子宫动脉栓塞及胎盘原位保留治疗凶险性前置胎盘伴胎盘植入的效果分析

Effect of uterine artery embolization and placenta preservation in situ in the treatment of dangerous placenta previa with placenta implantation

目的 探讨子宫动脉栓塞及胎盘原位保留治疗凶险性前置胎盘伴胎盘植入的临床效果.方法 收集2010年1月至2015年12月在苏州大学附属第一医院和苏州市立医院住院分娩的凶险性前置胎盘伴胎盘植入的孕妇共34例,根据治疗方法将其分为两组:A组18例,行剖宫产术将胎儿娩出后再行子宫动脉栓塞术,然后行胎盘剥离术;B组16例,行剖宫产术将胎儿娩出后将胎盘原位保留,术后给予甲氨喋呤(MTX)1 mg/kg单次肌肉注射给药,米非司酮50 mg/次,口服,2次/d,共7 d.比较两组孕妇的临床特点、治疗效果及并发症发生情况.结果 A、B两组人绒毛膜促性腺激素(HCG)转阴时间、住院时间、抗生素使用时间、子宫切除、产褥感染发生率、术中出血量、产后24 h出血量比较,差异均有统计学意义(P均<0.05).B组有3例胎盘排出失败,孕妇因血象及体温升高,出现菌血症,宫腔分泌物培养显示细菌生长,宫腔发生严重感染且治疗无效,行子宫次全切除术.结论 胎盘原位保留失败最主要的原因是感染,子宫动脉栓塞治疗凶险性前置胎盘伴胎盘植入,能有效控制术中出血,减少产褥感染,极大程度的保留了子宫,提高了患者的生存质量.

Objective To investigate the clinical effects of uterine artery embolization and placenta preservation in situ in the treatment of dangerous placenta previa with placenta implantation.Methods Thirty-four pregnant women with dangerous placenta previa and placenta implantation who delivered in the First Affiliated Hospital of Soochow University and Suzhou Municipal Hospital from January 2010 to December 2015 were enrolled in the study.All objects were divided into two groups by treatment methods.Eighteen pregnant women in group A underwent cesarean section,and then were given uterine artery embolization and placenta dissection successively after delivery.Sixteen pregnant women in group B underwent cesarean section to preserve the placenta in situ after delivery,and then they were given one intramuscular injection of MTX 1 mg/kg and orally took mifepristone 50 mg/time,twice a day for 7 days after operation.The clinical features,efficacy and complications of the two groups were compared.Results The human chorionic gonadotropin(HCG)negative time,hospitalization time,antibiotic use time,hysterectomy,puerperal infection rate,intraoperative bleeding,hemorrhage 24 hours after delivery in group A were significantly different from those in group B(P<0.05).In group B,3 cases failed to discharge placenta.Due to the increase in hemogram and body temperature,the 3 pregnant women developed bacteremia.The culture of uterine secretions showed bacterial growth,and severe infection occurred in uterine cavity and the treatment was ineffective.Subtotal hysterectomy was performed.&nbsp;Conclusions The most important reason of placental left in situ failure is infection.Uterine artery embolization in the treatment of pernicious placenta previa with placenta accreta can effectively control of bleeding,reduce puerperal infection,largely retained the uterus and improve the patients'quality of life.