Abstract：
OBJECTIVE: Fetoscopic laser coagulation of placental anastomoses is usually performed for a treatment of twin-to-twin transfusion syndrome (TTTS). A common complication of fetoscopic laser coagulation for TTTS is preterm preliminary rupture of fetal membranes (PPROM) aggravating the neonatal outcome significantly. However, use of an flexible 1 mm fetoscope with an curved sheath could reduce iatrogenic damage of the amniotic membrane and improve neonatal outcomes after laser treatment. The aim of this study was to compare neonatal outcomes using this flexible fetoscope with curved sheath vs. use of a standard lens technique.
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).
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).
摘要：
目的：胎儿镜下激光凝固胎盘吻合术通常用于治疗双胎对双胎输血综合征（TTTS）。用于TTTS的胎儿镜激光凝固术的常见并发症是早产胎膜初步破裂（PPROM）显着加重了新生儿结局。然而,使用带弯曲鞘的1mm柔性胎儿镜可减少羊膜医源性损伤,改善激光治疗后新生儿结局.这项研究的目的是比较使用这种带弯曲鞘的柔性胎儿镜与新生儿的结局。使用标准的镜头技术。
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。
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。
