs. 75.3 %). The procedure to delivery interval was significantly increased using the ultrathin fetoscope (89.1±35.0 d vs. 71.4±35.4 d, p=0.001) resulting in an increased gestational age at delivery by 11 days on average (231.9±28.1 d vs. 221.1±32.7 d, p=0.012).
CONCLUSIONS: Fetal survival can be significantly increased following TTTS using flexible fetoscope of 1 mm or 1.2 mm (sheath 2.65 mm2 or 3.34 mm2).
方法:在两个德国胎儿外科中心使用2mm的标准晶状体胎儿镜(前胎盘鞘6.63mm2或11.27mm2)和1mm或1.2mm的柔性胎儿镜(鞘2.65mm2或3.34mm2)后,对结果进行了回顾性分析。在2006-2019年期间执行。
结果:分析了247例TTTS患者的新生儿结局,包括双胎和单胎存活率。超薄技术组(n=154)中至少一个胎儿的存活率为97.2%,而标准晶状体胎儿镜组(p=0.008)中的存活率为88.3%(n=93)。两组胎儿的生存率没有差异(81.0vs.75.3%)。使用超薄胎儿镜,手术至分娩间隔显着增加(89.1±35.0d与71.4±35.4d,p=0.001)导致分娩时平均胎龄增加11天(231.9±28.1天vs.221.1±32.7d,p=0.012)。
结论:使用1mm或1.2mm的柔性胎儿镜(护套2.65mm2或3.34mm2)进行TTTS后,胎儿的存活率可以显着增加。