腹主动脉球囊预置术在凶险性前置胎盘合并胎盘植入孕妇中的应用

Clinical evaluation of prophylactic abdominal aorta balloon occlusion in patients with cesarean section of pernicious placenta previa and placenta accreta

目的探讨腹主动脉球囊预置术在凶险性前置胎盘伴胎盘植入产妇剖宫产术中的应用价值。方法回顾性分析2015年1月至2017年6月在复旦大学附属妇产科医院产科住院并剖宫产分娩的63例凶险性前置胎盘伴胎盘植入产妇的临床资料,以2016年11月1日起开展剖宫产术前腹主动脉球囊预置术为界分组,开展腹主动脉球囊预置术后为A组(17例),开展前为B组(46例),分析比较两组产妇的手术时间、术中出血量、术中输血量、手术方式、子宫切除率、术后住院时间、术后抗生素使用时间、新生儿Apgar评分和新生儿住院率等。结果 (1)两组产妇的年龄、孕次、产次、分娩孕周、既往剖宫产次数和妊娠期合并症及并发症比较,差异无统计学意义(P>0.05)。(2)两组产妇手术时间、术中出血量、术中输血量、术前术后血红蛋白的改变、膀胱损伤率差异均无统计学意义(P>0.05)。A组中使用其他缝合方法止血、宫腔填塞纱条或止血球囊、术后行子宫动脉栓塞的产妇均高于B组(41.2%vs.17.4%,47.1%vs.19.6%,52.9%vs.23.9%,P均<0.05)。A组术中弥漫性血管内凝血(DIC)和全子宫切除率均低于B组(5.9%vs.34.8%,17.6%vs.47.8%,P均<0.05)。(3)两组产妇术后住院时间、术后抗生素使用时间、术后病率差异无统计学意义(P>0.05)。(4)两组新生儿出生体重、1 min和5 min低Apgar评分、新生儿收住院率,差异均无统计学意义(P>0.05)。结论腹主动脉球囊预置术可以降低凶险性前置胎盘合并胎盘植入产妇剖宫产术中DIC和子宫切除的风险,但球囊释放后仍有继续出血的风险,需要辅助其他方法。

Objective To evaluate the effectiveness of prophylactic abdominal aorta balloon occlusion in cases of cesarean section of pernicious placenta previa and placenta accreta.Methods A total of 63 cases who had delivery in the Obstetrics and Gynecology Hospital of Fudan University from 1 January 2015 to 31 June 2017 were enrolled,who had cesarean section of pernicious placenta previa and placenta accreta.Based on the date of prophylactic abdominal aorta balloon occlusion on 1 November 2016,cases were divided into two groups：after（group A,17 cases）and before（group B,46 cases）,and we compared pregnancy and perinatal outcome,including operative time,intraoperative blood loss,blood transfusion volume,hemoglobin level,operation mode,hysterectomy rate,hospitalization time,time of antibiotic use,and neonatal Apgar score and ward admission rate.Results（1）There was no significant difference in age,gravidity,parity,length of pregnancy,prior cesarean deliveries or complications of pregnancy between the two groups（P〉0.05）.（2）Operative time,intraoperative blood loss,blood transfusion volume,change in hemoglobin and bladder injury rate did not differ between the two groups（P〈0.05）.The patients receiving other suture methods（respectively41.2%,17.4%）,intrauterine packing with gauze or Bakey balloon（respectively 47.1%,19.6%）,postoperative uterine artery embolization（respectively 52.9%,23.9%）were more in group A（P〈0.05）.The rates of DIC（respectively 5.9%,34.8%）and hysterectomy（respectively 17.6%,47.8%）were lower in group A（P〈0.05）.（3） There was no significant difference in postoperative hospitalization time,postoperative antibiotic use time or postoperative morbidity between the two groups（P〉0.05）.（4）There was no significant difference in neonatal birth weight,oneminute and five-minute low Apgar score,or neonatal hospitalization rate between the two groups（P〉0.05）.Conclusion The prophylactic abdominal aorta balloon occlusion can reduce DIC and hysterectomy risk in patients with pernicious placenta previa and placenta accreta during cesarean section,while the risk of bleeding still exists after balloon removal,so other hemostatic methods are needed.