复杂性胎盘植入的临床特点和围术期管理  

The clinical characteristics and perioperative management of complicated placenta increta

作　　者：钟柳英[1] 陈敦金[2] 苏春宏[2] 贺芳[2] 余琳[2] 钟梅[1] 

机构地区：[1]南方医科大学南方医院,广州市5105153 [2]广州医科大学附属第三医院广州重症孕产妇救治中心广东省产科重大疾病重点实验室,510150

出　　处：《实用医学杂志》2016年第17期2837-2840,共4页The Journal of Practical Medicine

基　　金：2011年广东省社会发展领域科技计划项目(编号:20110316)

摘　　要：目的:探讨复杂性胎盘植入的临床特点、围术期处理,有效降低母婴的不良围产期结局。方法:回顾分析2013年1月至2015年12月广州医科大学附属第三医院收治的复杂性胎盘植入25例的临床特点,并按围术期处理分组为术前行输尿管置管组9例及无置管组16例;常规子宫切除组17例与经后路子宫切除组8例,比较其手术时间、产后出血、输血量、膀胱损伤或输尿管损伤率、转入ICU率和住院时间。结果:出现孕期反复的无痛性阴道流血者占76%,分娩前出血者占56%。产前诊断17例(占68%)。术前行膀胱镜检查+双侧输尿管逆行置管或经后路子宫切除,手术时间较短、产后出血较少、减少输血量、无泌尿系损伤率、转入ICU率低,差异有统计学意义(P<0.05)。结论:复杂性胎盘植入要重视孕期的反复的无痛性阴道流血,提高产前诊断率。围术期处理是综合、有效、规范的多科参与,术前输尿管置管及经后路子宫切除术能有效降低母婴的不良围产期结局。Objective To study the clinical characteristicsand perioperative managementof complicated placenta increta, effectively reduce the maternal adverse perinatal outcomes. Methods Retrospective analysis 25 cases of complicated placenta increta between January 2013 and December 2015 in the Third Affiliated Hospital Of Guangzhou Medical University. Grouped into preoperative line 9 cases of ureteral catheter group and without catheter group 16 cases; Conventional hysterectomy group of 17 cases and the posterior hysterectomy group of 8 cases, compare the operation time, postpartum hemorrhage, blood transfusion amount, bladder injury or ureteral injury rate, rate of transferred to the ICU and hospital stay. Results 76% appear repeatedly painless vaginal bleeding during pregnancy, 56% appear bleeding before delivery. Prenatal diagnosis of 17 cases （68%）. The preoperative line cystoscopy ＋ bilateral retrograde ureteral catheter or after the posterior hysterectomy, shorter operation time, less postpartum hemorrhage, reduce blood transfusion volume, no urinary tract injury rate, transferred to the ICU rate is low, the difference was statistically significant （P 〈 0.05）. Conclusions We should attach importance to repeated painless vaginal bleeding, improve prenatal diagnostic rate of complicated placenta increta. The perioperative managementis more comprehensive, effective and standard participation, preoperative ureteral catheter and the posterior hysterectomy can effectively reduce the maternal adverse perinatal outcomes.

关 键 词：复杂性胎盘植入 输尿管置管 经后路子宫切除 

分 类 号：R714.7[医药卫生—妇产科学]