剖宫产术前子宫动脉置管术中行栓塞术对防治凶险性前置胎盘产后出血的疗效评价

Uterine artery embolization with femoral artery catheterization before cesarean delivery prevents postpartum hemorrhage in women with pernicious placenta pervia

目的评价凶险性前置胎盘患者剖宫产术前子宫动脉置管术中行子宫动脉栓塞术对防治产后出血的疗效并评估其临床意义。方法回顾性分析我院2013年6月至2014年12月收治的30例凶险性前置胎盘合并胎盘植入患者剖宫产术前经股动脉子宫动脉置管，胎儿娩出后立即行子宫动脉栓塞术（术中栓塞组）与20例剖宫产术后行子宫动脉栓塞术（术后栓塞组）的病例资料，比较两种方法治疗产后出血的效果。结果术中栓塞组出现弥散性血管内凝血（diffuse intravascular coagulation, DIC）2例（占6.7%），术后栓塞组发生DIC 4例（占20.0％），2组比较差异有统计学意义（P〈0.05）。术中栓塞组平均出血量（2500±800）mL，术后栓塞组平均出血量（5000±500）mL,2组比较差异有统计学意义（P〈0.05）。术中栓塞组剖宫产所需时间（80-135 min，平均102 min）少于术后栓塞组（110-170 min，平均138 min，P〈0.05）。结论对于凶险性前置胎盘合并胎盘植入者，于剖宫产术前子宫动脉置管术中行子宫动脉栓塞术，可有效减少术中、术后出血量，缩短手术时间，是一种值得提倡的治疗方法。

Objective To evaluate the curative effect and clinical significance of femoral artery catheterization before cesarean delivery and then followed by uterine arterial embolization immediately after delivery of baby in patients with pernicious placenta pervia. Methods A retrospective study was performed on 50 patients of pernicious placenta pervia with placenta implantation admitted in our department from June 2013 to December 2014. The treatment group （n=30） were given by indwelling femoral artery catheter before cesarean and then uterine arterial embolization immediately after delivery of baby. The control group （n=20） were proceeded femoral artery catheterization and uterine arterial embolization after cesarean section. Postpartum hemorrhage volume was used to compare the therapeutic effect of the 2 therapeutic methods. Results There were 2 cases of diffuse intravascular coagulation （DIC, 6.7%） in the treatment group and 4 cases （20.0%） in the control group, with significant difference between the 2 groups （P〈0.05 ）. Mean bleeding volume was 2 500±800 and 5 000±500 mL respectively in the treatment group and control group, and significant difference was seen （P〈0.05）. Conclusion For patients of pernicious placenta pervia combine with placenta implantation, femoral artery catheterization before cesarean section and proceeding uterine arterial embolization immediately after delivery of baby can reduce the amount of bleeding effectively during and after operation, and shorten the time of operation. So, this therapy is worthy of advocating.