髂内动脉球囊临时置入在五例凶险性前置胎盘剖宫产中的应用

The application of temporary balloon occlusion of the internal iliac artery in performing cesarean hysterectomy for patients with pernicious placenta previa:an initial experience in five cases

目的探讨髂内动脉球囊临时置入在凶险性前置胎盘剖宫产中的临床应用。方法 5例均经超声和磁共振诊断为凶险性前置胎盘伴胎盘植入患者,在剖宫产术前行髂内动脉球囊临时置入,待胎儿娩出脐带结扎后充盈球囊,剖宫产术后24 h去除球囊,记录所受射线剂量、出血量,并观察有无并发症发生。结果 5例髂内动脉球囊临时置入,均获得成功。出血量<500 ml者3例,>1 000 ml者2例。3例保留子宫,2例因难治性出血,行子宫全切1例,子宫次全切1例。以上5例均未发生球囊置入并发症。结论髂内动脉球囊临时置入可减少凶险性前置胎盘剖宫产出血量,并降低了子宫切除风险。

Objective To explore the clinical application of temporary balloon occlusion of the internal iliac artery in performing cesarean hysterectomy for patients with pernicious placenta previa. Methods Five cases with ultrasound and MRI- proved pernicious placenta previa were enrolled in this study. Before cesarean hysterectomy, temporary balloon implantation in internal iliac artery was carried out in all five patients. The balloon was inflated by using a syringe immediately after the removal of the fetus and clamping of the umbilical cord were accomplished. The balloon was removed at 24 hours after the cesarean section. The radiation dose and the amount of blood loss during the procedure were recorded. Close inspection of the occurrence of complications was executed. The results were analyzed. Results Technical success, including correct placement of balloon, was obtained in all five patients. The blood loss 〈 500 ml was seen in three patients and 〉 1000 ml in 2 patients. The uterus was retained in 3 cases. Massive intractable hemorrhage during cesarean section occurred in 2 cases, and total hysterectomy （n = 1） or partial hysterectomy （n = 1） had to be carried out. Conclusion The results of this study indicate that temporary balloon occlusion of the internal iliac artery in performing cesarean hysterectomy is a safe and effective technique, it can reduce the amount of blood loss during the procedure as well as the risk of hysterectomy.