胎盘植入产后出血的介入治疗以及临床分析

Clinical analysis of treatment of placenta accreta postpartum hemorrhage by intervention therapy

目的分析并评价介入治疗胎盘植入产后大出血患者临床疗效以及安全性。方法对中南大学附属湘雅医院院自2009年1月至2011年2月期间收治的8例胎盘植入产后出血患者,采用病变侧子宫动脉给予甲氨喋呤同时进行栓塞的方法实施治疗,评价临床疗效以及不良反应情况。结果本组全部患者均获得栓塞成功,平均手术用时为(42±7)min,术后患者阴道均停止出血,但存在血性恶露,行清宫术后子宫恢复正常,对清出组织进行检验结果显示为蜕化绒毛或胎盘组织。本组全部患者未见血常规与肝肾功能异常;全部8例患者的月经均恢复正常,无子宫切除病例。结论介入疗法对胎盘植入的治疗效果令人满意,该技术操作简单、手术时间短、可以保留子宫、不良反应小,值得临床广泛推广应用。

Objectlve To analyze and evaluate clinical efficacy and safety of interventional therapy for placenta accreta postpartum hemorrhage. Methods From 2009 January to 2011 February, a total of 8 cases of placenta acereta postpar- tum hemorrhage patients,the lesion side uterine artery given methotrexate and embolization treatment implementation, e- valuated the clinical efficacy and adverse reaction. Results All patients were successfully embolized,the average opera- tion time was （42 _＋ 7 ）min, postoperative vaginal stop bleeding, but the presence of lochia, after uterine curettage uterus return to normal, inspection of the tissue showed degenerated villous or placental tissue. All patients showed no blood and liver and kidney dysfunction ;8 patients menstruation returned to normal, without hysterectomy cases. Conclusions The interventional therapy for placenta implantation therapeutic effect is satisfactory, the technique has the advantages of sim- ple operation, short operation time, can preserve the uterus, adverse reactions less, and wide application in clinic.