双侧股动脉预置管联合剖宫产治疗凶险型前置胎盘的临床研究

Clinical Research of Bilateral Femoral Artery Catheter Combined With Cesarean Section Treatment of Pernicious Placenta Previa

目的评价双侧股动脉预置管联合剖宫产治疗凶险型前置胎盘的临床效果,总结治疗经验。方法 2011年2月~2014年8月收治18例凶险型前置胎盘产妇,11例急诊、7例择期,均登记注册。介入科会诊,局麻,Selding技术穿刺右股动脉,插入5F导管至腹主动脉下段,置导管鞘,行剖宫产。取出胎儿及其附件后,纱条止血,造影下将导管插入出血血管,以2 mm×2 mm×2 mm明胶海绵颗粒栓塞,钝锐性结合剥离胎盘,局部缝扎、宫缩剂止血。术后复查,若无活动性出血拔管,肌注MTX促胎盘组织萎缩、肌化,随访6个月,复查HCG,复行彩色血流超声。结果无死亡、严重并发例。出血1 800~3 700 ml、平均（2 422±834）ml,输注红细胞悬液4.0~12.0 U、血浆400~1 200 ml、住院总日数5~21 d、平均（11.8±6.4）d、新生儿体重（2 583±866）g,Apgar 1min（9.6±0.8）分、Apgar 5 min（8.8±1.8）分。术后出现腰背痛1例,无再出血、HCG异常。结论在严格掌握适应证、禁忌证条件下,双侧股动脉预置管联合剖宫产治疗凶险型前置胎盘效果较好,有助于保留子宫,减少出血量,降低风险。

Objective To evaluate the bilateral femoral artery preset tube joint cesarean delivery for treatment of dangerous type of placenta previa,sum up treatment experience.Methods From February 2011 to August 2014,to select 18 cases of dangerous type of placenta previa maternal, 11 cases of emergency,7 cases undergoing emergency,and all registered.Interventional radiology consultation,given Local anesthesia,and used the selding technique to puncture right femoral artery.Insert a 5F catheter into the next section of the abdominal aorta,placed in the catheter sheath,then begin to produce.After removal of the fetus and its annex,with gauze to stop bleeding,contrast conditions,inserted the catheter into the bleeding vessel,embolizated with 2 mm ＆#215; 2 mm ＆#215;2 mm gelatin sponge particles.Blunt sharp combined with the release of placenta,local suture ligation combined with oxytocin to stop the bleeding.Postoperative review,if there was no active bleeding,extubation. Intramuscular injection of MTX promoting placenta tissue atrophy,muscle,then,followed up for 6 months,reviewed HCG and CDFI. ResultsNo death and serious complications.The amount of bleeding was between 1800 and 3700 ml,the average bleeding volume was （2422 ＋ 834） ml.The amount of red blood cell suspension was between 4 U and 12 U,and the plasma volume was between 400 and 1200 ml.The total number of hospital days was between 5 d and 21 d,the average number was （11.8±6.4）days,the average weight of newborns was （2583 ＋ 866） g,the average 1min Apgar score was （9.6 ＋ 0.8） pionts,and the average 5min Apgar score was （9.6 ＋ 0.8）pionts.There were 1 cases of low back pain after operation.No patient with bleed and HCG abnormal.ConclusionUnder the condition of strictly grasp the indications, contraindications,bilateral femoral artery preset tube type of placenta previa with cesarean delivery therapy disaster is good to the uterus,less blood loss,and reduce the risk.