腹主动脉球囊阻断在不同植入程度凶险性前置胎盘剖宫产中的应用效果  

Effects of abdominal aortic balloon occlusion on caesarean section of pernicious placenta previa with different implantation degree

作　　者：倪筱静 丁艳婷 李继军[3] 王谢桐[1] 左常婷[1] 孟金来[1] Ni Xiaojing;Ding Yanting;Li Jijun et al(Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021;Beijing Obstetrics and Gynecology Hospital, Capital Medical University Beijing Maternal and Child Health Care Hospital,Beijing 100006;Department of Interventional Radiology,Shandong Medical Imaging Research Institute, Jinan 250021)

机构地区：[1]山东大学附属省立医院妇产科,济南250021 [2]首都医科大学附属北京妇产医院北京妇幼保健院,北京100006 [3]山东省医学影像学研究所介入放射学研究室,济南250021

出　　处：《现代妇产科进展》2018年第3期175-178,共4页Progress in Obstetrics and Gynecology

基　　金：第48批教育部回国留学人员科研启动基金[教外司留(2014)1685号]

摘　　要：目的:研究腹主动脉球囊阻断术在不同植入程度凶险性前置胎盘(PPP)剖宫产中的应用效果。方法:选取2014年3月至2016年3月在山东省立医院产科行手术治疗的PPP伴植入患者115例。其中伴穿透性植入者60例(深植入组),非穿透性植入者55例(浅植入组)。根据是否行腹主动脉球囊阻断术,将两组再各分为阻断组和非阻断组。回顾分析患者的术中出血量、输血量、手术时间、子宫切除、膀胱损伤及新生儿窒息情况,以及腹主动脉球囊阻断的术中和术后并发症。结果:深植入阻断组的术中出血量中位数为1000ml,较非阻断组(2000ml)明显减少(P<0.05);浅植入患者阻断组与非阻断组的术中出血量比较,差异无统计学意义(400ml vs 350ml,P>0.05)。深植入阻断组的子宫切除率[7%(3/41)]低于非阻断组[37%(7/19)],差异有统计学意义(P<0.05);浅植入组均无切除子宫者。深浅植入患者中,阻断组和非阻断组的膀胱损伤率、手术时间、新生儿窒息情况比较,差异均无统计学意义。64例腹主动脉球囊阻断术中发生导管打折1例,股动脉血栓20例,下肢深静脉血栓2例,术后穿刺点渗血2例,股动脉-股静脉瘘1例。结论:腹主动脉球囊阻断术可明显减少PPP伴穿透性植入患者的术中出血、降低子宫切除率,但对非穿透性植入的应用效果不佳。腹主动脉球囊阻断术后可发生较严重的并发症,应严格掌握其适应证。Objective：To compare the intraoperative effects of abdominal aorta balloon occlusion between patients with different degrees implantation of pernicious placenta previa（PPP）.Methods：From Mar. 2014 to Mar. 2016,115 cases with PPP undergoing surgery in Obstetrics Department of Shandong Province Hospital Affiliated to Shandong University were studied retrospectively.Those patients were divided into 2 groups：placenta percreta group and non-percreta group.Then,each group was divided into another two groups（ occlusion group and non-occlusion group） respectively according to whether aortic balloon occlusion was performed.Finally,intraoperative blood loss,blood transfusion,surgical time,hysterectomy,bladder injury,and neonatal asphyxia of different group were compared.Meanwhile,the operative and postoperative complications of abdominal aortic balloon occlusion were also listed.Results：For placenta percreta group,the intraoperative blood loss of occlusion group[1000 ml（ median）]was significantly reduced compared with non-occlusion group[2000 ml（ median）]（ P〉0.05）.For placenta increta group,there was no significant difference between occlusion and non-occlusion groups（400 ml vs 350 ml,P〈0.05）. For placenta percreta group,the hysterectomy rate of occlusion group[7%（3/41）] was lower than the non-occlusion group[37%（ 7/19）]（ P〈0. 05）. There was no hysterectomy among placenta non-percreta group. The bladder injury,surgical time and neonatal asphyxia of different group had no statistical difference.Among 64 cases with ballon occlusion,there was 1 case with catheter broken,20 cases with femoral artery thrombosis,2 cases with deep venous thrombosis,2 cases with postoperative bleeding of puncture point and 1 case with femoral artery-femoral venous fistula. Conclusion： Abdominal aorta balloon occlusion can significantly reduce intraoperative blood loss of plaenta previa percreta group and the rate of hysterectomy.However,the effect on placenta previa but non-percreta is not good. M

关 键 词：凶险性前置胎盘 胎盘植入 腹主动脉球囊阻断 

分 类 号：R714.4[医药卫生—妇产科学]