子宫动脉栓塞术对凶险性前置胎盘并胎盘植入高血压患者的疗效研究  

Efficacy of uterine artery embolization in hypertensive patients with dangerous placenta previa and placenta accreta

作　　者：孙莉莉 杜瑞娟 黄娜 袁乐 王苓 王雪梅[1] Sun Lili;Du Ruijuan;Huang Na;Yuan Le;Wang Ling;Wang Xuemei(Department of Seven Branches of Gynecology,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,P.R.China)

机构地区：[1]唐山市妇幼保健院妇七科,河北唐山063000

出　　处：《中国计划生育和妇产科》2024年第2期42-45,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：河北省2024年度医学科学研究课题计划(项目编号:20242186)。

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的高血压患者疗效影响。方法选取唐山市妇幼保健院2020年1月至2021年5月收治的凶险性前置胎盘并胎盘植入的高血压患者113例作为研究对象,行剖宫产术+双侧子宫动脉介入造影栓塞术+胎盘剥离术64例作为观察组,行剖宫产术+胎盘原位保留法49例作为对照组。比较两组子宫切除率、相关临床指标[手术时间、术中出血量、术后24 h出血量、抗生素使用时间、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]、穿刺部位情况(感觉异常、出血)、并发症发生情况等。结果与对照组比较,观察组术后穿刺部位感觉异常、出血,术后发热发生情况,差异无统计学意义(P>0.05);观察组子宫切除率、产褥感染、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发生率均低于对照组,抗生素使用时间、hCG转阴时间、术后下床活动时间和住院时间短于对照组,手术时间、术中出血量、术后24 h出血量多于对照组,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能够尽量保留凶险性前置胎盘并胎盘植入高血压患者的子宫,降低并发症发生率,兼顾安全性和有效性,值得推广。Objective To analyze the effect of bilateral uterine artery interventional angiography embolization on hypertensive patients with dangerous placenta previa and placenta implantation.Methods 113 hypertensive patients with dangerous placenta previa and placenta implantation admitted to Tangshan Maternal and Child Health Hospital from January 2020 to May 2021 were selected as the study objects.64 cases underwent cesarean section+bilateral uterine artery interventionization+placenta dissection as the observation group,and 49 cases underwent cesarean section+placenta in situ retention as the control group.The hysterectomy rate,relevant clinical indicators(operation time,intraoperative blood loss,24 h postoperative blood loss,antibiotic use time,hCG conversion time,postoperative activity time and hospital stay),the situation of puncture site(paraesthesia,bleeding)and complications were compared between the two groups.Results Compared with the control group,the incidence of paraesthesia,bleeding and postoperative fever at the puncture site in the observation group had no statistical significance(P>0.05).The incidence of hysterectomy rate,puerperal infection,incision infection,placental discharge failure,DIC,hemorrhagic shock and renal function damage in the observation were all lower than those in the control group.The time of antibiotic use,the time of hCG turning negative,the time of getting out of bed and the time of hospitalization were shorter than those of control group,and the time of operation,the amount of blood loss during operation and the amount of blood loss 24 h after operation were higher than those of control group,the differences were statistically significant(P<0.05).Conclusion Bilateral uterine artery interventional angiography embolization can preserve the uterus of hypertensive patients with the dangerous placenta previa and placenta implantation as much as possible,reduce the incidence of complications,with safety and effectiveness,and is worthy of promotion.

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：R714.462[医药卫生—妇产科学]