子宫颈提拉加固缝合术在重型-凶险性胎盘植入手术止血中的应用  

Application of cervical lifting suture in hemostasis of placenta previa with increta and percreta

作　　者：陈运山[1] 赵扬玉[1] 张龔 王妍[1] 种轶文[1] 张爱青[1] Chen Yunshan;Zhao Yangyu;Zhang Yan;Wang Yan;Zhong Yiwen;Zhang Aiqing(Department of Obstetrics and Gynecology,Peking University Third Hospital,Belting 100191,China)

机构地区：[1]北京大学第三医院妇产科,100191

出　　处：《中华妇产科杂志》2018年第7期459-463,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：国家重点研发计划（2016YFC100040）;首都卫生发展科研专项（首发2016-1-4091）

摘　　要：目的 评价子宫颈提拉加固缝合术在重型-凶险性胎盘植入手术中应用的止血效果。 方法 收集2016年1月至2017年6月于北京大学第三医院分娩、根据术前超声检查评分诊断并在术中确诊为重型-凶险性胎盘植入的孕妇共 65 例（0.78%，65/8 322），最终纳入本研究 62 例（0.75%，62/8 322）。根据术前超声检查评分分为5～9分组（42例，67.7%）及≥10分组（20例，32.3%），均行胎盘植入子宫颈提拉加固缝合术进行术中止血，收集两组孕妇的年龄、孕次、产次等一般资料及术中出血、输注悬浮红细胞量、子宫切除率、围产期结局等，进行比较分析。 结果 （1）一般情况：5～9分组与10分组孕妇的年龄、孕次、产次、既往剖宫产史的比例及终止妊娠的孕周，分别比较，差异均无统计学意义（P均〉0.05）。（2）术中情况：5～9分组与≥10分组孕妇的术中出血量［分别为1 600（范围：700~10 000）、4 000（1 200~13 000）ml］、输注悬浮红细胞量［分别为1 200（0~8 000）、2 000（800~8 800）ml］、手术时间［分别为135（69~335）、240（108~1 200）min］，分别比较，差异均有统计学意义（P均〈0.05）。保留子宫失败的8例（12.9%，8/62）孕妇中，5～9分组3例，≥10分组5例，其术中出血量均〉4 000 ml；余54例（87.1%）孕妇均成功保留子宫，其中5～9分组39例，≥10分组15例。（3）术后情况：5～9分组和≥10分组孕妇的术后入住ICU率（分别为26%，11/42；80%，16/20）及住院时间［分别为（4.9±1.9）、（6.3±1.7）d］，分别比较，差异均有统计学意义（P均〈0.05）。两组孕妇均无明显产后严重并发症发生者，其新生儿Agpar评分及出生体质量分别比较，差异也均无统计学意义（P均〉0.05）。 结论 子宫颈提拉加固缝合术应用于重型-凶险性胎盘植入手术中，能极大程度上减少孕妇出血并保留其子宫。Objective To evaluate the effect of cervical lifting suture in treatment of placenta previa with increta and percreta. Methods From January 2016 to June 2017, 65 cases（0.78%, 65/8 322） were diagnosed placenta previa with increta and percreta by prenatal ultrasonic score system and confirmed by intraoperative findings in the department of obstetrics and gynecology of Peking University Third Hospital. Totally 62 cases （0.75%, 62/8 322） were included, because 3 cases underwent hysterectomy with placenta in situ. According to ultrasonic score system, 62 cases were divided into two groups, score 5-9 group （n=42, 67.7%） and score≥10 group （n=20, 32.3%）, cervical lifting suture techniques were all performed in cesarean sections. Demographic and clinical data were collected and compared. Results （ 1 ）There were no significant differences between two groups in age, gravidity, parity, cesarean section history ratio and gestational week of termination （all P〉0.05）. （2）In score≥10 group, the median intraoperative bleeding volume was 4 000 ml（1 200-13 000 ml） , while in score 5-9 group, it was 1 600 ml（700-10 000 ml） , intraoperative blood transfusion volume was 2 000 m1（800-8 800 ml） in score≥10 group, while 1 200 ml（0- 8 000 ml） in score 5-9 group. The median operation time was 240 minutes（108-1 200 minutes） in score≥ 10 group, significantly higher than that in score 5-9 group, which was 135 minutes （69-335 minutes;all P〈0.05）. In 8 cases for hysterectomy （12.9%,8/62）, 3 cases in score 5-9 group, 5 cases in score≥10 group. （3） In score≥10 group, the rate of postoperative ICU registration was 80% and mean hospitalization time was （6.3±1.7） days, were significantly different, compared with those in score 5-9 group, which were 26%, （4.9± 1.9） days. No serious postpartum complications were found in both groups, and there were no significant differences in Apgar score and weight of newborns （all P〉0.05）. Conclusion Cervical lifting suture

关 键 词：侵入性胎盘 止血 手术 子宫颈 缝合技术 保留生育能力 

分 类 号：R713.8[医药卫生—妇产科学]