微波消融和射频消融减胎术治疗复杂性单绒毛膜妊娠的比较

目的评估微波消融(microwave ablation,MWA)和射频消融(radiofrequency ablation,RFA)减胎术对复杂性单绒毛膜妊娠的治疗效果。方法本研究收集2012年1月1日—2018年12月31日在北京大学第三医院产科进行MWA和RFA减胎术治疗的复杂性单绒毛膜妊娠孕妇的临床资料,包括术前资料、手术资料和妊娠结局。比较MWA和RFA减胎术的手术过程和妊娠结局。结果181例减胎孕妇中,132例行MWA,49例行RFA。两组手术过程比较显示,MWA组比RFA组消融时长短(6.0 min和7.5 min,P=0.010)、消融功率低(35.0 W和50.0 W,P<0.001)。妊娠结局比较显示,RFA组和MWA组的保留胎儿存活情况差异无统计学意义(57.7%和66.2%),但在胎死宫内率(42.0%和23.4%,P=0.011)、新生儿出生低体重率(55.6%和31.1%,P=0.021)以及新生儿转重症监护室率(60.0%和32.2%,P=0.011)上,RFA组要高于MWA组。结论MWA作为一种新的减胎手术方式,与RFA减胎术术后的胎儿存活率没有统计学差异,但保留胎儿胎死宫内率和出生低体重率更低,并且手术消融时长更短、消融功率更低,手术更为便捷,在临床应用中更有优势。

Comparison of microwave ablation and radiofrequency ablation for fetal reduction in the treatment of complicated monochorionic pregnancy

Objective To evaluate the therapeutic effect of microwave ablation(MWA)and radiofrequency ablation(RFA)fetal reduction on complicated monochorionic pregnancy.MethodsThis study collected clinical data of women with complicated monochorionic pregnancy who underwent MWA and RFA fetal reduction treatment in the obstetric department of Peking University Third Hospital from January 1,2012 to December 31,2018,including preoperative data,surgical data and pregnancy outcomes.We compared the surgical process and pregnancy outcomes of MWA and RFA fetal reduction.ResultsAmong 181 pregnant women with reduced fetuses,132 received MWA and 49 received RFA.The comparison of the surgical process between the two groups showed that MWA group had shorter ablation duration(6.0 min vs 7.5 min,P=0.010)and lower ablation power(35.0W vs 50.0W,P<0.001)than RFA group.There was no significant difference in the survival of the preserved fetus between the RFA group and the MWA group(57.7%vs 66.2%),but RFA group had higher rate than MWA group in intrauterine fetal death(42.0%vs 23.4%,P=0.011),low birth weight of newborns(55.6%vs 31.1%,P=0.021),and neonatal conversion to intensive care units(60.0%vs 32.2%,P=0.011).ConclusionAs a new method of fetal reduction surgery,MWA has no statistical difference in fetal survival rate than RFA fetal reduction.Compared with RFA,MWA has lower rate of retained intrauterine fetal death,low birth weight,duration and power of surgical ablation,as well as more convenient operation.It has more advantages in clinical application.