凶险型前置胎盘伴胎盘植入剖宫产术中止血方式评价  

Evaluation of different hemostatic methods during caesarean section with pernicious placenta previa and placenta accreta

作　　者：金日男[1] 钟永红[1] 

机构地区：[1]汕头大学附属粤北人民医院妇产科,广东韶关512026

出　　处：《中华临床医师杂志（电子版）》2014年第19期30-34,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：探讨以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法在凶险型前置胎盘伴胎盘植入剖宫产术中的止血效果及临床应用价值。方法收集广东省韶关市粤北人民医院自2012年1月至2014年6月收治的46例凶险型前置胎盘患者的临床资料，对胎盘植入发生率、诊断、处理方法及随诊情况进行回顾性分析。结果（1）46例凶险型前置胎盘中并发胎盘植入17例，发生率36.96%；穿透性胎盘植入9例，发生率19.57%。（2）术前彩色多普勒超声诊断胎盘植入7例，诊断率70.00%（7/10）；术前行MR检查诊断胎盘植入8例，诊断率为88.89%。（3）保留子宫38例（82.61%），切除子宫8例，子宫切除率17.39%。（4）术后42-61 d随访8例胎盘植入保留子宫患者，均恶露干净、子宫复旧良好。结论彩色多普勒检查和盆腔MR 检查可提高凶险型前置胎盘伴胎盘植入的诊断率；剖宫产术中采用以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法，可迅速有效地减少剖宫产术中出血量，缩短手术时间，降低子宫切除率。Objective To evaluate the hemostatic effect of transverse annular compression sutures combined surgical repair in the lower uterine segment and its value on clinical application to control postpartum Hemorrhage at cesarean delivery for pernicious placenta previa with placenta accreta. Methods We conducted a retrospective study at 46 pregnant women with pernicious placenta previa, who were treated at the Affiliated Yuebei People＇s Hospital of Shantou University Medical College from January 2008 to June 2012. This study reviewed the incidence rates, diagnosis and treatment. Results Among the 46 patients, 17 were diagnosed pernicious placenta praevia with placenta accreta; the incidence rate was 36.5%;while 9 patients were pernicious placenta praevia with placenta percreta, which incidence rate was 19.57%. Ten patients were diagnosed by color Doppler ultrasound before operation;the diagnosis rate was 70.00%（7/10）;Eight patients were diagnosed by magnetic-resonance before operation;the diagnosis rate was 88.89%（8/9）. Hysterectomy was used in 8 cases （17.39%）, and 38 cases （82.61%） were preserve utero. Eight postoperative patients of pernicious placenta praevia with placenta accreta were followed up to 42-61 days, not only their lochia all disappeared, but uterine instauration was good. Conclusion Color Doppler ultrasonography and magnetic-resonance can improve the diagnosis rate of pernicious placenta previa with placenta accreta. It is the effective way to reduce bleeding,operating time and hysterectomy rate of pernicious placenta previa with placenta accreta cases applying transverse annular compression sutures combined surgical repair in the lower uterine segment.

关 键 词：前置胎盘 剖宫产术 胎盘植入 

分 类 号：R719.8[医药卫生—妇产科学]