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凶险性前置胎盘(pernicious placenta previa,PPP)指既往有过剖宫产史,此次妊娠胎盘附着于原手术瘢痕部位,常伴有胎盘植入,分娩时容易引起难以控制的大出血[1]。近年来随着我国剖宫产率的居高不下以及人口生育政策的放开,同时伴随B超声及MRI诊断技术的提高,PPP发生率呈逐年上升趋势[2]。PPP伴胎盘植入病人手术过程中平均失血量3 000~5 000 mL,大于10 000 mL并非少见,是产科最具挑战性的疾病之一。MACHADO等[3]报道,PPP伴胎盘植入已取代子宫收缩乏力成为产科子宫切除的首要原因。如何减少PPP剖宫产术中失血,降低子宫切除率,改善母儿结局,一直是产科研究的难点和热点。本研究对PPP伴胎盘植入剖宫产术中应用髂内动脉球囊阻断术,进一步探讨该方法的临床效果和应用价值。现作报道。
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2组的年龄、分娩孕周、孕产次、既往剖宫产次数、孕妇体质量指数(BMI)、距离末次剖宫产时间等差异均无统计学意义(P>0.05)(见表 1)。胎儿射线暴露:球囊组胎儿射线暴露剂量为(23.4±2.8)mGy。
分组 n 年龄/岁 孕周 孕次 产次 BMI/(kg/m2) 剖宫产
次数距末次剖宫产
时间/年球囊组 50 32.0±5.1 34.6±1.6 3.6±1.3 1.2±0.4 26.0±1.3 1.2±0.5 6.9±3.7 对照组 36 31.9±5.1 34.5±2.7 3.3±1.4 1.3±0.6 26.9±1.6 1.1±0.4 5.2±3.5 t — 0.07 0.22 1.02 0.28 1.83 1.02 1.98 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 表 1 2组一般资料比较(x±s)
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球囊组术中出血量及术中输血量均少于对照组(P < 0.05),2组手术时间、术后住院时间、子宫切除率及膀胱损伤发生率差异均无统计学意义(P>0.05)(见表 2)。球囊组有1例术后发生右下肢动脉血栓,2组均无输尿管及肠管损伤。
分组 n 术中出血量/mL 输红细胞量/U 手术时间/min 术后住院时间/d 子宫切除 膀胱损伤 血栓形成 球囊组 50 1 585.3±769.9 4.5±3.8 139.7±50.3 7.9±3.1 20(40.00) 6(12.00) 1(2.00) 对照组 36 2 044.1±1 362.9 6.8±4.9 143.8±45.4 7.5±2.9 16(44.44) 4(11.11) 0(0.00) t — 2.15 2.44 0.39 0.58 0.17* 0.02* 0.73* P — < 0.05 < 0.05 >0.05 >0.05 >0.05 >0.05 >0.05 *示χ2值 表 2 2组手术情况比较[n; 百分率(%); x±s]
髂内动脉球囊阻断术在植入型凶险性前置胎盘剖宫产术中的应用疗效分析
Analysis of the application value of internal iliac artery balloon occlusion in cesarean section patients with pernicious placenta previa
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摘要:
目的探讨髂内动脉球囊阻断术在植入型凶险性前置胎盘剖宫产术中的应用价值。 方法选择凶险性前置胎盘伴胎盘植入产妇86例临床资料,其中50例选择髂内动脉球囊阻断术(球囊组),36例仅行剖宫产术(对照组)。比较2组术中出血量、术中输血量、手术时间、术后住院时间、子宫切除率及相关并发症。 结果球囊组术中出血量(1 585.3±769.9)mL及术中输红细胞量(4.5±3.8)U,均小于对照组术中出血量(2 044.1±1 362.9)mL及术中输红细胞量(6.8±4.9)U(P < 0.05);球囊组子宫切除率40.00%,膀胱损伤率12.00%,与对照组子宫切除率44.44%、膀胱损伤率11.11%,差异均无统计学意义(P>0.05);球囊组有1例发生术后右下肢动脉血栓,对照组未发生。 结论植入型凶险性前置胎盘剖宫产术中采用髂内动脉球囊阻断术,可减少出血量及输血量,并不能有效降低子宫切除率,且有血栓形成风险。 Abstract:ObjectiveTo explore the application value of the internal iliac artery balloon occlusion in cesarean section patients with pernicious placenta previa (PPP). MethodsThe clinical data of 86 puerperas were retrospectively analyzed.Fifty cases treated with internal iliac artery balloon occlusion and 36 cases treated with cesarean section were divided into the balloon group and control group, respectively.The operative time, intraoperative blood loss, intraoperative blood transfusion, hysterectomy rate, postoperative hospital stay and related complications were compared between two groups. ResultsThe intraoperative blood loss and intraoperative red blood cell transfusion in balloon group[ (1 585.3±769.9)mL, (4.5±3.8)U] were less than those in control group[ (2 044.1±1 362.9)mL, (6.8±4.9)U], respectively (P < 0.05).The hysterectomy rate and bladder injury rate in balloon group and control group were (40.00%, 12.00%) and (44.44%, 11.11%), respectively, and the difference of which was not statistically significant (P>0.05).One case of right lower extremity artery thrombosis occurred in balloon group. ConclusionsThe internal iliac artery balloon occlusion in cesarean section patients with PPP can reduce the amount of intraoperative blood loss and blood transfusion, but not effectively reduce the rate of uterine resection, and has a risk of occuring thrombus. -
Key words:
- placenta previa /
- placental implantation /
- cesarean section /
- balloon occlusion /
- internal iliac artery
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表 1 2组一般资料比较(x±s)
分组 n 年龄/岁 孕周 孕次 产次 BMI/(kg/m2) 剖宫产
次数距末次剖宫产
时间/年球囊组 50 32.0±5.1 34.6±1.6 3.6±1.3 1.2±0.4 26.0±1.3 1.2±0.5 6.9±3.7 对照组 36 31.9±5.1 34.5±2.7 3.3±1.4 1.3±0.6 26.9±1.6 1.1±0.4 5.2±3.5 t — 0.07 0.22 1.02 0.28 1.83 1.02 1.98 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 表 2 2组手术情况比较[n; 百分率(%); x±s]
分组 n 术中出血量/mL 输红细胞量/U 手术时间/min 术后住院时间/d 子宫切除 膀胱损伤 血栓形成 球囊组 50 1 585.3±769.9 4.5±3.8 139.7±50.3 7.9±3.1 20(40.00) 6(12.00) 1(2.00) 对照组 36 2 044.1±1 362.9 6.8±4.9 143.8±45.4 7.5±2.9 16(44.44) 4(11.11) 0(0.00) t — 2.15 2.44 0.39 0.58 0.17* 0.02* 0.73* P — < 0.05 < 0.05 >0.05 >0.05 >0.05 >0.05 >0.05 *示χ2值 -
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