凶险型前置胎盘65例临床分析

CLINICAL ANALYSIS OF 65 CASES OF PERNICIOUS PLACENTA PREVIA

目的分析凶险型前置胎盘的临床特点,如何充分术前准备,据病情选择适当的手术方式,减少术中出血,降低子宫切除几率。方法对65例凶险型前置胎盘病例胎盘植入情况、新生儿窒息率、子宫切除几率、术中出血情况等多项指标进行回顾性分析,根据术中胎盘前置及植入情况选择不同处理方式,并比较各种处理方式的出血量和子宫切除率。结果 65例中45例发生胎盘植入、新生儿窒息7例、子宫切除的6例;不同的手术方式比较术中出血量、子宫切除几率,产妇并发症(DIC、孕产妇死亡等)。结论凶险型前置胎盘对孕产妇有极大的威胁,术前诊断非常必要、做好充分术前准备以及产后出血的抢救准备,适当应用介入栓塞技术可减少子宫切除的发生,减少产妇并发症及死亡风险。

Objective To analyze the clinical characters of pernicious placenta previa ,and to prepare well pre-operation ,choose appropriate operation manner ,reduce intraoperative blood loss ,decrease the proba-bility of metrectomy .Methods A retrospective analysis in 65 cases with pernicious placenta previa was performed ,the data of placenta accrete ,the rate of neonatal asphyxia ,probability of metrectomy and intra-operative blood loss were collected .The operation manner was chosen according to the characters of the placenta previa ,comparison of the probability of metrectomy and intraoperative blood loss between cases with different operation manner were performed .Results Forty -five from a total of 65 cases occurred placenta accrete ,7 cases of neonatal asphyxia and 6 cases of metrectomy .A total of 65 cases with perni-cious placenta previa were divided into 4 groups according to the treatment ,45 cases occurred placenta ac-crete ,7 cases of neonatal asphyxia and 6 cases of metrectomy .The intraoperative blood loss ,rate of me-trectomy and complication of maternal （DIC ,death） in group C ,which were treated by lower segment ce-sarean section after bilateral uterine artery chemoembolization induced by radiation ,were significantly lower than those from other 3 groups .Conclusion Pernicious placenta previa heavily threatens maternal ,a con-firmed preoperative diagnosis is necessary ,well preparation before operation and rescue measure for intrao-perative bleeding ,and interventional embolization w hen needed ,can reduce the complication and maternal mortality .