改良剖宫产在凶险性前置胎盘伴胎盘植入手术中的应用效果分析  

Application of modified cesarean section in women with pernicious placenta previa complicated with placenta accrete

作　　者：王伟 蒋清阔 Wang Wei;Jiang Qingkuo(Suiping Ren'an Hospital,Henan Dahe Medical Group,ZhuMadian 463100,China)

机构地区：[1]河南大河医疗集团遂平仁安医院,463100

出　　处：《国际医药卫生导报》2020年第22期3439-3442,共4页International Medicine and Health Guidance News

摘　　要：目的探讨凶险性前置胎盘伴胎盘植入行剖宫产术终止妊娠时,在不辅助介入治疗如放置主动脉球囊或子宫动脉栓塞等方法的前提下更加有效的手术术式。方法选取2017年4月至2019年8月就诊于本院的28例凶险性前置胎盘伴胎盘植入的患者,行改良剖宫产手术终止妊娠,从出血量、手术时间、子宫切除率、输血量、住院费用以及手术并发症等方面进行分析。结果采用本院改良的剖宫产术,28例手术均顺利完成,且无严重手术并发症发生;术中出血量范围为200~1100ml,平均430 ml;手术时间范围为65~135 min,平均105 min;子宫切除2例,占7.1%;输血量范围为400~800 ml(术前备血),平均500 ml;住院费用范围为5740.50~11068.23元,平均费用7053.18元;从上述指标看,除手术时间无明显差异外,其余指标都明显优于介入辅助治疗下的剖宫产手术,尤其是出血量、住院费用、并发症等方面优势更为突出。结论凶险性前置胎盘伴胎盘植入通过改变术式,完全可以免除使用介入手段阻塞血管的辅助治疗方法,且术中出血少,效果确切,有效化解了凶险性前置胎盘伴胎盘植入产后出血的风险。Objective To explore a more effective surgical operation free of auxiliary interventional treatment such as placed aortic balloon or uterine artery embolization when pernicious placenta previa(PPP)complicated with placenta accreta is terminated by cesarean section to control intraoperative bleeding.Methods 28 patients diagnosed with PPP and placenta accrete were selected to undergo modified cesarean section to terminate pregnancy at our hospital from April,2017 to August,2019.The bleeding volume,operation time,hysterectomy rate,blood transfusion volume,hospitalization cost,and surgical complications were analyzed.Results All the 28 cases successfully completed the operation without serious complications.The Intraoperative bleeding volume was 200–1100 ml,with an average of 430 ml.The operation time was 65-135 minutes,with an average of 105 minutes.Hysterectomy was performed in 2 cases(7.1%).The blood transfusion volume was 400-800 ml(preoperative blood preparation),with an average of 500 ml.The hospitalization expenses ranged from 5740.50 yuan to 11068.23 yuan,with an average of 7053.18 yuan.From the above indicators,except for no obvious difference in operation time,the other indicators were obviously superior to cesarean section under interventional adjuvant therapy,especially in bleeding volume,hospitalization expenses,and complications.Conclusions By changing the operation mode,PPP complicated with placenta accrete can completely avoid the auxiliary treatment method of blocking blood vessels by interventional means,and has less bleeding during operation and definite effect,thus effectively resolving the risk of postpartum hemorrhage.

关 键 词：凶险性前置胎盘 胎盘植入 介入治疗 改良剖宫产手术 

分 类 号：R719.8[医药卫生—妇产科学]