髂内动脉球囊置入联合倒刺线在凶险性前置胎盘术中的应用  

Application of internal iliac artery balloon placement combined with barbed wire in dangerous placenta previa

作　　者：左馨[1] 孙澜栩[1] 罗静[1] 陈智聪[1] 

机构地区：[1]昆明市第一人民医院产科,云南昆明650011

出　　处：《中国现代医生》2016年第29期50-52,55,共4页China Modern Doctor

摘　　要：目的分析髂内动脉临时球囊置入联合双向倒刺线在凶险性前置胎盘术中的治疗效果。方法 对31例凶险性前置胎盘患者术前在介入室行双侧髂内动脉临时球囊置入术,然后进行剖宫产,在胎儿娩出脐带结扎后将球囊充盈,栓塞成功后,尽量剥除胎盘,对部分胎盘剥离面活动性出血采用常规止血方法,促宫缩、按摩子宫无效,用双向倒刺线缝合出血处止血。术后取出球囊,记录患者的出血量、发热天数、术后并发症及出院时血红蛋白量、新生儿Apgar评分。结果 失血量〈500 m L 10例,500~1000 m L 8例,〉1000 m L 13例,其中保留子宫30例,1例因发生胎盘植入、DIC行子宫次全切除术。患者中出院时血红蛋白在100 g/L及以上者18例,血红蛋白在90~99 g/L之间5例,80~89 g/L之间6例,75~79 g/L 2例,1例发生下肢静脉血栓。新生儿Apgar评分1 min、5 min、10 min评分均〉8分。结论 剖宫产术前双侧髂内动脉临时球囊置入术联合双向倒刺线在凶险型前置胎盘剖宫产术中使用安全可靠,操作时间短,术中止血效果明确,手术操作简便,有效地保留了患者子宫,术后阴道流血少,预后良好,无新生儿窒息情况发生。Objective To analyze the therapeutic effect of temporary intra-iliac arterial balloon placement combined with bidirectional barbed wire in dangerous placenta previa. Methods A total of 31 patients with dangerous placenta previa were given temporary bilateral iliac artery balloon placement in the interventional room before the surgery, and then they were given Cesarean section. After the fetus was delivered, and the umbilical cord was ligated, the balloon was filled. When embolization was successful, the placenta was tried to be stripped. The active bleeding in partial pla- cental dissection was given conventional hemostasis method, and uterine contraction and uterus massage were made in- valid. The bleeding wound was sutured by the tw0-way barbed wire for hemostasis. After the operation, the amount of hemorrhage, days of fever, postoperative complications, hemoglobin amount at discharge, and neonatal Apgar scores were recorded and analyzed retrospectively. Results The blood loss of less than 500 ml were in 10 patients, the blood loss of 500-1000 ml was in 8 patients, and the＇ blood loss of more than 1000 ml was in 13 patients, among whom 30 patients retained the uterus, and 1 patient was given subtotal hysterectomy due to placenta accreta and DIC. Upon dis- charge, the hemoglobin at 100 g/L or more of 18 patients, the hemoglobin at 90-99 g/L of 5 patients, 80-89 g/L of 6 patients, and 75-79 g/L of 2 patients. Venous thrombosis of the lower limbs was seen in 1 patient. Neonatal Apgar scores at 1 minute, 5 minutes, and 10 minutes were all higher than 8. Conclusion The use of temporary bilateral intra- iliac arterial balloon placement combined with bidirectional barbed wire in Cesarean section is safe and reliable. The time of operation is short, the operative effect of hemostasis is clear, and the surgical operation is convenient. Patient＇s uterus is retained effectively, with less postoperative vaginal bleeding, favorable prognosis and no neonatal asphyxia.

关 键 词：凶险性前置胎盘 髂内动脉 球囊 可吸收双向倒刺线 

分 类 号：R719.8[医药卫生—妇产科学]