臨床婦人科産科73巻6号

2019年06月発行

今月の臨床 多胎管理のここがポイント―TTTSとその周辺 TTTS

胎児鏡下レーザー凝固術（FLP）の適応と手法

著者： 小澤克典¹ 室本仁¹ 杉林里佳¹ 和田誠司¹ 左合治彦¹

所属機関： ¹国立成育医療研究センター周産期・母性診療センター胎児診療科

ページ範囲：P.527 - P.534

●胎児鏡下胎盤吻合血管レーザー凝固術（FLP）は根拠に基づいてその適応を定めている．

●FLPの完遂には，胎児鏡を挿入する位置が非常に重要となる．

●レーザー凝固の方法は，成績を改善するために工夫されてきた．

●手術の難易度は症例ごとに異なり，技術の習得・維持のための集約化が必要である．

参考文献

1）De Lia JE, et al : Fetoscopic neodymium : YAG laser occlusion of placental vessels in severe twin-twin transfusion syndrome. Obstet Gynecol 75 : 1046-1053, 1990

2）Ville Y, et al : Preliminary experience with endoscopic laser surgery for severe twin-twin transfusion syndrome. N Engl J Med 332 : 224-227, 1995

3）Quintero RA, et al : Staging of twin-twin transfusion syndrome. J Perinatol 19 : 550-555, 1999

4）Senat MV, et al : Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med 351 : 136-144, 2004

5）Murakoshi T, et al : Japan Fetoscopy Group : Validation of Quintero stage III sub-classification for twin-twin transfusion syndrome based on visibility of donor bladder : characteristic differences in pathophysiology and prognosis. Ultrasound obstet gynecol 32 : 813-818, 2008

6）Valsky DV, et al : Fetoscopic laser surgery for twin-to-twin transfusion syndrome after 26 weeks of gestation. Fetal Diagn Ther 31 : 30-34, 2012

7）Baud D, et al : Fetoscopic laser therapy for twin-twin transfusion syndrome before 17 and after 26 weeks' gestation. Am J Obstet Gynecol 208 : 197.e191-197, 2013

8）Nakata M, et al : A prospective pilot study of fetoscopic laser surgery for twin-to-twin transfusion syndrome between 26 and 27 weeks of gestation. Taiwanese J Obstet Gynecol 55 : 512-514, 2016

9）Gratacos E, et al : A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 30 : 28-34, 2007

10）Ishii K, et al : Ultrasound predictors of mortality in monochorionic twins with selective intrauterine growth restriction. Ultrasound Obstet Gynecol 37 : 22-26, 2011

11）Ishii K, et al : feasibility and preliminary outcomes of fetoscopic laser photocoagulation for monochorionic twin gestation with selective intrauterine growth restriction accompanied by severe oligohydramnios. J Obstet Gynaecol Res 41 : 1732-1737, 2015

12）Ozawa K, et al : Fetoscopic laser photocoagulation for amniotic fluid discordance bordering on twin-twin transfusion syndrome : feasibility, perinatal and long-term outcomes. J Obstet Gynaecol Res 43 : 1256-1262, 2017

13）Sato Y, et al : Incidences of feto-fetal transfusion syndrome and perinatal outcomes in triplet gestations with monochorionic placentation. Fetal Diagn Ther 40 : 181-186, 2016

14）Ishii K, et al : Perinatal outcome after laser surgery for triplet gestations with feto-fetal transfusion syndrome. Prenat Diagn 34 : 734-738, 2014

15）Stirnemann JJ, et al : Profiling fetal cardiac function in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 35 : 19-27, 2010

16）Khalil A, et al : Thilaganathan. Evolution of stage 1 twin-to-twin transfusion syndrome（TTTS） : systematic review and meta-analysis. Twin Res Hum Genet 19 : 207-216, 2016

17）Sago H, et al : The outcome and prognostic factors of twin-twin transfusion syndrome following fetoscopic laser surgery. Prenat Diagn 30 : 1185-1191, 2010

18）Egawa M, et al : Chorioamniotic membrane separation after fetoscopic laser surgery for twin-twin transfusion syndrome. Prenat Diagn 33 : 89-94, 2013

19）Quintero RA, et al : Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 16 : 230-236, 2000

20）Slaghekke F, et al : Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome : an open-label randomised controlled trial. Lancet 383 : 2144-2151, 2014

21）Quintero RA, et al : Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med 20 : 763-768, 2007

22）Nakata M, et al : Modified sequential laser photocoagulation of placental communicating vessels for twin-twin transfusion syndrome to prevent fetal demise of the donor twin. J Obstet Gynaecol Res 35 : 640-647, 2009

23）Murata S, et al : The experience of modified sequential selective laser photocoagulation of communicating vessels technique for twin-twin transfusion syndrome. J Matern Fetal neonatal Med 31 : 1137-1141, 2018

24）Thilaganathan B, et al : Sono-endoscopic delineation of the placental vascular equator prior to selective fetoscopic laser ablation in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 16 : 226-229, 2000

25）Morris RK, et al : Fetoscopic laser coagulation for severe twin-to-twin transfusion syndrome : factors influencing perinatal outcome, learning curve of the procedure and lessons for new centres. BJOG 117 : 1350-1357, 2010

26）Hecher K, et al : Endoscopic laser coagulation of placental anastomoses in 200 pregnancies with severe mid-trimester twin-to-twin transfusion syndrome. Eur J Obstet Gynecol Reprod Biol 92 : 135-139, 2000

27）Chalouhi GE, et al : Laser therapy for twin-to-twin transfusion syndrome（TTTS）. Prenat Diagn 31 : 637-646, 2011

28）Sago H, et al : Fetoscopic laser photocoagulation for twin-twin transfusion syndrome. J Obstet Gynaecol Res 44 : 831-839, 2018