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双胎输血综合征(twin-twin transfusion syndrome,TTTS)是双胎妊娠的一种特殊病理状态,是单绒毛膜双胎妊娠最常见、最严重的并发症。TTTS在双胎妊娠的发生率为5%～15%,在单绒毛膜双羊膜囊双胎妊娠的发生率为15%。TTTS的病因,总的来说是遗传基因的异常,功能性胎盘血管吻合进而继发胎儿血容量改变是主要的病理生理变化,而不平衡的血流交换被认为是TTTS发生的主要原因。在诊断上,目前TTTS主要靠产前超声诊断,根据TTTS的严重程度,将其分为5期。在治疗上,TTTS的治疗方案主要有羊水减量法、胎儿镜下激光凝固吻合血管法。后者的存活率及存活儿的神经系统影响均优于前者,具有较好的发展前景。虽然,胎儿宫内手术在国内开展不多,技术要求高,但可以在有条件的医疗机构逐步开展。
Twin-twin transfusion syndrome (TTTS) is a special pathological condition of twin pregnancy, which is the most common and serious complication of single-cell twin pregnancy. The incidence of TTTS in twin pregnancies is 5% to 15%, with a 15% incidence of twin pregnancies in monochorionic double amniotic sacs. The etiology of TTTS, in general gene abnormalities, functional placental vascular anastomosis and consequent changes in fetal blood volume is the main pathophysiological changes, and unbalanced blood flow exchange is considered to be the main cause of TTTS. In the diagnosis, the current TTTS mainly by prenatal ultrasound, according to the severity of TTTS, will be divided into five. In treatment, the treatment of TTTS mainly amniotic fluid reduction method, fetal laser coagulation anastomosis vascular law. The survival rate of the latter and the survival of children’s nervous system are better than the former, with good prospects for development. Although, intrauterine fetal surgery carried out in the country is not much, high technical requirements, but can be gradually carried out in the conditional medical institutions.