凶险性前置胎盘伴胎盘植入患者剖宫产术中不同止血术式的选择及预后比较

Selection and prognosis comparison of different hemostasis methods in caesarean section for patients with dangerous placenta previa and placenta implantation

目的探讨凶险性前置胎盘伴胎盘植入患者剖宫产中选择不同止血术式对预后的影响。方法收集2012年1月-2017年12月四川省简阳市人民医院产科收治的97例凶险性前置胎盘伴胎盘植入产妇为研究对象,根据患者剖宫产术中止血方法不同将其分为髂内动脉栓塞术(IIAE)组(A组,n=47)、子宫动脉栓塞术(UAE)组(B组,n=30)、传统手术组(C组,n=20)3组,观察3组手术结果及患者预后。结果 3组患者术中失血量、输入红细胞量及输入血浆量比较差异均有统计学意义(F/P=343.368/0.000、423.660/0.000、186.671/0.000),且C组>A组>B组(P<0.05);A、B 2组均未发生子宫切除、DIC和失血性休克,C组患者子宫切除、DIC和失血性休克发生分别为6例(30.0%)、4例(20.0%)、2例(10.0%);3组手术时间及术后住院时间比较差异有统计学意义(F/P=74.664/0.000、74.780/0.000),且A组、B组短于C组(P<0.05);3组新生儿1min及5 min Apgar评分比较差异无统计学意义(P>0.05)。结论 IIAE与UAE均能有效控制凶险性前置胎盘合并胎盘植入患者剖宫产术中出血量,降低产后大出血、DIC及失血性休克发生率,而与IIAE相比,UAE疗效更优。

Objective To explore the effect of different hemostasis methods on prognosis of patients with dangerous placenta previa and placenta implantation during cesarean section.Methods Ninety-seven cases of dangerous placenta previa with placenta implantation were collected from January 2012 to December 2017 in the obstetrics department of the People s Hospital of Jianyang City,Sichuan Province.According to the different methods of hemostasis during cesarean section,the patients were divided into two groups:internal iliac artery embolization(IIAE)group(A group,n=47),uterine artery embolization(UAE)group(B).n=30)and traditional operation group(group C,n =20)were used to observe the results of operation and prognosis of patients in three groups.Results There were significant differences in intraoperative blood loss,red blood cell input and plasma input among the three groups(F/P= 343.368/0.000,423.660/0.000,186.671/0.000),and group C>group A>group B(P<0.05).No hysterectomy,DIC and hemorrhagic shock occurred in group A and B.In group C,hysterectomy,DIC and hemorrhagic shock occurred in 6 cases(30.0%),4 cases(20.0%)and 2 cases(10.0%)respectively.There were significant differences in operative time and hospitalization time between the three groups(F/P=74.664/0.000,74.780/0.000),and group A and group B were shorter than group C(P<0.05).There was no significant difference in Apgar scores of 1 min and 5 min among the three groups(P>0.05).Conclusion Both IIAE and UAE can effectively control the amount of bleeding during cesarean section in patients with dangerous placenta previa complicated with placenta implantation,and reduce the incidence of postpartum hemorrhage,DIC and hemorrhagic shock.Compared with IIAE,UAE has better curative effect.