Email Alert | RSS

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (5): 943-947. doi: 10.19723/j.issn.1671-167X.2022.05.022

• 论著 • 上一篇    下一篇

经腹胎儿颅内与胸腔内注射氯化钾减胎的临床效果

张红霞,杨蕊,杨硕,潘宁宁,王琳琳,李蓉*()   

  1. 北京大学第三医院生殖医学中心, 北京 100191
  • 收稿日期:2022-04-07 出版日期:2022-10-18 发布日期:2022-10-14
  • 通讯作者: 李蓉 E-mail:roseli001@sina.com
  • 作者简介:李蓉，主任医师、教授、博士研究生导师。北京大学第三医院妇产科主任、生殖医学中心主任。中国医师协会生殖医学专业委员会副主任委员兼总干事、中国医疗保健国际交流促进会生殖医学分会主任委员和生殖感染与微生态分会副主任委员、中国中药协会女性生殖健康专委会副主任委员、北京医学会生殖医学分会常委兼秘书。
    1998年起在北京大学第三医院妇产科工作，2003年进入生殖医学中心开始专攻生殖内分泌疾病、不孕症和辅助生殖技术的临床工作。主持国家重点研发计划、“十二五”科技支撑计划、国家自然科学基金等多项省部级研究课题，开展女性生育力流行病学调查、女性生殖内分泌疾病对辅助生殖技术子代影响的队列研究等。主编“十二五”国家重点图书《生殖内分泌诊断与治疗》和十四五规划教材《遗传与优生》，参与发表SCI论文150余篇，其中作为第一或通信作者(含共同)发表 50篇。2009、2011、2017年三次获国家科技进步二等奖，2018年获得北京市茅以升科技奖和教育部科技进步二等奖(第一完成人)，2021年获得妇幼健康科技进步一等奖(第一完成人)
  • 基金资助:
    北京市科技计划(Z191100006619085)

Clinical effect of fetal reduction by intracranial and intrathoracic KCl injection

Hong-xia ZHANG,Rui YANG,Shuo YANG,Ning-ning PAN,Lin-lin WANG,Rong LI*()   

  1. Reproductive Medical Center, Peking University Third Hospital, Beijing 100191, China
  • Received:2022-04-07 Online:2022-10-18 Published:2022-10-14
  • Contact: Rong LI E-mail:roseli001@sina.com
  • Supported by:
    Beijing Science and Technology Planning Project(Z191100006619085)

RICH HTML

   

PDF (PC)

摘要：

目的: 评估中孕早期多胎妊娠经腹胎儿颅内注射氯化钾(KCl)减胎的可行性和有效性。方法: 回顾性分析北京大学第三医院生殖中心2006年1月至2019年12月363例经腹减胎患者的临床资料, 根据减胎穿刺部位分为两组: 颅内注射组(n=196)和胸腔内注射组(n=167), 比较两组减胎过程及妊娠结局。结果: 两组患者平均年龄、辅助生殖技术助孕前不孕症类型、妊娠方式、减胎指征、减胎前活胎数、减灭胎儿数目、保留胎儿数目比例差异均无统计学意义(P＞0.05)。颅内注射组和胸腔内注射组穿刺次数≥2次发生率(12.1% vs. 8.6%, P=0.249)及更换穿刺部位发生率(10.7% vs. 6.4%, P=0.161)差异均无统计学意义。减胎术后1 d复查彩超, 颅内注射组和胸腔内注射组减灭胎儿胎心复跳发生率[3.6%(8/224) vs. 1.1%(2/187), P=0.188]、KCl使用量[(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079]、减胎术后4周内流产率(1.0% vs. 0.6%, P=0.654), 差异均无统计学意义。另外, 两组减胎术后总流产率、早产率、剖宫产率、分娩孕周及新生儿出生体质量差异亦无统计学意义(P＞0.05)。结论: 颅内注射KCl减胎术可成为胸腔内注射KCl减胎术的有效替代方案。

关键词: 多胎妊娠, 选择性减胎, 颅内穿刺, 胸腔内穿刺

Abstract:

Objective: To evaluate the feasibility and effectiveness of fetal reduction by transabdominal intracranial KCl injection for multifetal pregnancies in the early second trimester. Methods: The data of 363 patients who underwent transabdominal fetal reduction in the Reproductive Medical Center of Peking University Third Hospital from January 2006 to December 2019 were analyzed retrospectively. According to the location of fetal reduction, they were divided into two groups: Intracranial injection group (n=196) and intrathoracic injection group (n=167). The process of fetal reduction and pregnancy outcome of the two groups were compared. Results: There was no significant difference between the two groups in the average age and the proportion of type of infertility before assisted reproductive technology, conception method, indication for fetal reduction, starting number of fetuses, reduced number of fetuses, and finishing number of fetuses (P>0.05). There was no significant difference between the two groups in the proportion of the number of puncture ≥ 2 times (12.1% vs. 8.6%, P=0.249) and the incidence of replacing puncture site (10.7% vs. 6.4%, P=0.161). The next day after fetal reduction, color Doppler ultrasound was rechecked. In the intracranial injection group and intrathoracic injection group, the incidence of fetal heartbeat recovery [3.6% (8/224) vs. 1.1% (2/187), P=0.188], the volumes of KCl used [(2.6±1.0) mL vs. (2.8±1.1) mL, P=0.079], and the abortion rate within 4 weeks after fetal reduction (1.0% vs. 0.6%, P=0.654) were of no significant difference. In addition, there was no significant difference in the total abortion rate after fetal reduction, premature delivery rate, cesarean section rate, delivery gestational week and neonatal birth weight between the two groups (P>0.05). Conclusion: Intracranial KCl injection can be an effective alternative to intrathoracic KCl injection for multifetal pregancy reduction.

Key words: Multiple pregnancy, Selective fetal reduction, Intracranial puncture, Intrathoracic puncture

中图分类号: 

  • R714.23

表1

经腹减胎患者基本情况"

Characteristics Intracranial injection (n=196) Intrathoracic injection (n=167) t/χ2 P
Age/years, ${\bar x}$±s 32.1±4.3 32.5±4.6 -0.976 0.330
Type of infertility before ART, n(%) 0.959 0.327
  Primary infertility 92 (46.9) 87 (52.1)
  Secondary infertility 104 (53.1) 80 (47.9)
Conception method, n(%) 2.866 0.239
  IVF-ET/FET 131 (66.8) 122 (73.0)
  IUI 49 (25.0) 28 (16.8)
  Ovulation stimulation 16 (8.2) 17 (10.2)
Indication for fetal reduction, n(%) 2.603 0.272
  Fetal malformation 17 (8.7) 21 (12.6)
  Maternal factors 74 (37.8) 69 (41.3)
  Multiple pregnancy 105 (53.5) 77 (46.1)
Time of fetal reduction (weeks of gestation), n(%) 0.460 0.795
  12 weeks 121 (61.7) 105 (62.9)
  13 weeks 58 (29.6) 45 (26.9)
  14 weeks 17 (8.7) 17 (10.2)
Starting number of fetuses, n(%) 0.360 0.835
  2 144 (73.5) 118 (70.7)
  ≥3 52 (26.5) 49 (29.3)
Reduced number of fetuses, n(%) 0.42 0.52
  1 168 (85.7) 147 (88.0)
  2 28 (14.3) 20 (12.0)
Finishing number of fetuses, n(%) 1.922 0.166
  Singleton 169 (86.2) 135 (80.8)
  Twins 27 (13.8) 32 (19.2)

表2

经腹颅内注射与胸腔内注射KCl减胎术过程比较"

Items Intracranial injection Intrathoracic injection t/χ2 P
Total reduced number of fetuses, n 224 187
Number of puncture ≥2, n(%) 27 (12.1) 16 (8.6) 1.331 0.249
Change puncture site, n(%) 24 (10.7) 12 (6.4) 2.355 0.161
Fetal reduction again after fetal reduction failure, n(%) 8 (3.6) 2 (1.1) 1.737 0.188
Volume of KCl/mL, ${\bar x}$±s 2.6±1.0 2.8±1.1 -1.763 0.079

表3

经腹颅内注射与胸腔内注射KCl减胎术后临床结局比较"

Outcomes Intracranial injection Intrathoracic injection t/χ2 P
Total abortion rate 11.7% (23/196) 6.6% (11/167) 2.815 0.093
Abortion rate within 4 weeks after fetal reduction 1.0% (2/196) 0.6% (1/167) 0.201 0.654
Preterm birth rate 15.0% (26/173) 23.7% (37/156) 2.784 0.095
Cesarean section rate 76.9% (133/173) 76.3% (119/156) 0.001 0.982
Singleton delivery (weeks of gestation), ${\bar x}$±s 37.9±2.4(n=148) 37.8±2.3(n=128) 0.227 0.821
Singleton newborn weight/g, ${\bar x}$±s 3 078.4±582.4(n=148) 3 011.8±559.4(n=128) 0.965 0.335
Twin delivery (weeks of gestation), ${\bar x}$±s 36.5±1.9(n=24) 35.8±2.4(n=25) 1.133 0.263
Twin newborn weight/g, ${\bar x}$±s 2 410.0±517.6(n=48) 2 409.2±504.5(n=50) 0.608 0.545
1 Zipori Y , Haas J , Berger H , et al. Multifetal pregnancy reduction of triplets to twins compared with non-reduced triplets: A meta-analysis[J]. Reprod Biomed Online, 2017, 35 (3): 296- 304.
doi: 10.1016/j.rbmo.2017.05.012
2 Evans MI , Andriole S , Britt DW . Fetal reduction: 25 years' experience[J]. Fetal Diagn Ther, 2014, 35 (2): 69- 82.
doi: 10.1159/000357974
3 Kim MS , Choi DH , Kwon H , et al. Procedural and obstetric outcomes after embryo reduction vs fetal reduction in multifetal pregnancy[J]. Ultrasound Obstet Gynecol, 2019, 53 (2): 214- 218.
doi: 10.1002/uog.19024
4 Raffé-Devine J , Somerset DA , Metcalfe A , et al. Maternal, fetal, and neonatal outcomes of elective fetal reduction among multiple gestation pregnancies: A systematic review[J]. J Obstet Gynaecol Can, 2022, 44 (1): 60- 70.
doi: 10.1016/j.jogc.2021.07.020
5 Li R , Yang R , Chen X , et al. Intracranial KCl injection: An alternative method for multifetal pregnancy reduction in the early second trimester[J]. Fetal Diagn Ther, 2013, 34 (1): 26- 30.
doi: 10.1159/000350174
6 Lembet A , Selam B , Bodur H , et al. Intracranial injection with KCl: An alternative method in selected cases of multifetal pregnancy reduction[J]. Fetal Diagn Ther, 2009, 26 (3): 134- 136.
doi: 10.1159/000243714
7 Luo L , Cai B , Jie HY , et al. Influence of spontaneous fetal reduction on dichorionic diamniotic twin pregnancy outcomes after in vitro fertilization: A large-sample retrospective study[J]. J Matern Fetal Neonatal Med, 2019, 32 (11): 1826- 1831.
doi: 10.1080/14767058.2017.1419178
8 Hasson J , Shapira A , Many A , et al. Reduction of twin pregnancy to singleton: Does it improve pregnancy outcome[J]. J Matern Fetal Neonatal Med, 2011, 24 (11): 1362- 1366.
doi: 10.3109/14767058.2010.547964
9 李红燕, 李善玲, 王谢桐, 等. 多胎妊娠中孕期选择性减胎术[J]. 中国实用妇科与产科杂志, 2015, 31 (7): 602- 607.
10 Corrado F , Cannata ML , La Galia T , et al. Pregnancy outcome following mid-trimester amniocentesis[J]. J Obstet Gynaecol, 2012, 32 (2): 117- 119.
doi: 10.3109/01443615.2011.633717
11 Evans MI , Berkowitz RL , Wapner RJ , et al. Improvement in outcomes of multifetal pregnancy reduction with increased experience[J]. Am J Obstet Gynecol, 2001, 184 (2): 97- 103.
doi: 10.1067/mob.2001.108074
12 Hirayama E , Ebina Y , Kato K , et al. Cervical polyps in early pregnancy are a risk factor for late abortion and spontaneous preterm birth: A retrospective cohort study[J]. Int J Gynaecol Obstet, 2022, 156 (1): 64- 70.
doi: 10.1002/ijgo.13608
13 Mastrolia SA , Baumfeld Y , Hershkovitz R , et al. Independent association between uterine malformations and cervical insufficiency: A retrospective population-based cohort study[J]. Arch Gynecol Obstet, 2018, 297 (4): 919- 926.
doi: 10.1007/s00404-018-4663-2
14 鞠辉, 李红燕, 王谢桐. 多胎妊娠孕中期选择性减胎术后不良妊娠结局危险因素分析[J]. 中国实用妇科与产科杂志, 2016, 32 (8): 779- 783.
15 胡琳莉, 黄国宁, 孙海翔, 等. 多胎妊娠减胎术操作规范(2016)[J]. 生殖医学杂志, 2017, 26 (3): 193- 198.
doi: 10.3969/j.issn.1004-3845.2017.03.001
No related articles found!
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部