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Neonatal Med > Volume 23(4); 2016 > Article
Neonatal Medicine 2016;23(4):203-210.
DOI: https://doi.org/10.5385/nm.2016.23.4.203    Published online November 30, 2016.
The Impact of Introduction of Fetoscopic Laser Surgery on Twin-to-Twin Transfusion Syndrome.
Soo Hyun Kim, Euiseok Jung, Mi Young Lee, Byong Sop Lee, Hye Sung Won, Ellen Ai Rhan Kim, Ki Soo Kim
1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kskim@amc.seoul.kr
2Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Abstract
PURPOSE
Fetoscopic laser surgery (FLS) is considered an optimal therapeutic strategy for twin-to-twin transfusion syndrome (TTTS). We aimed to determine the clinical outcomes of TTTS patients since the introduction of FLS.
METHODS
A retrospective study of TTTS patients born between January 2005 and December 2015 was conducted. Mortality and morbidity were compared in the FLS and non-FLS groups. The FLS group was divided into selective FLS and Solomon technique group, and subgroup analysis was performed.
RESULTS
Of 70 pregnancies diagnosed with TTTS during the study period, FLS was performed for 35 (50%). Survival of at least one infant at discharge was achieved in 100% (35/35) of pregnancies in the FLS group and 91.4% (32/35) in the non-FLS group (P=0.028). Subgroup analysis revealed that the Solomon technique group had a higher dual survival rate than the selective FLS group (81.3% vs. 57.9%, P=0.036). Neonatal mortality was significantly lower in the FLS group than in the non-FLS group (1.7% vs. 16.4%, P=0.005). Severe intraventricular hemorrhage more than grade 3 was less frequent in the FLS group than in the non-FLS group (0% vs. 18.2%, P= 0.001). The FLS group showed smaller inter-twin differences in birth weight (24.4% vs. 33.7%, P= 0.032) and lower incidence of twin anemia-polycythemia sequence (0% vs. 43.8%, P<0.001).
CONCLUSION
Since the introduction of FLS, the survival rate of TTTS patients has improved. The Solomon technique resulted in better dual survival rates than selective FLS.
Key Words: Twin-to-twin transfusion syndrome, Fetoscopic surgery, Neonate


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