凶险型前置胎盘剖宫产术中辅助子宫动脉栓塞的X线剂量研究

The study of radiation dose in the procedure of uterine arterial embolization adjuvant to the cesarean section for the treatment of puerpera with pernicious placenta previa

目的：探讨凶险型前置胎盘剖宫产术中辅助子宫动脉栓塞过程中胎儿及孕妇所受X线辐射剂量的安全性.方法：2012年7月-2013年2月,我院7例诊断为凶险型前置胎盘的高危产妇,采用术中子宫动脉栓塞辅助剖宫产分娩,分段记录介入手术过程中的X线辐射剂量分布,测算胎儿与孕妇所受X线辐射剂量,评估其安全性.结果：7例凶险性前置胎盘产妇,8例新生儿成功剖宫产分娩.1例产妇因胎盘植入累及子宫颈,胎儿分娩后,子宫切除,其余6例产妇均成功保留子宫.剖宫产术中辅助子宫动脉栓塞的过程中,胎儿所受X线辐射的皮肤剂量（cutaneous dose,CD）6.04～23.9 mGy,平均17.66 mGy,X线透视时间41～196 s,平均102 s.产妇所受的CD为56～156 mGy,平均94.5 mGy,X线透视时间为305～885 s,平均580 s.结论：介入术中辅助剖宫产治疗瘢痕妊娠时胎儿所受的X线辐射剂量是安全的.

Objective： To investigate the safety of radiation to infants du/ing uterine arterial embolization（UAE） procedures which are adjuvant to the cesarean section surgery in parturient with pernicious placenta previa. Methods： From July 2012 to February 2013,7 high-risk puerperas with pernicious placenta previa were, subjected to UAE adjuvant to cesarean section. Distribution of radiation doses during UAE were documented step by step in order to calculate and differentiate the infants＇ dose from that of puerperae＇s, thus facilitating the evaluation of UAE＇s safety to infants. Results： Among seven cases diagnosed with pernicious placenta previa, only one case with additional placenta penetration into full-thickness cervical tissues underwent hysterectomy, the other six all successfully fulfilled labor and conserved uteri. The distribution of radiation dose revealed that with infant in uterus the mean cutaneous dose（CD） was 17.66 mGy（6.04-23.9 mGy）. mean fluoroscopy time （FT） was 102 seconds（41-196 seconds）. The mean CD in puerperae was 94.5 mGy（56-156 mGy） with the mean FT of 580 seconds（305-885 seconds）. Conclusion： The radiation dose produced by UAE on infants during UAE plus CS for high- risk patients with pernicious placenta previa and/or accreta was considered to be in the safe range.