子宫下段环形切除加端端吻合术在前置胎盘并胎盘植入治疗中的应用研究  

Application of Circular Resection of Lower Uterine Segment and End-to-end Anastomosis in the Treatment of Placenta Previa and Placental Implantation

作　　者：刘静[1] 李玉芳 赵青 李彦丽[3] 田娟 LIU Jing;LI Yu-fang;ZHAO Qing;LI Yan-li;TIAN Juan(Department of Obstetrics and Gynecology,the Fourth Hospital of Shijiazhuang,Shijiazhuang 050000,China;Department of Obstetrics and Gynecology,Dingzhou Maternal and Child Health Hospital,Dingzhou,Hebei 073000,China;Department of Obstetrics and Gynecology of Traditional Chinese Medicine,Hebei Hospital of Traditional Chinese Medicine,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第四医院妇产科,石家庄050000 [2]定州市妇幼保健院妇产科,河北定州073000 [3]河北省中医院中医妇产科,石家庄050000

出　　处：《解放军医药杂志》2020年第7期80-83,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省中医药管理局科研计划项目(2019465)。

摘　　要：目的探讨子宫下段环形切除加端端吻合术在前置胎盘并胎盘植入治疗中的应用效果。方法选择2016年3月-2018年3月收治的临床确诊为凶险性前置胎盘并胎盘植入患者100例,按手术方法分为A组和B组,每组50例。A组应用子宫下段环形切除加端端吻合术治疗,B组应用髂内动脉结扎术治疗。观察2组围术期情况、血流动力学变化、随诊及新生儿情况。结果A组术中出血量、术后出血量、总输血量少于B组,手术时间短于B组(P<0.05)。A组不同时间点平均动脉压波动范围超过术前基准值±15%、±20%、±30%频率小于B组(P<0.05)。A组子宫切除率、术后感染率低于B组,恶露持续时间、月经恢复时间均短于B组,且经超声测量宫颈长度长于B组(P<0.05)。2组新生儿出生体重、Apgar评分、新生儿窒息情况比较差异无统计学意义(P>0.05)。结论子宫下段环形切除加端端吻合术是前置胎盘并胎盘植入的一种有效的精密手术方法,可以达到止血的目的,同时最大程度地保护器官功能并减少手术创伤。Objective To investigate the clinical effect of circular resection of lower uterine segment and end-to-end anastomosis in the treatment of placenta previa and placental implantation.Methods A total of 100 patients with dangerous placenta previa and placental implantation admitted from March 2016 to March 2018 were selected and divided into group A(n=50)and group B(n=50)according to different surgical methods.Group A was treated with circular resection of lower uterine segment and end-to-end anastomosis,and group B was treated with internal iliac artery ligation.The perioperative conditions,hemodynamic changes,follow-up and neonatal conditions of the two groups were observed.Results The intraoperative and postoperative blood loss and total transfusion volume of group A were less than those of group B,and the duration of operation was shorter than that of group B(P<0.05).The frequency of fluctuation range of mean arterial pressure of group A at different time points that exceeded the preoperative baseline value of±15%,±20%,and±30%was less than that of group B(P<0.05).The hysterectomy rate and postoperative infection rate of group A were lower than those of group B,the duration of lochia and menstrual recovery time were shorter than those of group B,and the length of cervix measured by ultrasound was longer than that of group B(P<0.05).There was no significant difference in birth weight,Apgar score and neonatal asphyxia between the two groups(P>0.05).Conclusion Circular resection of lower uterine segment and end-to-end anastomosis is an effective and precise method for placenta previa and placental implantation.It can achieve the purpose of hemostasis,protect organ function to the greatest extent and reduce surgical trauma.

关 键 词：前置胎盘 胎盘植入 子宫下段环形切除加端端吻合术 髂内动脉结扎术 血流动力学 APGAR评分 

分 类 号：R714.46[医药卫生—妇产科学]