胎儿娩出后即刻动脉栓塞在抢救植入性凶险性前置胎盘大出血中的应用

Application of immediate artery embolization after fetal disengagement in rescue of postpartum hemorrhage induced by implantable dangerous placenta previa

目的探讨胎儿娩出后即刻动脉栓塞在抢救凶险性前置胎盘伴胎盘植入术中大出血的作用。方法回顾性分析20例凶险性前置胎盘伴胎盘植入患者的临床资料,其中行动脉栓塞者6例为介入组,非介入组14例,比较两组术中出血量、DIC发生率、子宫切除率。结果介入组6例无子宫切除,非介入组14例中7例子宫切除,非介入组子宫切除率明显高于介入组（χ^2=0.034,P〈0.05）;介入组术中平均失血量2 383 ml,1例术后阴道仍有持续出血,经积极抢救后好转,除1例患者术后发生下肢血栓外,无严重并发症发生。非介入组14例术中平均失血量3 307 ml,其中发生DIC 5例,两组在术中出血量及DIC发生率上比较无明显差异（χ^2=-0.228和t=0.129,P均〉0.05）,非介入组中7例子宫切除患者的平均失血量为4 300 ml。结论胎儿娩出后即刻动脉栓塞在抢救植入性凶险性前置胎盘剖宫产术中大出血中可以快速有效减少出血,从而降低子宫切除率。严格掌握首次剖宫产指征、减少不必要的首胎剖宫产术;宫腔操作注意保护子宫内膜是减少凶险性前置胎盘发生的关键。

Objective To explore the role of immediate artery embolization after fetal disengagement in rescue of postpartum hemorrhage induced by implantable dangerous placenta previa. Methods The clinical data of 20 patients with dangerous placenta previa combined with placental implantation were analyzed retrospectively,then the patients were divided into intervention group（ 6 patients treated by artery embolization） and non- intervention group（ 14 patients）. The amounts of intraoperative blood loss,the incidence rates of DIC,and the rates of hysterectomy in the two groups were compared. Results In intervention group,no patients underwent hysterectomy; in non- intervention group,7 patients underwent hysterectomy; the rate of hysterectomy in non- intervention group was statistically significantly higher than that in intervention group（ χ^2= 0. 034,P〈0. 05）. In intervention group,the average amount of intraoperative blood loss was2 383 ml,one patient was found with persistent vaginal bleeding after operation,then the patient was improved after active rescue,no serious complications occurred except one patient with thrombus of lower limb after operation. In non- intervention group,the average amount of intraoperative blood loss was 3 307 ml,five patients were found with DIC,there was no statistically significant difference in the average amount of intraoperative blood loss and the incidence rate of DIC between the two groups（ χ^2=- 0. 228,P〈0. 05; t = 0. 129,P〈0. 05）,the average amount of blood loss in seven patients undergoing hysterectomy was 4 300 ml. Conclusion Immediate artery embolization after fetal disengagement in rescue of postpartum hemorrhage induced by implantable dangerous placenta previa can quickly and efficiently reduce the amount of hemorrhage and the rate of hysterectomy. The key points of reducing the occurrence of dangerous placenta previa include strictly mastering the indications of the first cesarean section,reducing unnecessary cesarean section,and paying attention to protecting endometrium during intrauterine operation.