쌍태아수혈증후군의 주산기 예후: 10년(2000-2009)간의 임상경험
THE PERINATAL OUTCOMES OF TWIN-TO-TWIN TRANSFUSION SYNDROME FOR 10 YEARS’ EXPERIENCES (2000-2009)
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목적쌍태아수혈증후군(twin-to-twin transfusion syndrome, TTTS)은 일융모막쌍태아에서 가장 중요한 문제점 중의 하나이다. 우리는 10년간 본원에서 진단, 치료받았던 TTTS 환자를 stage에 따라서 구분하여 보고 그들의 예후에 관하여 살펴보았다. 연구방법2000년부터 2009년까지 출생한 쌍태아 476예(312예의 이융모막쌍태아, 164예의 일융모막쌍태아) 중 TTTS로 진단된 27예(일융모막쌍태아의 16%)를 대상으로 하였다. 진단 당시 초음파 소견에 따라 stage가 결정되었으며, 분만 후 모든 쌍태아의 태반을 확인하였다. 20예에서 양수감압술이 시행되었으며 이 중 8예인 16명의 태아는 추적관찰을 하였다. 결과I, II, III, IV, V기는 각각 8예, 2예, 3예, 4예, 10예로 분류되었다. Early stage일수록 진단에서 출생까지의 기간이 더 길었다. 두 태아가 모두생존한 경우에 그렇지 않은 군에 비하여 출생 시 임신주수와 진단에서 출생까지의 기간이 더 긴 것을 관찰할 수 있었다. 하지만 신생아의출생체중, 두 신생아 간의 체중차이는 생존과 관련성을 보이지 않았다. 총 20예에서 양수감압술이 시행되었고 60% (24/40)의 생존율을보였으며 I-III기에서는 86%, IV, V기에서는 28%로 나타났다. 양수감압술을 시행한 태아에서 최종적으로 신경학적 손상을 받은 아이는 1예있었다. 결론TTTS의 빠른 진단과 적극적인 양수감압술은 태아의 생존율을 향상시켜 좋은 주산기 예후를 나타낼 것이다.
Abstract
Objective Twin-to-twin transfusion syndrome (TTTS) is the most serious complication in monochorionic twin. We investigated the stage and prognosis of pregnant women who diagnosed as TTTS at our institution for 10 years. Methods Between 2000 and 2009, 476 twins (312 dichorionic twins, 164 monochorionic twins) were born in our hospital. We reported the perinatal outcomes for 27 cases of TTTS (16% of monochorionic twins), which were classifi ed by Quintero’s clinical staging. Stage was decided at the time of initial examination by ultrasound. We examined placentas of all cases after delivery and confi rmed the exact chorionicity. In total 20 cases, amnioreduction were performed and 8 cases (16 baby) were followed. Results There were 8 cases of stage I, 2 case of stage II, 3 case of stage III, 4 cases of stage IV, and 10 cases of stage V. There was signifi cant difference of the time period between diagnosis and birth in early stage of TTTS. In cases in which both fetuses survived,time period between diagnosis and birth, and pregnancy duration were signifi cantly longer than other one fetus survived or both twin death cases. Amnioreduction was performed in 20 cases for the treatment of TTTS and 60% of mean survival rates of neonate were shown. There were 86% of survival rate in stage I-III, 27% in stage IV-V. Only one baby developed neurological sequelae after amnioreduction. Conclusion Early diagnosis of TTTS and aggressive amnioreduction may improve the fetal survival rate.
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