髂内动脉球囊封堵在凶险型前置胎盘剖宫产围手术期的临床应用

Clinical application of preoperative endovascular balloon occlusion of the internal iliac arteries before caesarean operation for pernicious placenta previa

目的：探讨髂内动脉球囊封堵在凶险型前置胎盘剖宫产围手术期的临床疗效。方法：收集2014年1月至2015年2月徐州市中心医院产科收治的凶险型前置胎盘产妇42例,将患者随机分为封堵组（22例）和对照组（20例）。封堵组剖宫产术前应用双侧髂内动脉球囊封堵术,对照组采用常规剖宫产术。观察两组产妇的出血量、输血量、子宫切除率及新生儿Apgar评分情况。结果：封堵组中产后出血量≥3000ml的比率明显少于对照组[0.0%（0/22）vs 20.0%（4/20）]。与对照组比较,封堵组的术中及术后平均输血量（309.09ml vs 740.00ml）及子宫切除率[0.0%（0/22）vs 25.0%（5/20）]明显降低,差异均有统计学意义（P〈0.05）。两组的产后出血量1000~3000ml、术前与术后24h后血色素差值、术后1~5d恶露量、新生儿1min及5min Agpar评分比较,差异均无统计学意义（P〉0.05）。结论：凶险型前置胎盘采用剖宫产术前预置髂内动脉球囊是控制产后大出血（≥3000ml）及减少子宫切除率的有效手段,较常规剖宫产术具有明显的优势。

Objective： To explore the clinical efficacy of preoperative endovascular balloon occlusion of the bilateral internal iliac arteries in the treatment of women with pernicious placenta previa before caesarean operation. Methods： From Jan. 2014 to Feb. 2015,42 cases from Xuzhou Central Hospital diagnosed with pernicious placenta previa were randomly divided into two groups： the blocking group（ 22 cases） using bilateral internal iliac arteries balloon occlusion before caesarean operation and the control group（ 20 cases） treated with traditional cesarean delivery methods. Postpartum hemorrhage,transfusion volume,the hysterectomy rate and newborn agpar scores were compared between the groups. Results： The rate of postpartum hemorrhage over 3000 ml in the blocking group was significantly lower than that in the control group[0. 0%（ 0 /22） vs 20. 0%（ 4 /20） ]. Compared with the control group,the mean blood transfusion volume aroumd the caesarean operation（ 309. 09 ml vs 740. 00ml） and the hysterectomy rate[0. 0%（ 0 /22） vs 25. 0%（ 5 /20） ]were both significantly lower than those in the control group. The differences between the two groups were all statistically significant（ P 0. 05）.However,there were no statistical differences between the two groups as to the rate of postpartum hemorrhage between 1000 ml and 3000 ml,the hemoglobin difference from pre-surgery to24 h post-operative period,lochia from 1d to 5d after surgery and the neonatal one minute,five minutes apgar scores（ P 0. 05）. Conclusions： The preoperative endovascular balloon occlusion of the bilateral internal iliac arteries used in pernicious placenta previa before cesarcean is an effective means to avoid serious postpartum hemorrhage（ over 3000ml） and followed hysterectomy post caesarean operation,showing great advantages compared with traditional cesarean delivery.