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首页> 外文期刊>Surgical Endoscopy >Minimal-access fetal surgery for twin-to-twin transfusion syndrome.
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Minimal-access fetal surgery for twin-to-twin transfusion syndrome.

机译：双胎-双胎输血综合征的最小限度胎儿手术。

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Background: Laser ablation of placental vessels effectively halts severe twin-to-twin transfusion syndrome (TTTS), but fetal surgery remains a dangerous approach. The authors present the technical aspects of endoscopic fetal surgery in their initial clinical experience. Methods: Altogether, 11 women underwent endoscopic fetal surgery for severe TTTS. Access to the recipient's sac was obtained by the Seldinger technique via minilaparotomy. A 12-Fr peel-away introducer was used as a cannula to accommodate a custom-curved 9-Fr sheath containing a 1.9-mm semirigid fiber endoscope. Laser ablation was performed on all unpaired vessels crossing the intertwin membrane using a 400- micro m neodymium: yttrium-aluminum-garnet (Nd: YAG) fiber. The cannula was removed over a gelatin sponge plug. Results: The median operating time was 65 min (range, 45-105 min). No patient experienced amniotic leak postoperatively. The length of hospital stay was 2.8 +/- 1.6 days. Immediate improvement of the TTTS was noted in all but two patients. Pneumonia developed, in one mother leading to premature labor. There were no other major surgical complications. Fetal survival at 2 weeks was 73%. Conclusions: The safety and efficacy of endoscopic fetal surgery for severe TTTS can be optimized with the application of current minimal-access techniques. The superiority of this approach over less invasive means is still being evaluated through prospective studies.
机译：背景：胎盘血管的激光消融术可以有效地阻止严重的双胎双输血综合征（TTTS），但是胎儿手术仍然是一种危险的方法。作者在其最初的临床经验中介绍了内窥镜胎儿手术的技术方面。方法：共有11名妇女接受了严重TTTS的内窥镜胎儿手术。通过Seldinger技术通过微型剖腹术获得了接受者的囊。使用12-Fr剥离式导入器作为套管，以容纳包含1.9-mm半刚性纤维内窥镜的定制弯曲的9-Fr护套。使用400微米钕：钇铝石榴石（Nd：YAG）纤维对所有穿过双胞膜的未配对血管进行激光消融。在明胶海绵塞上除去套管。结果：中位手术时间为65分钟（范围为45-105分钟）。没有患者术后出现羊水泄漏。住院时间为2.8 +/- 1.6天。除两名患者外，其他患者均发现TTTS立即改善。一位母亲因早产导致了肺炎。没有其他重大手术并发症。 2周胎儿存活率为73％。结论：内镜胎儿手术治疗重度TTTS的安全性和有效性可通过应用当前的最小获取技术得到优化。通过前瞻性研究仍在评估这种方法相对于侵入性较小的方法的优越性。

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