双侧子宫动脉介入造影栓塞对凶险性前置胎盘并胎盘植入患者子宫切除率和新生儿窒息发生率的影响  

Influence of bilateral uterine artery interventional angiography and embolization on hysterectomy rate and incidence of neonatal asphyxia in patients with dangerous placenta previa and placenta accreta

作　　者：曹正青 高丽丽 习开超 李冰[1] 佟雪 张素萍[1] 张洪莉[1] 曹淑新[1] CAO Zheng-qing;GAO Li-li;XI Kai-chao(Operating Room,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China)

机构地区：[1]唐山市妇幼保健院手术室,河北唐山063000

出　　处：《临床和实验医学杂志》2023年第16期1740-1743,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省2020年度医学科学研究课题计划(编号:20201488)。

摘　　要：目的分析双侧子宫动脉介入造影栓塞对凶险性前置胎盘并胎盘植入患者子宫切除率和新生儿窒息发生率的影响。方法回顾性选取2020年1月至2021年5月唐山市妇幼保健院收治的113例凶险性前置胎盘并胎盘植入患者作为研究对象。按照治疗方式不同分组,其中,行剖宫产术+双侧子宫动脉介入造影栓塞术+胎盘剥离术者64例,设为A组,行剖宫产术+常规治疗者49例,设为B组。观察并记录两组子宫切除率、新生儿窒息发生率、相关临床指标[手术时间、术中出血量、术后24 h出血量、抗生素应用时间、人绒毛膜促性腺素(HCG)转阴时间、术后下床活动时间和住院时间]及并发症[产褥感染、产后出血、切口感染、胎盘排出失败、弥散性血管内凝血(DIC)、失血性休克和肾功能损害]。结果A组子宫切除率为10.94%,显著低于B组(44.90%),差异有统计学意义(P<0.05),但两组新生儿窒息发生率相比,差异无统计学意义(P>0.05)。A组手术时间、术中出血量、术后24 h出血量均显著多于B组,抗生素应用时间、HCG转阴时间、术后下床活动时间和住院时间均显著短于B组,差异均有统计学意义(P<0.05)。A组产褥感染、产后出血、切口感染、胎盘排出失败、DIC、失血性休克和肾功能损害发生率均明显低于B组,差异均有统计学意义(P<0.05)。结论双侧子宫动脉介入造影栓塞术对尽量保留凶险性前置胎盘并胎盘植入患者子宫有一定价值。Objective To analyze the impact of bilateral uterine artery interventional angiography and embolization on the hysterectomy rate and the incidence of neonatal asphyxia in patients with dangerous placenta previa and placenta accreta.Methods A total of 113 patients with dangerous placenta previa and placenta accreta admitted in Tangshan Maternal and Child Health Hospital from January 2020 to May 2021 were retrospectively selected as the research subjects.According to the different treatment methods,64 cases were divided into group A by cesarean section+bilateral uterine artery interventional angiography embolization+placental dissection,and 49 cases were divided into group B by cesarean section section+conventional treatment.The rate of hysterectomy,incidence of neonatal asphyxia,related clinical indicators[operating time,intraoperative blood loss,24 h postoperative blood loss,antibiotic use time,human chorionic gonadotropin(HCG)negative time,postoperative time to get out of bed and hospital stay]and complications[puerperal infection,postpartum hemorrhage,incision infection,placental discharge failure,diffuse intravascular coagulation(DIC),hemorrhagic shock and renal impairment]were observed and recorded.Results The hysterectomy rate in group A was 10.94%,which was lower than that in group B(44.90%),the difference was statistically significant(P<0.05),but the difference in the incidence of neonatal asphyxia between the two groups was not statistically significant(P>0.05).The operation time,amount of intraoperative blood loss and 24 h postoperative blood loss in group A were significantly more than those in group B,the antibiotic use time,HCG conversion time,postoperative time to get out of bed and hospital stay were significantly shorter than those in group B,and the differences were statistically significant(P<0.05).The incidence of puerperal infection,postpartum hemorrhage,incision infection,placental discharge failure,DIC,hemorrhagic shock and renal impairment in group A were significantly lower than those in gr

关 键 词：凶险性前置胎盘并胎盘植入 双侧子宫动脉介入造影栓塞术 剖宫产术 子宫切除率 新生儿窒息 

分 类 号：R714.2[医药卫生—妇产科学]