开放与腔内腹主动脉暂时阻断在凶险性前置胎盘合并胎盘植入剖宫产手术中的应用比较  

Comparison of using open and endovascular temporary aortic occlusion in cesarean section for pregnancies with dangerous placenta previa and concomitant placenta accreta

作　　者：唐雅兵 刘睿[2] 王伟[2] 潘华[1] 杨景[1] 黄建华[2] TANG Yabing;LIU Rui;WANG Wei;PAN Hua;YANG Jing;HUANG Jianhua(The Third Department of Obstetrics,Maternal and Child Health Hospital of Hunan Province,Changsha 410008,China;Department of Vascular Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]湖南省妇幼保健院产三科,湖南长沙410008 [2]中南大学湘雅医院血管外科,湖南长沙410008

出　　处：《中国普通外科杂志》2019年第12期1519-1525,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目（81873525）

摘　　要：目的:比较腹主动脉暂时阻断(TAL)与腹主动脉球囊阻断(LABO)在凶险性前置胎盘合并胎盘植入剖宫产手术中的预防出血的优劣。方法:回顾2016年1月-2018年7月在湖南省妇幼保健院住院分娩的84例凶险性前置胎盘合并胎盘植入患者资料,其中48例采用开放TAL止血,36例采用LABO止血。比较两组患者术前情况、手术相关指标、手术后及新生儿情况等各项参数。结果:两组患者的年龄、孕产次、分娩间隔时间、分娩孕周、术前胎盘超声评分差异均无统计学意义(均P>0.05);两组患者剖宫产手术时间、术中出血量、输浓缩红细胞量、子宫切除率差异均无统计学意义(均P>0.05);两组患者在新生儿Apgar评分、新生儿体质量、术后住院时间差异均无统计学意义(均P>0.05),TAL组剖宫产术后血管并发症发生率明显低于LABO组、住院费用明显少于LABO组(19.4%vs. 0;40278元vs. 29100元,均P<0.05)。结论:在凶险性前置胎盘合并胎盘植入剖宫产手术中,TAL与LABO止血效果及子宫切除率相似,但前者更安全、经济,并发症少,值得推广。Objective: To compare the effectiveness of temporary aortic ligation(TAL) and lower abdominal aortic balloon occlusion(LABO) in preventing hemorrhage during cesarean section in women with dangerous placenta previa complicated by placenta accreta. Methods: The clinical data of 84 patients with dangerous placenta previa and concomitant placenta accreta giving birth in the Maternal and Child Health Hospital of Hunan Province from January 2016 to July 2018 were reviewed. Of the patients, 48 cases underwent open TAL and 36 cases underwent temporary LABO to prevent hemorrhage. The variables that included the preoperative general conditions, intraoperative parameters, postoperative results and newborns’ conditions between the two groups were compared.Results: There were no significant differences in age, times of pregnancy and childbirth, delivery interval, gestational weeks, and placental score between the two groups of patients(all P>0.05). There were no significant differences in time of cesarean section, intraoperative blood loss, amount of packed red blood cell transfusion, and hysterectomy rate between the two groups of patients(all P>0.05). There were no significant differences in Apgar score and weight of the newborn as well as the length of hospital stay between the two groups of patients(all P>0.05). The incidence of vascular complications after cesarean section was significantly higher and the hospitalization cost was significantly lower in TAL group than those in LABO group(19.4% vs. 0;40 278 yuan vs. 29 100 yuan, both P<0.05).Conclusion: In cesarean section for pregnancies with dangerous placenta previa complicated by placenta accreta, the hemostatic effects and hysterectomy rates of TAL and LABO are similar, but the former is more safe and costeffective with lesser incidence of complications, so it is recommended to be used.

关 键 词：主动脉 腹 阻断治疗 止血 手术 剖宫产术 前置胎盘 

分 类 号：R654.3[医药卫生—外科学]