[1]李亚玲,范忠婷,肖娴,等.46例单绒毛膜双胎中孕期胎儿镜下手术护理 及体会[J].中国计划生育和妇产科,2020,(4):80-83.
　LI Ya ling,FAN Zhong ting,XIAO Xian,et al.Nursing care and experience of fetal endoscopic surgery in 46 cases of single chorionic twins during second trimester[J].Chinese Journal of Family Planning & Gynecotokology,2020,(4):80-83.
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46例单绒毛膜双胎中孕期胎儿镜下手术护理 及体会
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2020年4期
页码:
80-83
栏目:
论著与临床
出版日期:
2020-04-25

文章信息/Info

Title:
Nursing care and experience of fetal endoscopic surgery in 46 cases of single chorionic twins during second trimester
作者:
李亚玲; 范忠婷; 肖娴; 陆宁丽; 郑明明; 叶红芳*
南京大学医学院附属鼓楼医院妇产科
Author(s):
LI Yaling;  FAN Zhongting;  XIAO Xian;  LU Ningli;  ZHENG Mingming;  YE Hongfang*
Department of Obstetrics and Gynecology, Drum Tower Hospital, Medical College of Nanjing University, Nanjing Jiangsu，P.R.China
关键词:
单绒毛膜双胎; 胎儿镜手术; 优质护理; 妊娠结局
Keywords:
single chorionic twin; fetal endoscopic surgery; surgical care;  pregnancy outcome
分类号:
R 47371
摘要:
目的 总结复杂性单绒毛膜双胎中孕期胎儿镜下双极电凝脐带血管阻断术及激光凝固胎盘血管术的手术护理，为胎儿镜下手术孕妇提供优质护理。方法 回顾性分析南京大学医学院附属鼓楼医院2015年11月至2019年2月46例中孕期单绒毛膜双胎胎儿镜手术护理，包括充分的术前准备，术中认真执行无菌技术、应用曲线型仰卧位护理、综合保温护理、严密观测手术中羊膜腔灌注量及速度、掌握胎儿镜及其配件安装和操作等护理措施，默契配合手术医生和B超医生完成手术。结果 46例孕妇中，44例手术顺利，其中28例行胎儿镜下激光凝固胎盘吻合血管术（fetaloscopic laser occlusion of chorioangiopagous vessels，FLOC）、16例行胎儿镜下双极电凝脐血管阻断术（bipolar cord coagulation，BCC）。手术时间45～120 min，平均 （7607±2377）min。2例因术中穿刺时针刺胎盘边缘，呈血性羊水停止胎儿镜手术，改为射频消融减胎术（radio frequency ablation，RFA）。46例孕妇中有7例尚在正常妊娠中，38例已结束妊娠，其中29例孕妇成功分娩，平均妊娠孕周（3655±021）周，存活率7436 %；6例孕妇于胎儿镜术后出现迟发型胎膜早破致流产、早产。1例FLOC 后残留的血管吻合（术后1周供血儿胎死宫内，受血儿孕32周胎膜早破，臀位，剖宫产娩出活产儿），1例胎死宫内，1例术后感染终止妊娠，1例RFA后失访（妊娠结局不明）。结论胎儿镜下手术可改变单绒毛膜双胎并发症的妊娠结局，改善新生儿预后。术中认真执行无菌技术、应用曲线型仰卧位护理、综合保温护理、术中羊膜腔灌注护理、专科器械管理及使用等优质护理措施可提高手术安全性及效率、降低手术并发症发生率。
Abstract:
ObjectiveTo summarize the surgical nursing of bipolar electrocoagulation umbilical cord vascular occlusion and laser coagulation placenta vascular surgery under fetal microscopy in pregnant women with complex single chorionic twins during second trimester. MethodsRetrospective analysis of 46 cases of single chorionic twin fetal endoscopy in midpregnancy from November 2015 to February 2019 in Drum Tower Hospital, Medical College of Nanjing University, including adequate preoperative preparations, aseptic techniques during the operation, the application of curved supine nursing, comprehensive thermal insulation nursing, close observation of the amniotic cavity perfusion volume and speed during operation, mastering the installation and operation of fetal mirrors and their accessories, the tacit understanding cooperates with the surgeon and the ultrasound doctor to complete the operation.ResultsOf the 46 pregnant women, 44 were successfully operated, of which 28 underwent fetaloscopic laser occlusion of chorioangiopagous vessels (FLOC), and 16 underwent fetal microscopy bipolar cord coagulation (BCC) umbilical vascular occlusion. The operation time ranged from 45 to 120 minutes, with an average of (7607 ± 2377) minutes. In the 2 cases, fetal endoscopic surgery was stopped due to bleeding amniotic fluid at the edge of placenta during intraoperative puncture, which was replaced by radio frequency ablation（RFA） and fetal reduction. Among the 46 pregnant women, 7 were in normal pregnancy and 39 had finished pregnancy, among which 29 were successful in delivery，with the average gestational week of pregnancy (3655 ± 021) weeks,and the survival rate 7436 %. 6 pregnant women suffered from delayed rupture of membranes after foetoscope, resulting in miscarriage and preterm labor. The residual vascular anastomosis after FLOC occurred in 1 case, intrauterine fetal death in 1 case, and postoperative infection terminated pregnancy in 1 case, 1 case was lost to followup after RFA (pregnancy outcome unknown). ConclusionFetal endoscopic surgery can change the natural course of complications of single chorionic twins and improve the prognosis of neonates, intensive implementation of highquality nursing measures such as aseptic technique, curved supine nursing, comprehensive thermal insulation nursing, intraoperative amniotic cavity irrigation, specialized equipment management during the operation can improve the safety and efficiency of the operation and reduce the incidence of surgical complications.

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更新日期/Last Update: 2020-04-25