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目的探讨超声引导下射频消融术在胎儿宫内治疗中的初步应用。方法本组6例孕妇,其中双胎输血综合征(TTTS)3例,单绒毛膜囊双胎伴其中一胎重度宫内生长受限(sIUGR)2例,此5例均在超声引导下行射频消融减胎术;另1例单胎胎盘绒毛膜血管瘤伴胎儿严重贫血,在超声引导下行血管瘤射频消融治疗术。结果 5例被减胎儿在2~3次射频加热循环后血流消失,保留胎儿手术过程心脏搏动均正常;1例胎盘绒毛膜血管瘤射频消融治疗术,经过4次射频加热循环后,血管瘤内血流明显减少,术中胎儿心脏搏动正常。5例减胎术,其中4例均剖宫产出健康新生儿,1例术后流产;1例胎盘绒毛膜血管瘤治疗术,术后流产。结论射频消融术是可以用于胎儿宫内治疗的一种可操作的微创手术,它具有一定安全性及可靠性,可有效提高保留胎儿的出生质量。
Objective To investigate the preliminary application of ultrasound-guided radiofrequency catheter ablation in intrauterine fetal therapy. Methods The group of 6 pregnant women, including twin transfusion syndrome (TTTS) in 3 cases, single choriocapsule twin with one intrauterine growth restriction (sIUGR) in 2 cases, the 5 cases under the guidance of ultrasound-guided radio frequency Ablation and abortion surgery; the other one case of single placental choriocarcinoma with severe fetal anemia, guided by ultrasound-guided radiofrequency ablation of hemangiomas. Results In 5 cases of aborted fetus, the blood flow disappeared after 2-3 cycles of radiofrequency heating and the heart beat during fetal operation was preserved. One case of radiofrequency ablation of placental chorionic hemangioma performed 4 cycles of radiofrequency ablation, Internal blood flow was significantly reduced intraoperative fetal heart beat normal. 5 cases of abortion, including 4 cases of cesarean section to produce healthy newborns, 1 case of postoperative abortion; 1 case of placental choriocarcinoma treatment and postoperative abortion. Conclusion Radiofrequency ablation is a kind of operable minimally invasive surgery that can be used in intrauterine fetal treatment. It has some safety and reliability, which can effectively improve the birth quality of the preserved fetus.