凶险性前置胎盘子宫切除的影响因素分析  

Influencing Factors of Hysterectomy in Patients with Placenta Previa Hysterectomy

作　　者：杨丽娜[1] 张地 耿力[1] YANG Lina;ZHANG Di;GENG Li(The Department of Obstetrics,the First Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650031,China)

机构地区：[1]昆明医科大学第一附属医院产科,云南昆明650031

出　　处：《实用妇产科杂志》2021年第9期710-712,共3页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨凶险性前置胎盘(PPP)患者子宫切除的相关因素。方法:回顾性分析2015年1月至2020年1月在昆明医科大学第一附属医院行剖宫产分娩的PPP患者83例的临床资料,其中行子宫切除31例为研究组,未行子宫切除52例为对照组。对两组患者的一般情况、既往剖宫产相关因素、手术相关因素等行单因素分析,并采用Logistic回归行多因素分析。结果:两组患者年龄、体质量指数(BMI)、孕产次、分娩孕周、剖宫产次数及前置胎盘剖宫产史发生率相比,差异均无统计学意义(P>0.05)。两组术前预置髂总动脉球囊率及术中子宫切口选择避开胎盘率相比,差异无统计学意义(P>0.05)。研究组胎盘植入程度较深、妊娠期糖尿病(GDM)、妊娠期高血压疾病(HDP)及妊娠期肝内胆汁淤积症(ICP)的发生率显著高于对照组,差异有统计学意义(P<0.05)。Logistic回归分析示,胎盘植入程度、GDM、HDP及ICP是PPP子宫切除的独立危险因素(OR>1,P<0.05)。胎盘植入程度对子宫切除的影响最大(OR=31.512,95%CI 3.298~276.109)。结论:胎盘植入程度是影响子宫切除的重要因素,妊娠期并发症GDM、HDP及ICP增加了子宫切除的可能性。Objective:To analyze the factors affecting hysterectomy in patients with pernicious placenta previa.Methods:The retrospective analysis included 83 patients who had a pernicious placenta previa and underwent surgery in our hospital between January 2015 and January 2020.Thirty-one patients with hysterectomy were classified into the study group and 52 patients without hysterectomy were classified into the control group.The monofactor analysis and Logistic regression analysis were used to analyze the general conditions, the previous cesarean section, and the operation-related factors.Results:There was no statistical difference(P>0.05)in age, BMI,number of births, pregnancy weeks and the history of pre-placental caesarean section.There was no statistical difference(P>0.05)in pre-operative iliac artery balloon rate and the intraoperative uterine incision avoiding the placenta.The severity of placental implantation, gestational diabetes mellitus, gestational hypertension and intrahepatic cholestasis of pregnancy was significantly higher in the study group than in the control group(P<0.05).The results of Logistic regression analysis showed that the degree of placenta implantation, gestational diabetes mellitus, hypertension disorders complicating pregnancy and intrahepatic cholestasis of pregnancy was influencing factors(OR>1,P<0.05),the degree of placenta implantation had the greatest influence on hysterectomy(OR=31.512,95%CI 3.298-276.109).Conclusions:The degree of placental implantation is an important factor affecting hysterectomy, and gestational diabetes mellitus, gestational hypertension and intrahepatic cholestasis of pregnancy increase the likelihood of hysterectomy.

关 键 词：凶险性前置胎盘 胎盘植入 子宫切除 影响因素 

分 类 号：R714.2[医药卫生—妇产科学]