Objective: To analyze the perioperative maternal complications of twin-twin transfusion syndrome (TTTS) after fetolascopic laser photocoagulation (FLP). Methods: A retrospective study was conducted among 182 cases with TTTS received FLP in Shanghai First Maternity and Infant Hospital from January 2010 to December 2018. The types, incidence and related factors of perioperative maternal complications as well as the changes of maternal laboratory parameters before and after FLP were analyzed. Results: The age of 182 TTTS pregnant women was (29.8±3.9) years old, body mass index (BMI) before pregnancy was (21.3±2.9) kg/m2. The median gestational week of FLP treatment was 22.0 weeks, the preoperative cervical length was (34.1±9.0) mm, and the median preoperative maximum vertical pocket was 12.0 cm. During the perioperative period of FLP treatment, 22 cases (12.1%, 22/182) presented maternal complications, among which 4 cases (2.2%, 4/182) presented severe postoperative maternal complications, including 3 cases of pulmonary edema and 1 case of pulmonary embolism accompanied with right cardiac insufficiency. There were 18 cases (9.9%, 18/182) of common maternal complications during the perioperative period, including 6 cases (3.3%, 6/182) of intraoperative hemorrhage, 5 cases (2.7%, 5/182) of intraoperative amniotic fluid leakage into the pelvic cavity, 5 cases (2.7%, 5/182) of premature rupture of membrane 72 hours after the operation, 1 case (0.5%, 1/182) of inevitable abortion, and 1 case (0.5%, 1/182) of infection. The analysis of related risk factors found that maternal complications were only related to BMI before pregnancy, and the BMI of TTTS pregnant women with complications was lower than that of those without complications, the difference was statistically significant (P<0.01). The hemoglobin level, hematocrit and albumin level of TTTS pregnant women were significantly decreased at 4-6 hours and 24 hours after FLP respectively, compared with those before surgery (P<0.01), and there were no significant correlations with the amount of amniodrainage during surgery (P>0.05 for all). Conclusions: The overall incidence of perioperative maternal complications in the treatment of TTTS by FLP is not high, among which the serious complications mainly include pulmonary edema and pulmonary embolism. Timely correction of maternal hemodilution that may occur in TTTS pregnant women could achieve a good prognosis after FLP.
目的： 分析胎儿镜激光凝固术（FLP）治疗双胎输血综合征（TTTS）的围手术期母体并发症。 方法： 收集2010年1月至2018年12月在同济大学附属第一妇婴保健院确诊并接受FLP治疗的TTTS孕妇共182例，回顾性分析围手术期母体并发症的种类、发生率、相关因素及手术前后母体血液学相关指标的变化。 结果： 182例TTTS孕妇年龄（29.8±3.9）岁，孕前体质指数（BMI）为（21.3±2.9） kg/m2，行FLP治疗的中位孕周为22.0周，术前子宫颈长度为（34.1±9.0） mm，受血儿术前最大羊水深度中位数为12.0 cm。FLP围手术期出现母体并发症22例（12.1%，22/182），其中，术后严重母体并发症4例（2.2%，4/182），包括3例肺水肿和1例肺栓塞伴右心功能不全；围手术期常见母体并发症18例（9.9%，18/182），包括术中出血6例（3.3%，6/182）、术中羊水渗漏至盆腹腔5例（2.7%，5/182）、术后72 h内胎膜早破5例（2.7%，5/182）、难免流产1例（0.5%，1/182）、感染1例（0.5%，1/182）。相关高危因素分析发现，母体并发症仅与孕前BMI有关，有并发症的TTTS孕妇BMI低于无并发症者，两者比较，差异有统计学意义（P<0.01）。TTTS孕妇FLP术后4~6 h、术后24 h血红蛋白水平、血细胞比容和白蛋白水平分别与术前比较，均显著降低（P均<0.01），且均与术中减去的羊水量无明显相关性（P均>0.05）。 结论： FLP治疗TTTS患儿围手术期母体并发症的总体发生率不高，严重并发症主要包括肺水肿及肺栓塞。FLP术后，及时纠正TTTS孕妇可能发生的稀释性贫血和低蛋白血症可获得良好预后。.
Keywords: Fetofetal transfusion; Fetoscopy; Laser coagulation; Perioperative period; Postoperative complications.