沙氏钳用于胎盘植入性疾病剖宫产的可行性和安全性临床研究  

Feasibility and safety of the application of Satinsky forceps in patients with placenta accreta spectrum

作　　者：杨燕[1] 王志群[1] 顾宁[1] 李强[1] 戴毅敏[1] Yang Yan;Wang Zhiqun;Gu Ning(Department of Obstetrics and Gynecology,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing,210008)

机构地区：[1]南京医科大学鼓楼临床医学院妇产科

出　　处：《现代妇产科进展》2020年第1期29-32,共4页Progress in Obstetrics and Gynecology

基　　金：江苏省产科临床医学中心(创新平台)建设单位(苏卫科教[2016]17号)

摘　　要：目的:评价沙氏钳用于胎盘植入性疾病剖宫产术中临时阻断子宫血流的可行性和安全性。方法:回顾分析2017年5月至2019年5月于南京医科大学鼓楼临床医学院妇产科住院分娩的疤痕子宫再次妊娠、完全性前置胎盘伴植入的孕妇58例,其中沙氏钳组35例,腹主动脉球囊预置组23例。比较两组围手术期及相关并发症情况。结果:两组产后24h出血总量、术中失血量、产后大出血率(≥1500ml)、异体红细胞输注率、输注量、大量输血率(异体红细胞输注量≥4U)、子宫切除率、术后住院天数、术后转重症监护病房率无显著差异(P>0.05)。动脉球囊预置组的手术操作时间为(110.3±42.5)min,动脉血流阻断时间为(31.8±23.6)min,显著高于沙氏钳组[(83.0±22.0)min,P=0.008;(6.3±0.8)min,P<0.001]。动脉球囊预置组母儿接受的平均放射剂量为(0.23±0.16)mGy,住院总费用明显大于沙氏钳组(P<0.001)。结论:沙氏钳钳夹子宫血管预防术中出血的外科方式,缩短了手术时间,降低了放射介入的潜在损伤及住院费用,为改进胎盘植入性疾病的手术治疗提供了良好的选择。Objective:To evaluate the feasibility and safety of Satinsky forceps for temporary occlusion of uterine blood flow during cesarean section in patients with placenta accreta spectrum.Methods:From May 2017 to May 2019,58 women with complete placenta previa and accreta overlying previous uterine scar were given birth in Nanjing Drum Tower Hospital.Satinsky forceps were used in 35 women,temporary balloon occlusion in abdominal aorta was carried out in 23 women.The perioperative outcomes and complications were compared.Results:There was no significant difference between the two groups in the amount of postpartum or intraoperative blood loss.The rate of postpartum hemorrhage(≥1500 ml),allogeneic red blood cell transfusion,allogeneic transfusion of RBC≥4 U,hysterectomy,and the rate of transferring to intensive care unit were similar(P>0.05).In the balloon group,the average operation duration was(110.3±42.5)min and the average blocking time was(31.8±23.6)min,which were higher than that in the Satinsky forceps group,which were(83.0±22.0)min(P=0.008)and(6.3±0.8)min(P<0.001)respectively.The average radiation dose of balloon group was(0.23±0.16)mGy.The hospitalization costs were higher in the balloon group than that in the Satinsky forceps group(P<0.001).Conclusions:The application of Satinsky forceps for temporary occlusion of uterine blood flow during cesarean section shortens the operation duration,reduces the potential radiation injury and hospitalization costs,which provides an alternative way for improving the surgical outcomes of placenta accreta spectrum.

关 键 词：前置胎盘 胎盘植入性疾病 动脉球囊预置 沙氏钳 

分 类 号：R714[医药卫生—妇产科学]