经子宫后路子宫切除术在凶险性前置胎盘伴胎盘植入中的临床应用

Clinical Application of the Posterior Hysterectomy in the Treatment of Placenta Previa and Accreta

目的:探讨经子宫后路子宫切除术在凶险性前置胎盘伴胎盘植入中的临床应用价值。方法:对经临床或病理诊断凶险性前置胎盘伴胎盘植入患者90例分为经子宫后路子宫切除术组(观察组)23例和传统子宫切除术组(对照组)67例,对比两组平均手术时间、术中出血量、术后24小时出血量、术后住院天数、严重并发症。结果:观察组无孕产妇死亡,对照组1例孕产妇死亡。观察组未发生膀胱损伤,1例(4.34%)输尿管损伤、1例(4.34%)肠管损伤;对照组5例(7.46%)膀胱损伤,7例(10.4%)输尿管损伤、7例(10.4%)肠管损伤;两组各并发症比较差异均有统计学意义(P<0.05)。观察组与对照组比较,手术平均时间(143.7±40.5分钟vs 180.8±37.2分钟)、术中出血量及术后24小时出血量(2243.6±1010.7 ml vs 2866.5±985.9 ml,2468.5±120.7 ml vs 3084.1±110.5 ml)、输注红细胞量(12.3±5.6 U vs 17.1±6.7 U)、术后住院天数(7.8±3.2天vs 10.7±2.9天)差异有统计学意义(P<0.05)。结论:经子宫后路子宫切除术治疗凶险性前置胎盘伴胎盘植入,能有效控制产后出血量,减少手术并发症,可能是更好的手术选择。

Objective,To explore the clinical application of the posterior hysterectomy in the treatment of placen- ta previa and accreta. Methods： From 2012 to 2014 by clinical or pathological diagnosis of 90 cases of patients with placenta previa and accreta was divided into the posterior uterine hysterectomy group of 23 cases （observation group） and traditional hysterectomy group of 67 cases（control group） ,average operation time,intraoperative blood loss,24 hours of postoperative blood loss,postoperative hospitalization days,and serious complications were compared between the two groups. Results：There was no metemal deaths in observation group, 1 case of maternal death in control group. In observation group,there was no bladder injury,1 case（4. 34%） of ureteral injury,1 case （4. 34%） bowel injury,in control（10. 4%） of ureteral injury,7 cases（10. 4%） bowel injury,the difference between the two groups had statistical significance（ P 〈0. 05）. When observation group was compared with control group,the average operation time was（143. 7±40. 5 ）min and（180. 8±37. 2） min,intraoperative blood loss and 24 hours of postoperative blood loss were（2243. 6±1010. 7）ml and（2866. 5±985. 9） ml, （2468. 5 ±120. 7）ml and（3084. 1±110. 5） ml,trans-fusion of red blood cells was（12. 3±5.6）U and（17. 1±6. 7） U, postoperative hospitalization days were（7. 8±3.2）d and（10. 7±2. 9）d,in the observation group and control group respectively the differencees were statistitically significant （ P 〈0. 05）. Conclusions：The posterior uterine hysterectomy inthetreatment of placenta previa and accreta,can effectively control postpartum hemorrhage,reduce the surgical complications,may be a better surgical option.