改良的腹膜侧后入路的剖宫产子宫切除术在妊娠晚期穿透性胎盘治疗中的应用

Modified cesarean hysterectomy for placenta previa percreta in the third trimester via peritoneum lateral approach

目的:探讨改良的腹膜侧后入路的剖宫产子宫切除术在妊娠晚期穿透性胎盘治疗中的应用。方法:回顾性分析中南大学湘雅医院2008年1月至2011年12月收治的孕龄≥34周且为同一术者完成的8例穿透性胎盘剖宫产子宫切除病例的临床资料,按病例配对的原则,将病例分为改良的腹膜侧后入路手术组(改良组,n=4)和常规手术组(n=4),比较术中出血量、输浓缩RBC量及手术并发症的发生情况。结果:改良组出血量为(2280±687)mL,明显少于常规组的(6150±2023)mL(P<0.05);改良组输浓缩RBC量为(4.5±2.1)U,亦明显少于常规组的(11.7±8.9)U(P<0.05)。改良组无凝血功能障碍和输尿管损伤的发生;而常规组分别有2例(P<0.05)和1例(P<0.05)。两组均有2例发生膀胱侵蚀裂伤。结论:穿透性胎盘患者术中出血严重,改良的腹膜侧后入路的剖宫产子宫切除术可减少患者术中出血量及输血量,降低手术并发症的发生率。

Objective： To investigate the application of modified cesarean hysterectomy for placenta previa percreta in the third trimester via peritoneum lateral approach. Methods： Data of 8 patients at 34 weeks or more gestation, who underwent cesarean hysterectomy for placenta previa percreta in Xiangya Hospital, Central South University, between January 2008 and December 2011, were analyzed retrospectively. The patients were divided into a modified cesarean hysterectomy by peritoneum lateral approach group （modified group, n=4） and a conventional cesarean hysterectomy group （conventional group, n=4）, according to the principles of the case-control and the operation performed by the same doctor. The incidence of blood loss, the number of transfusions of RBC, and the occourrance of complications were compared between the 2 groups. Results： The blood loss in the modified group and the conventional group was （2280±687） mL and （6150±2023） mE, and the number of transfusions of RBC was （4.5±2.1） U and （11.7±8.9） U, respectively. There was no coagulation disorder and ureteral injury in the modified group whereas there were 2 disorders and 1 injury in the conventional group. Two patients with bladder laceration were observed in the 2 groups. Conclusion： Large amounts of bleeding will be onset in the placenta previa percreta. Modified cesarean hysterectomy for placenta previa percreta can reduce the blood loss and the incidence of related complications in the operation.