剖宫产术中宫腔填塞联合腹主动脉远端预置球囊阻断治疗植入型凶险型前置胎盘

Uterine Packing with Prophylactic Distal Abdominal Aorta Balloon Occlusion during Caesarean Section for Pernicious Placenta Previa and Placenta Accreta

目的：探讨宫腔填塞联合腹主动脉远端预置球囊阻断术治疗植入型凶险型前置胎盘的效果。方法2012年4月～2013年12月，福建省立医院产科8例超声诊断植入型凶险型前置胎盘患者，剖宫产术前于腹主动脉远端预置球囊，术中切开子宫壁时充盈球囊，迅速娩出胎儿剥离胎盘，运用COOK止血球囊或宫腔塞纱止血，DSA造影提示仍有出血或子宫血管交通支丰富者行超选择子宫动脉栓塞。结果4例术中出血＜1000 ml（400～600 ml），未使用血制品。除1例因胎盘侵犯盆壁组织行子宫切除术外，其余7例均成功保留子宫。5例无需术后栓塞。除1例孕母大出血急诊入院者新生儿重度窒息外，其余新生儿Apgar评分均正常。结论剖宫产术中宫腔填塞联合腹主动脉远端预置球囊阻断术治疗植入型凶险型前置胎盘比较安全，可以有效控制术中出血，争取保留子宫。

Objective To explore the clinical application of uterine packing with prophylactic distal abdominal aorta balloon occlusion for patients with pernicious placenta previa and placenta accreta . Methods A total of 8 cases of pernicious placenta previa and placenta accreta from April 2012 to December 2013 in Fujian Provincial Hospital were enrolled .Prophylactic distal abdominal aorta catheterization was carried out before operation .The balloon was inflated to block blood flow while cutting uterine wall . Uterine packing was performed after removing fetus and placenta .And then uterine artery was embolized according to the situation . Results Four cases had an intraoperative blood loss less than 1000 ml, without blood transfusion .The uterus was successfully conserved in 7 cases, except for 1 case of hysterectomy because of placenta implantation of the pelvic wall tissue .Postoperative uterine arterial embolization was not required in 5 cases.Neonates had normal Apgar scores except one had severe asphyxia due to emergent hemorrhage of mother . Conclusions This study indicates that uterine packing with prophylactic distal abdominal aorta balloon occlusion during cesarean is a safe and effective technique .It can reduce the amount of blood loss during the procedure , as well as the risk of hysterectomy .