Fogarty取栓球囊与普通扩张球囊用于凶险性前置胎盘剖宫产术中阻断髂内动脉  

Fogarty balloon and conventional balloon for occlusion of internal iliac artery during caesarean section for pernicious placenta previa

作　　者：郭燕兵 苏秀琴 于世平[2] 乔建军[2] 冯敬东[2] 卫丹[2] 李强[2] 杜晶磊[2] GUO Yanbing;SU Xiuqin;YU Shiping;QIAO Jianjun;FENG Jingdong;WEI Dan;LI Qiang;DU Jinglei(Department of Medical Imaging,Shanxi Medical University,Taiyuan 030001,China;Department of Interventional Therapy,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学医学影像学系,山西太原030001 [2]山西医科大学第二医院介入治疗科,山西太原030001

出　　处：《中国介入影像与治疗学》2019年第7期415-419,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：山西省卫生计生委科研课题(2015044)

摘　　要：目的对比Fogarty取栓球囊与普通扩张球囊用于凶险性前置胎盘(PPP)剖宫产术中阻断髂内动脉的价值。方法回顾性分析57例PPP产妇,依据剖宫产术中阻断髂内动脉所用球囊将其分为2组,A组(n=27)采用Fogarty取栓球囊,B组(n=30)采用经皮腔内血管成形术(PTA)所用普通扩张球囊(PTA球囊)。剖宫产前将球囊预置在双侧髂内动脉内,胎儿娩出后充盈球囊。胎盘完全剥离后,根据术中出血量决定是否立即排空球囊。根据病情,必要时加行DSA引导下子宫动脉栓塞术、子宫切除术或转入重症监护室(ICU)治疗。评价临床结局,分为良好(剖宫产后顺利出院)和不佳(合并术后并发症、接受子宫动脉栓塞术或子宫切除术、转入ICU)。通过统计学分析比较2组在剖宫产手术时间、术中出血量、是否输血、输血量、是否行子宫动脉栓塞、住院时间及临床结局方面的差异。结果A组剖宫产手术时间明显短于B组[(72.37±17.39)minvs(86.93±27.79)min,t=-2.40,P=0.02],输血患者占比低于B组[44.44%(12/27)vs73.33%(22/30),χ^2=4.93,P=0.03]且术中出血量[500(300)mlvs700(150)ml,U=190,P<0.01]及输血量[0(400)mlvs400(800)ml,U=249,P=0.01]均少于B组。2组间在是否接受子宫动脉栓塞(χ^2=1.52,P=0.22)、住院时间(t=-0.12,P=0.91)及产妇临床结局(χ^2=1.38,P=0.24)方面差异均无统计学意义。结论与PTA球囊相比,Fogarty取栓球囊用于PPP剖宫产术中阻断髂内动脉的效果更优,有利于减少术中出血及缩短手术时间。Objective To compare the application value of Fogarty balloon and conventional balloon for occlusion of internal iliac artery during caesarean section for pernicious placenta previa (PPP).Methods Data of 57 pregnant women with PPP were retrospectively analyzed.The patients were divided into group A ( n =27,using Fogarty balloon) and group B ( n =30,using percutaneous transluminal angioplastry [PTA] conventional balloon)for internal iliac artery occlusion.The balloons were placed into bilateral internal iliac arteries before cesarean section.After the delivery of fetus,the balloons were dilated.Whether the balloons were deflated immediately depended on the amount of intraoperative bleeding after complete separation of placenta.The patients were treated with DSA-guided uterine artery embolization,hysterectomy or transferred into intensive care unit (ICU) after cesarean section if necessary.The clinical outcomes were analyzed and classified into good (discharge smoothly after cesarean section) and poor (occurring postoperative complications,needing uterine artery embolization,hysterectomy or getting ICU admission).The differences of duration time of cesarean section,intraoperative bleeding volume,blood transfusion,uterine artery embolization,duration of hospitalization and clinical outcomes were statistically compared between the two groups.Results The duration time of cesarean section of group A was significantly shorter than that of group B ([72.37±17.39]min vs [86.93±27.79]min,t =-2.40,P =0.02).The proportion of transfusion of group A was lower than that of group B (44.44%[12/27]) vs 73.33%[22/30],χ^2 =4.93,P =0.03).The intraoperative bleeding volume (500[300]ml vs 700[150]ml,U =190,P <0.01) and the blood transfusion volume (0 [400]ml vs 400 [800]ml,U =249,P =0.01) of group A were significantly lower than those of group B.There was no significant difference of uterine arterial embolization (χ^2 =1.52,P =0.22),duration of hospitalization ( t =-0.12,P =0.91)nor clinical outcomes (χ^2 =1.38,P =0.24) between the

关 键 词：髂内动脉 气囊阻塞 胎盘 前置 剖宫产术 

分 类 号：R714.2[医药卫生—妇产科学] R815[医药卫生—临床医学]