低位腹主动脉血管外阻断术与低位腹主动脉球囊阻术在凶险性前置胎盘合并胎盘植入治疗中的比较

Comparative study of extra vascular occlusion of low abdominal aorta and low abdominal aortic balloon occlusion in the treatment of placenta previa with implantation

目的比较低位腹主动脉血管外阻断术与低位腹主动脉球囊阻断术在植入型凶险性前置胎盘治疗中的临床疗效。方法选择2014年1月至2017年7月住院治疗的凶险性前置胎盘合并胎盘植入患者68例,分为两组,剖宫产术中行低位腹主动脉血管外阻断术34例(A组)和剖宫产术前行低位腹主动脉球囊阻断术34例(B组),观察比较两组孕妇术中、术后情况。结果 A组在手术操作时间、手术并发症血管损伤、血栓形成、胎儿放射线暴露均显著低于B组(P<0.05);两组患者在术后感觉障碍发生率、剖宫产手术时间、术中出血量、输血率、子宫切除率、住院时间比较,差异均无统计学意义(P>0.05)。结论两种手术在凶险性前置胎盘合并胎盘植入的治疗中均能安全、有效减少术中出血。而A组手术操作时间短,术中术后无穿刺部位出血、无盆腔及下肢动脉血栓形成,无需X线暴露,对母胎更安全,可在临床推广。

Objective To compare the clinical efficacy of extra vascular occlusion of low abdominal aorta and low abdominal aorta balloon occlusion in the treatment of placenta previa with placenta previa. Methods From January 2014 to July 2017, 68 implantable placenta previa patients were divided into two groups, elective cesarean section of extra vascular occlusion of low abdominal aorta in 34 eases （group A） and cesarean section on the lower abdominal aorta balloon occlusion in 34 eases （group B ） , and observation of pregnant women was compared between surgery of two groups. Results Operation time, complications of vascular injury and thrombosis, fetal radiation exposure in group A were significantly lower than that of group B （P 〈 0.05 ） ; two groups of patients with sensory dysfunction incidence, cesarean operation time, intraoperative blood loss, blood transfusion rate, the uterus resection rate, hospitalization time had no statistically significant difference postoperatively （P 〉 0.05 ）. Conclusion Two kinds of operation can safely and effectively reduce the bleeding during the treatment of placenta previa. While group A surgery operation time is short, without intraoperative and postoperative bleeding of the puncture site, without pelvic and lower extremity arterial thrombosis, without X-ray exposure, more safety of the womb and can be popularized in clinic.