髂内动脉球囊阻断术在凶险型前置胎盘中的应用价值  

The Application of Internal Iliac Artery Balloon Occlusion in Pernicious Placenta Previa

作　　者：綦小蓉[1] 刘兴会[1] 游泳[1] 王晓东[1] 周容[1] 邢爱耘[1] 张力[1] 宁刚[1] 赵福敏[1] 李开明[1] 

机构地区：[1]四川大学华西第二医院妇产科出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《四川大学学报（医学版）》2016年第4期618-623,共6页Journal of Sichuan University(Medical Sciences)

基　　金：四川省卫生和计划生育委员会科研课题(No.140046)资助

摘　　要：目的评价髂内动脉球囊阻断术在凶险型前置胎盘中的应用价值。方法回顾性研究2010年1月至2015年1月四川大学华西第二医院产科收治的凶险型前置胎盘病例资料。比较实施(球囊组,52例)与未实施髂内动脉球囊阻断术的患者(对照组,69例)在剖宫产中失血量、输血量、手术时间、剖宫产子宫切除率、术后住院天数、术后并发症等的差异。结果球囊组和对照组相比,术中失血量、输血量更少,子宫切除率更低,住院天数更短(P<0.05)。手术时间、进入ICU的比例、低血压、感染、低氧血症、膀胱损伤、肠梗阻、新生儿窒息的发生率差异没有统计学意义。但在球囊组中,凝血功能障碍、低蛋白血症、电解质紊乱发生率更高。球囊组的剖宫产子宫切除中失血量较对照组增加(P<0.05)。而在保留子宫的剖宫产患者中,球囊组的术中失血量与对照组相比,差异没有统计学意义。对合并胎盘植入的患者,球囊组的子宫切除率与对照组相比明显下降,两组的失血量比较,差异没有统计学意义。而在没有合并胎盘植入的患者中,球囊组术中失血量低于对照组(P<0.05),但剖宫产子宫切除率差异没有统计学意义。球囊组切除子宫与合并胎盘植入、子宫下段血管明显怒张、胎盘穿透子宫肌层达浆膜层、手取胎盘、胎盘浸润膀胱、子宫下段增粗呈桶状以及胎盘无法剥离有关。结论髂内动脉球囊阻断术可能是治疗凶险型前置胎盘的一种有效手段。Objective To evaluate the clinical application value of internal iliac artery balloon occlusion in pernicious placenta previa.Methods We retrospectively reviewed the medical records of the patients of pernicious placenta previa in a single center from Jan,2010 to Jan,2015.The patients were divided into two groups,internal iliac artery balloon occlusion group and the control group without endovascular intervention.Blood loss in operation,volume of transfused blood products,caesarean hysterectomy,operating time,hospital days after operation and postoperative morbidity were compared between the two groups.Results The balloon occlusion group had significantly less blood loss,the volume of transfused blood products,caesarean hysterectomy,hospital day after operation than the control group had.There was no statistical difference in operating time,intensive care units（ICU）,hypotension,infection,hypoxemia,bladder injury,bowel obstruction,neonatal asphyxia between the two groups.The balloon occlusion group had significantly higher rate in coagulopathy,hypoalbuminemia,electrolyte imbalance.Among the patients whose uterus were preserved,the blood loss was not significantly difference between the two groups.Among the patients with the complication of placenta accreta,caesarean hysterectomy was less in balloon group,and blood loss between the two groups was not significantly different.Among the patients without placenta accrete,the blood loss was less in balloon group,and caesarean hysterectomy between the two groups was not significantly different.The risk of hysterectomy in balloon group was related to placenta accreta,uterine arteries engorgement,placental invasive serosa,taking placenta by hand,placental invasive bladder,barrel-shaped thickening of lower uterine segment,unable to remove placenta.Conclusion Internal iliac artery balloon occlusion is an effective treatment for pernicious placenta previa.

关 键 词：产后出血 凶险型前置胎盘 球囊阻断术 髂内动脉 

分 类 号：R719.8[医药卫生—妇产科学]