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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)の術後合併症と周産期予後

著者: 中田雅彦12 長崎澄人12 鷹野真由実12

所属機関: 1東邦大学大学院医学研究科産科婦人科学 2東邦大学医療センター大森病院産婦人科

ページ範囲:P.535 - P.539

文献概要

●TTTSに対する胎児鏡下胎盤吻合血管レーザー凝固術(FLP)は約30年前に始まり,技術革新が続いている.

●TTTSに対するFLPの生命予後は,二児生存率が約90%,少なくとも一児生存率が約70%である.

●TTTSに対するFLP後の生児の約10%に中枢神経障害を合併する.

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)名取道也,他 : Yagレーザーを用いた胎盤血管凝固術を施行した双胎間輸血症候群の1例.日産婦会誌44 : 117-120, 1992
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6)Lewi L, et al : Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome : is there more than meets the eye? Am J Obstet Gynecol 194 : 790-795, 2006
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15)Akkermans J, et al : Twenty-five years of fetoscopic laser coagulation in twin-twin transfusion syndrome : A systematic review. Fetal Diagn Ther 38 : 241-253, 2015
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18)Diehl W, et al : Fetoscopic laser coagulation in 1020 pregnancies with twin-twin transfusion syndrome demonstrates improvement in double-twin survival rate. Ultrasound Obstet Gynecol 50 : 728-735, 2017
19)Ishii K, et al : Survival rate without brain abnormalities on postnatal ultrasonography among monochorionic twins after fetoscopic laser photocoagulation for selective intrauterine growth restriction with concomitant oligohydramnios. Fetal Diagn Ther 45 : 21-27, 2019
20)Hecher K, et al : Long-term outcomes for monochorionic twins after laser therapy in twin-to-twin transfusion syndrome. Lancet Child Adolesc Health 2 : 525-535, 2018
21)Pruetz JD, et al : Recipient twin circular shunt physiology before fetal laser surgery : survival and risks for postnatal right ventricular outflow tract obstruction. J Ultrasound Med 36 : 1595-1605, 2017
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23)Takano M, et al : Chorioamniotic membrane separation after fetoscopic laser photocoagulation. Fetal Diagn Ther 43 : 40-44, 2018

掲載誌情報

出版社:株式会社医学書院

電子版ISSN:1882-1294

印刷版ISSN:0386-9865

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