前置胎盘对胎盘植入性疾病致子宫全/次全切除及胎盘植入部位子宫局部切除患者手术情况及妊娠结局的影响  

Effects of placenta previa on surgical and pregnancy outcomes in patients with total/subtotal or segmental hysterectomy attributed to placenta accreta spectrum disorders

作　　者：胡淼 杜丽丽[1,2,3,4,5] 张瑜亮 古士锋 古仲嘉 赖思莹 梁景英 刘雨 毕石磊 张丽姿 陈敦金 Miao Hu;Lili Du;Yuliang Zhang;Shifeng Gu;Zhongjia Gu;Siying Lai;Jingying Liang;Yu Liu;Shilei Bi;Lizi Zhang;Dunjin Chen(Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Guangzhou Medical University,Guangzhou 510150,China;Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangzhou 510150,China;Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine,Guangzhou 510150,China;Guangdong Engineering and Technology Research Center of Maternal-Fetal Medicine,Guangzhou 510150,China;Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology,Guangzhou 510150,China)

机构地区：[1]广州医科大学附属第三医院妇产科,广州510150 [2]广东省产科重大疾病重点实验室,广州510150 [3]粤港澳母胎医学高校联合实验室,广州510150 [4]广东省母胎医学工程技术研究中心,广州510150 [5]广东省妇产疾病临床医学研究中心,广州510150

出　　处：《中华围产医学杂志》2023年第8期635-643,共9页Chinese Journal of Perinatal Medicine

基　　金：国家重点研发计划(2022YFC2704500,2022YFC2704501);国家自然科学基金(81830045,82171666,82071652)。

摘　　要：目的探讨前置胎盘对胎盘植入性疾病(placenta accreta spectrum disorders,PAS)致子宫全/次全切除及胎盘植入部位子宫局部切除(简称植入部位切除)患者手术情况和妊娠结局的影响。方法回顾性纳入2017年1月1日至2022年12月31日于广州医科大学附属第三医院分娩、因PAS行子宫全/次全切除或者植入部位切除的患者510例。根据是否合并前置胎盘分为合并前置胎盘组(427例)和无前置胎盘组(83例)。根据子宫切除方式(子宫全/次全切除或植入部位切除)分层,子宫全/次全切除者根据是否合并前置胎盘分为合并前置胎盘组(221例)和无前置胎盘组(23例),植入部位切除者根据是否合并前置胎盘分为合并前置胎盘组(206例)和无前置胎盘组(60例)。采用非参数检验或χ^(2)检验比较组间临床特征、手术情况和妊娠结局的差异。利用二分类logistic回归分析前置胎盘对需要额外手术操作和发生不良妊娠结局的影响。结果(1)合并前置胎盘组与无前置胎盘组比较:与无前置胎盘组比较,合并前置胎盘组产后24 h出血量[1541 ml(1036~2368 ml)与1111 ml(695~2000 ml),Z=-3.91],以及需要额外手术操作[84.8%(362/427)与69.9%(58/83),χ^(2)=10.61]、子宫全/次全切除[51.8%(221/427)与27.7%(23/83),χ^(2)=16.10]、膀胱镜检查术和/或输尿管支架置入术[60.7%(259/427)与31.3%(26/83),χ^(2)=24.25]、总体不良妊娠结局[86.9%(371/427)与65.1%(54/83),χ^(2)=17.75]、产后24 h出血量>1500 ml[54.1%(231/427)与33.7%(28/83),χ^(2)=29.94]和输注血制品的比例较高[75.9%(324/427)与47.0%(39/83),χ^(2)=28.27](P值均<0.05)。采用二分类logistics回归分析,校正年龄、既往剖宫产次数、产次、孕期增重、双胎、是否辅助生殖技术受孕等混杂因素,发现前置胎盘是PAS子宫切除(全/次全切除和植入部位切除)患者需要额外手术操作(aOR=3.26,95%CI:1.85~5.72)及发生不良妊娠结局(aOR=5.59,95%CI:2.01~6.42)的危险因素。(2)按�Objective To investigate the effects of placenta previa on the surgical and pregnancy outcomes in patients with total/subtotal or segmental hysterectomy attributed to placenta accreta spectrum disorders(PAS).Methods This study retrospectively enrolled 510 patients who gave birth and underwent total/subtotal hysterectomy or segmental hysterectomy(local implantation site)due to PAS at the third Affiliated Hospital of Guangzhou Medical University from January 1,2017,to December 31,2022.These subjects were divided into the placenta previa group(427 cases)and non-placenta previa group(83 cases).According to the type of hysterectomy,they were further divided into the total/subtotal hysterectomy and placenta previa subgroup(221 cases),total/subtotal hysterectomy and non-placenta previa subgroup(23 cases),segmental hysterectomy and placenta previa subgroup(206 cases),and segmental hysterectomy and non-placenta previa subgroup(60 cases).Nonparametric test or Chi-square test were used to compare the differences in the clinical features,surgical and pregnancy outcomes between different groups.Binary logistic regression was used to analyze the effects of placenta previa on the risk of additional surgical procedures and adverse maternal outcomes.Results(1)Compared with the non-placenta previa group,the hemorrhage volume within 24 h postpartum[1541 ml(1036-2368 ml)vs 1111 ml(695-2000 ml),Z=-3.91]and the proportion of women requiring additional surgical procedures[84.8%(362/427)vs 69.9%(58/83),χ^(2)=10.61],with total/subtotal hysterectomy[51.8%(221/427)vs 27.7%(23/83),χ^(2)=16.10],cystoscopy and/or ureteral stenting[60.7%(259/427)vs 31.3%(26/83),χ^(2)=24.25],total adverse pregnancy outcomes[86.9%(371/427)vs 65.1%(54/83),χ^(2)=17.75],hemorrhage volume>1500 ml within 24 h postpartum[54.1%(231/427)vs 33.7%(28/83),χ^(2)=29.94],transfusion of blood products[75.9%(324/427)vs 47.0%(39/83),χ^(2)=28.27]were all higher in the placenta previa group(all P<0.05).Binary logistic regression analysis found that for PAS patients with hyst

关 键 词：前置胎盘 侵入性胎盘 子宫切除术 妊娠结局 

分 类 号：R713[医药卫生—妇产科学]