子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入中的应用效果

THE APPLICATION EFFECT OF UTERINE ARTERY EMBOLIZATION IN THE TREATMENT OF DANGEROUS PLACENTA PREVIA WITH PLACENTA ACCRETA

目的探讨子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入中的临床应用价值。方法收集2010年1月—2014年12月唐山市妇幼保健院产科收治的97例单胎妊娠,孕周大于32周的凶险性前置胎盘伴植入性胎盘或穿透性胎盘的患者。根据是否行子宫动脉栓塞术分为二组:1栓塞术组55例,即术前股动脉预置管,娩出胎儿后评估术中胎盘植入深度与范围进行子宫动脉栓塞术,随后处理胎盘,必要时切除子宫;2非栓塞术组42例,即娩出胎儿后,处理胎盘,根据术中胎盘植入情况,行宫腔填塞纱布压迫止血、子宫动脉上行支结扎术、B-lynch缝合术等,必要时切除子宫。比较二组患者的术中情况及临床结局。结果栓塞术组的患者失血量少于非栓塞术组,差异有统计学意义﹙P<0.05﹚。栓塞术组ICU入住率、子宫切除率、产后出血率、DIC发生率均低于非栓塞术组,差异有统计学意义﹙P<0.05﹚。二组患者的术后住院时间、产褥感染率及新生儿窒息发生率差异均无统计学意义(P>0.05)。结论子宫动脉栓塞术可以明显减少术中出血量,降低手术风险,改善凶险性前置胎盘患者的临床结局,值得推广应用。

Objective To discuss the clinical value of uterine artery embolization in danger placenta previa with placenta accreta.Methods A total of 97 cases of patients of singleton pregnancies greater than 32 weeks of gestational age dangerous placenta previa with placenta accreta or placenta penetration were collected for the study in author＇s hospital from January 2010 to December 2014.They were divided into two groups depending on whether uterine artery embolization.The embolization group of 55 cases（experimental group）received a preoperative femoral artery preset tube.According to intraoperative placenta implant depth and scope,doctors decided whether uterine artery embolization or not,after the expulsion of the fetus,then delivered the placenta,if necessary,removal of the uterus.The non-embolization group（control group）of 42 cases received delivered the placenta after the expulsion of the fetus.According to intraoperative placenta accreta by using uterine packing gauze to stop bleeding,ascending uterine artery ligation or B-lynch suture to stop bleeding were performed,then removal of the uterus,if necessary.Surgery and clinical outcome of the patient were compared.Results Patients in the embolization group blood loss were less than the non-embolization group,the difference was statistically significant（P〈0.05）.ICU admission,hysterectomy,postpartum hemorrhage,DIC were lower in the embolization group than the non-embolization group,the difference was statistically significant（P〈0.05）.Postoperative hospital stay and puerperal infection and neonatal asphyxia rate of two groups patients was no significant difference（P〉0.05）.Conclusions Uterine artery embolization can significantly reduce blood loss,lower surgical risk and improve clinical outcomes in patients with placenta previa dangerous.It should be widely applied.