股动脉预置管动脉栓塞治疗前置胎盘合并胎盘植入患者的临床观察

A clinical study on prophylactic pelvic artery catheterization and embolization in women with placenta previa accreta in late gestation

目的:本文旨在探讨股动脉预置管(prophylactic femoral artery catheterization)治疗前置胎盘合并胎盘植入的有效性,目的在于保留子宫,步骤包括股动脉插管、子宫下段剖宫产、子宫动脉或髂内动脉栓塞后娩出胎盘,保留子宫。方法:22例患者术前或术中诊断为前置胎盘合并胎盘植入,对6例前置胎盘合并胎盘部分植入的患者剖宫产前行股动脉置管,待新生儿娩出后,立即行动脉栓塞,栓塞成功后,术中尽量剥除胎盘,对有部分残留病例术后辅以MTX治疗。另16例采用传统方法,无效行子宫切除术,或直接行剖宫产子宫切除术。结果:6例预置管动脉栓塞的患者皆栓塞成功,保留子宫。而对照组16例最后皆子宫切除,两组在失血量,输红细胞悬液量及输血浆量方面差异有显著性,两组总的手术时间无差异,需入住ICU及术后住院天数差异无显著性。结论:股动脉预置管动脉栓塞为前置胎盘合并胎盘植入的患者保留子宫提供了一种新的选择,可明显提高患者生存质量,减少孕产妇并发症及病死率。

Objective： The purpose of this study was to describe the use of a staged procedure that involved femoral artery catheterization, cesarean section deliver）5 uterine and placental embolization, and placenta removal as possible as we can for placenta previa accreta in order to prevent from hysterectomy. Methods： The current study includes 22 patients diagnosed as placenta previa accreta identified histologically after operation or confirmed by doctors through ultrasound results before operation and the findings during operation. Six patients underwent femoral artery catheterization before C-section. Artery embolization was conducted right away after the babies were delivered. Five patients had residual placenta tissues, receiving MTX therapy after operation. Other 16 patients underwent traditional methods, they failed and hysterectomy or cesarean-hysterectomy. Results： Twenty-two cases of placenta previa accreta were identified histologically or diagnosed by doctors who performed the surgery. Six cases successfully underwent prophylactic pelvic artery catheterization and embolization, the uteri were preserved. These cases had significant reductions in blood loss （2 300 vs. 5 375 mL; P=0.0004）, units of MAP transfused （8 vs. 16.66; P=0.0108）, the amount of plasma transfused （800 vs. 1 375 mL, P=0.0135）. The total operation time was no different between the two groups. There were non-significant reductions in admission to the intensive care unit and length of hospital stay. Conclusion： We found that the successful use of prophylactic pelvic artery catheterization and embolization C-section procedure for placenta previa accreta is associated with decreased maternal morbidity and successfully preserved patient＇s uteri.