腹主动脉球囊阻断下子宫修复成形术在凶险性前置胎盘合并穿透性胎盘植入的治疗作用  

Efficacy of uteroplasty aided with temporary balloon occlusion of abdominal aorta in management of pernicious placenta previa combined with placenta percreta

作　　者：赵先兰[1] 杜莹莹[1] 赵磊[1] 刘传[1] 刘彩[1] 周艳[1] 杨慧霞[2] 

机构地区：[1]郑州大学第一附属医院产科,450052 [2]北京大学第一医院妇产科,100034

出　　处：《中华围产医学杂志》2017年第9期644-648,共5页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨腹主动脉球囊阻断下子宫修复成形术用于凶险性前置胎盘合并穿透性胎盘植入的治疗作用。方法回顾性分析2013年1月1日至2016年5月31日在郑州大学第一附属医院产科住院分娩的，剖宫产术中在腹主动脉球囊阻断基础上行子宫修复成形术，术前超声及MRI均提示前置胎盘合并胎盘大面积穿透性植入的62例患者的术前术后情况。记录患者的术中出血量、术后24h出血量、手术时间、并发症及术后恢复等情况。对数据采用描述性统计分析。结果62例中，10例（16．1％）胎盘穿透植入达子宫浆膜层，46例（74．2％）胎盘穿透子宫并植入膀胱后壁肌层，6例（9．7％）胎盘植入膀胱后壁肌层并穿透膀胱黏膜层。62例平均术中出血量为（1377．3±605．2）m1，平均术后24h出血量为（140．6±66．3）ml，平均手术时间为（72．3±24．5）min，平均术后住院天数为（5．8±1．6）d。6例穿透膀胱后壁者行膀胱修补术；61例成功保留子宫，1例因术中发生羊水栓塞行子宫次全切除术；1例术后并发下肢静脉血栓。62例均未发生肠管、输尿管损伤、产褥感染、子宫缺血坏死甚至死亡。随访至2017年5月31日，3例（4.8％）失访，其余59例产后42d体格检查提示子宫复旧好；其中58例月经复潮，绎量、经期同孕前无明显变化，1例未复潮仍在哺乳期。结论腹主动脉球囊阻断下子宫修复成形术治疗凶险性前置胎盘合并穿透性胎盘植入是安全的，可有效保留子宫。Objective To investigate the therapeutic effect of uteroplasty aided with temporary balloon occlusion of abdominal aorta in treating pernicious placenta previa combined with placenta percreta. Methods Sixty-two third-trimester gravidas who were diagnosed as pernicious placenta previa combined with placenta percreta by prenatal ultrasound and magnetic resonance imaging （MRI） in the First Affiliated Hospital of Zhengzhou University from January 1, 2013 to May 31,2016 were enrolled in this study. All of them received cesarean section and then underwent uteroplasty following temporary balloon occlusion of abdominal aorta. Efficacy of that treatment was evaluated from the perspectives of blood loss, operation time, complications and postoperative recovery. All data were analyzed by descriptive analysis. Results All of the 62 cases were diagnosed with placenta percreta during operation including 10 cases （16.1%） with perimetrium invasion, 46 cases （74.2%） with invasion to the muscular layer of bladder and six cases （9.7%） with bladder invasion. The average blood loss of all cases during and within 24 hours after operation was （1 377.3±605.2） ml and （140.6±66.3） ml, respectively. The average operation time was （72.3±24.5） rain and the average length ofpostoperative hospital stay was （5.8±1.6） d. The six cases of placenta percreta with bladder invasion received bladder repair. Sixty-one cases had their uterus preserved and the other one case had a sub-total hysterectomy due to amniotic fluid embolism. One woman developed phlebothrombosis in her lower limbs after operation. No intestinal or ureteral injury, puerperal infection, uterine ischemia necrosis or death was reported. In addition to three cases lost to follow-up, the other 59 patients were followed up to May 31, 2017. Results of physical examination indicated that the 59 cases had normal uterine involution after operation. Menses returned in 58 of the 59 cases without any difference from before, and did not return in one case du

关 键 词：前置胎盘 侵人性胎盘 主动脉 腹 气囊阻塞 修复外科手术 

分 类 号：R713[医药卫生—妇产科学]